Essential safeguards identified to protect vulnerable people from abuse in assisted dying law

Hugh Scher

Hugh Scher

The following article was published by Advocate Daily on March 3, 2016.

Toronto constitutional and human rights lawyer Hugh Scher is endorsing the Vulnerable Persons Standard, a list of evidence-based safeguards to protect Canadians requesting physician-assisted death who may be subject to coercion and abuse.

“There is certainly no guarantee that this standard alone is going to prevent unwanted deaths or the impact on our culture of legalized assisted death,” says Scher, principal of Scher Law and a frequent commentator on assisted dying issues.

“That said, the standard goes a long way to providing a level of protection against the risk of abuse of vulnerable people. It does provide for an effective means of oversight, which is essential in the event that this policy of assisted death is to possibly be safely implemented in this country.”

The Vulnerable Persons Standard includes the requirement for access to palliative care, and for two physicians as well as a judge or tribunal to sign off on a death. There is a requirement that consent be received at the time of the death, and that the consent is assessed at that time.

The standard has wide support among medical, legal and community-based organizations, including the Canadian Association for Community Living, the Council of Canadians with Disabilities, the Euthanasia Prevention Coalition, Vivre dans La Dignite and the Catholic Health Alliance of Canada.

Scher is counsel for the Euthanasia Prevention Coalition, a leading national and international association of doctors, nurses, people with disabilities and of leading experts on euthanasia and assisted suicide practices in foreign jurisdictions.

The intent is for the standard to become part of the new legislation or a form of regulation as the federal government prepares to introduce a new law on assisted dying.

Link to the full article

Vulnerable Persons Standard - protecting people from assisted death

The Council of Canadians with Disabilities and the Canadian Association for Community Living, in conjunction with many groups and advisors, have launched the Vulnerable Persons Standard as a way to protect Canadians who are vulnerable and that they not die an assisted death based on unresolved physical, psychological or social requirements or based on discrimination.

Link to the Vulnerable Persons Standard website.
The Vulnerable Persons Standard

The Vulnerable Persons Standard is a series of evidence-based safeguards intended to protect the lives of Canadians.

These safeguards will help to ensure that Canadians requesting assistance from physicians to end their life can do so without jeopardizing the lives of vulnerable persons who may be subject to coercion and abuse.

We are calling on all members of Parliament to ensure that federal legislation regulating physician-assisted death incorporate these safeguards. 

Why is vulnerability important?

Vulnerable persons who request physician-assisted dying may be motivated by a range of factors unrelated to their medical condition or prognosis. These factors are important and can often be addressed with adequate and appropriate care. As a society, we have both moral and legal obligations to address the needs of vulnerable persons. Access to physician-assisted dying cannot be allowed to diminish or undermine these important obligations.

Unmet needs should not be a cause of death

Extensive research shows that a wide range of factors related to social, financial, psychological and spiritual suffering can lead patients to request physician-assisted death.

The U.S. National Cancer Institute describes such requests as “a sign that unmet needs have built to an intolerable level.”

Link to the full article

Recommendations Contained in Report of Joint Committee on Physician-Assisted Dying Pose Significant Risk to Vulnerable Canadians

For Immediate Release - February 25, 2016 - Toronto

The Council of Canadians with Disabilities(CCD) and the Canadian Association for Community Living (CACL) are extremely dismayed that the recommendations contained in the report released today by Parliament’s Special Joint Committee on Physician-Assisted Dying will jeopardize the lives of vulnerable Canadians. They do not follow the Supreme Court’s call for “stringent limits that are scrupulously monitored and enforced.”

“We are concerned that the Committee’s permissive approach would put vulnerable people at risk. Their recommendations exceed guidance from the Supreme Court, as well as UN Conventions to which Canada is a signatory” states Tony Dolan, CCD Chair. 
“We appreciate that members of the Joint Committee were alert to concerns about vulnerable persons,” says Michael Bach, Executive Vice-President of the Canadian Association for Community Living. “Nevertheless, we are alarmed by the committee’s conclusions. We believe the recommendations contained in the Committee Report fall well short of the minimum safeguards we believe are essential to protecting vulnerable Canadians. Clearly there is a lot of work still to be done.”

Together CACL and CCD represent the concerns of Canadians with disabilities. Both organizations believe that their members will be harmed if the government adopts the committee’s recommendations. They have four principle concerns. 

First, both organizations believe the committee has erred by not accepting the trial judge’s definition of “grievous and irremediable medical conditions” to exclude psychosocial suffering as an eligible condition, and meaning an advanced state of weakening capacities with no chance of improvement. 

Second, the Committee suggests that concerns about vulnerability can be addressed within the context of physician assessments of decision making capacity. The evidence does not support this claim. Physicians are not generally trained or have expertise in the kinds of vulnerabilities that are known to motivate requests for assisted death. For example, a survey of U.S. physicians found that only 2% had training, experience or expertise in identifying signs of elder abuse in their patients, despite this growing demographic. “The Committee’s recommendation, which instructs decision makers to pay attention to vulnerability does nothing to assuage our concerns,” states Rhonda Wiebe, Co-Chairperson of CCD’s Ending of Life Ethics Committee.

Third, the Committee recommends allowing for advance directives. This is not consistent with the Supreme Court decision which clearly stated that a person has to be capable in the actual circumstances of taking the intervention intended to cause death. Advance directives would empower substitute decision makers to determine when someone should die. This should be explicitly prohibited in federal legislation. The risks to the most vulnerable in society are obvious.

Fourth, the Committee rejected proposals that requests be authorized through an independent prior review, instead relying on two physicians to make the assessment and authorize the intervention to terminate a person’s life. These are fundamentally irreconcilable roles, and combining them exposes physicians and patients to conflicts of interest and increases risk of abuse. A check and balance of prior review is essential. 

CCD and CACL will be urging the government to adopt a stronger system of safeguards, and to adopt a clear standard for protecting vulnerable persons. Canadians requesting assistance from physicians to end their life should be able to do so without jeopardizing the lives of vulnerable persons who may be subject to coercion, inducement and abuse.

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Media Contacts: 
Michael Bach, CACL Executive Vice President, Tel: 416-209-7942
Tony Dolan, CCD Chairperson, Tel: 902-569-2817
Dean Richert, Co-chair CCD Ending of Life Ethics Committee, Tel: 204-951-6273.
Rhonda Wiebe, Co-chair CCD Ending of Life Ethics Committee, Tel: 204-779-4493

Opposing the Supreme Court of Canada Assisted Suicide Decision

On February 6, the Supreme Court of Canada made an irresponsible and dangerous decision by decriminalizing assisted death. The EPC Board decided that the Federal government must invoke the notwithstanding clause to protect people with disabilitieselders who live with abuse, depressed and suicidal people and other people.

Please write a letter to Prime Minister Stephen Harper, Justice Minister Peter MacKay and your Member of Parliament or sign the online petition calling for the Protection of vulnerable Canadians from assisted suicide.

Letter writing is effective, but if you only want a message sent to the government then please  sign the online petition.

Your letter should state:
To the Hon... or (Member of Parliament):

Parliament must continue to protect people with disabilties, elders, people who live with depression or suicidal ideation, and other people from assisted suicide. 
This must be done through the use of the Notwithstanding clause. 
I am concerned ... (add a comment related to one of the eight talking points). 
Yours Sincerely (Name).

 Talking Points:

  1. People with disabilities oppose assisted suicide.
  2. Assisted suicide debate masks disability prejudice.
  3. Assisted suicide has devalued the lives of the elderly in Washington State.
  4. United Nations: Abuse of older women overlooked and under-reported.
  5. Depressed mother died by euthanasia in Belgium.
  6. Supreme court allows assisted suicide for depressed people.
  7. Suicide rate in Oregon continues to increase faster than the national average.
  8. Suicide prevention at odds with assisted suicide.

Letter writing campaign - Contact information:

The Right Honourable Stephen Harper
Office of the Prime Minister
80 Wellington St.
Ottawa ON K1A 0A2 (No stamp necessary)
Fax: 613-941-6900

The Honourable Peter Gordon MacKay
Minister of Justice and Attorney General of Canada
House of Commons
Ottawa ON K1A 0A6 (No stamp necessary)
Fax: 613-954-0811

Your Member of Parliament (Name) MP
House of Commons
Ottawa ON K1A 0A6 (No stamp necessary)
(Link to Members of Parliament

The Supreme Court of Canada to Release Assisted Suicide Decision Tomorrow.

FOR IMMEDIATE RELEASE

From the Council of Canadians with Disabilities and theCanadian Association for Community Living 

Toronto and Winnipeg: February 4, 2015 - Whatever decision the Supreme Court of Canada makes in the Carter vs. Canada ruling to be released on Friday – to hold the line against assisted suicide in the Criminal Code, or to strike it down - the public standards of what it means to live a dignified life are at stake. At the core is a question about what it means to live a meaningful life until the end – and in our Canadian society, a decision from the court cannot reflect the complexity of these choices in anyone’s individual life.

If the Court strikes down the prohibition against assisted suicide, the fears of some will be assuaged by the knowledge that, at a time of their choosing, they may seek state-sanctioned intervention to cause their death. But for a growing group of Canadians whose daily lives fundamentally depend on the personal care and support of others, their fears are only heightened by such an outcome.

What is the basis for this fear? For those who receive care, for those who provide care, and for those who advocate for equality and inclusion alongside a wide variety of Canadians, the risk is palpable. Dependence upon others will come to be seen as a suffering too great to bear. The risk is that in private conversations, in policy choices and in adjudicated determinations, dependence will come to be equated with indignity when actually it is an essential part of living. And the larger fear is that the shape of such a life will become a good reason to seek its termination.

The risk of this cultural slide may well present the biggest challenge to Canadian values in our generation, the underlying value of an individual life (...)

Download the full media release

For the CCD/CACL Factum to the Supreme Court of Canada.

CCD and CACL representatives will be available for comment following the Supreme Court decision Friday: 

  • Jim Derksen CCD Ending of Life Ethics Committee 204 781-4187 
  • Catherine Frazee CACL 902 818-2812 (for her Op-Eds on this topic see http://fragileandwild.com/supplementals/end-of-life) 
  • Dean Richert Chair CCD Ending of Life Ethics Committee 204 951-6273 
  • Amy Hasbrouck Not Dead Yet Canada (bilingual) 450-370-8195 
  • Laurie Larson, President, CACL Ph: 306-948-7341
  • Michael Bach – Executive Vice President CACL Ph: 416 209-7942 
  • Laurie Beachell National Coordinator CCD Ph. 204 981-6179 
  • Carmella Hutcheson Disabled Womens’ Network 403 935-4218 
  • Nancy Hansen CCD Ending of Life Ethics Committee 204 474-6458 
  • Heidi Janz CCD Ending of Life Ethics Committee 780-492-6676 
  • Tony Dolan Chair of CCD 902 626-1752

Download the full media release

A dangerous euthanasia bill to be debated in Canada's Senate.

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

Senator Nancy Ruth and Senator Larry Campbell introduced Senate Private Bill S 225, a bill that legalizes euthanasia by lethal injection and assisted suicide by lethal prescription. This bill is based on the private members bills that were introduced by Stephen Fletcher MP earlier this year.

The Euthanasia Prevention Coalition (EPC) welcomes an open debate that does not ignore the facts.

Canada has debated euthanasia and assisted suicide on many occasions with the most recent vote in parliament (April 2010) where bill C-384 was defeated by a vote of 228 to 59

The language of Senate Bill S 225 is intentionally permissive. The bill is designed to protect physicians who act by lethally injecting or assisting the suicide of their patients. It is not designed to protect the patients. 

  • The bill specifically allows euthanasia and assisted suicide for people with disabilities. 
  • The bill allows euthanasia or assisted suicide for "psychological suffering." Psychological suffering is not defined. 
  • The bill is not limited to terminal illness.
  • The bill requires the physician to self report the death after it has already occurred. This assumes that physicians will self-report abuse of the law. Since the patient is dead, when the act is reported, therefore no actual protection exists for the patient.

Link to the full article.

Catherine Frazee: There can be dignity in all states of life

By Catherine Frazee

In his article of Oct. 9, Desmond Tutu emphasizes the importance of language on the sensitive issue of medically assisted dying. In the spirit of advancing a respectful dialogue, I must urge him to consider the deeper meanings of dignity, and how our experience of human dignity leads disabled Canadians to a very different conclusion about end-of-life interventions.

Last week I had the opportunity to share my thoughts with a small group of parliamentarians on the subject of medically assisted dying.

I was not alone. Several friends and colleagues from the disability rights community were each given five minutes to present an argument against amending the criminal code to sanction medically assisted dying.

One spoke about the discriminatory implication of offering state-sanctioned assistance not for everyone, but only for persons who are frail, very ill, or seriously disabled. Another presented a chilling account of the “creep” of euthanasia in permissive jurisdictions.

Another spoke from personal experience, about the time someone said to him, “I don’t know how you do it; I’d rather be dead than in a wheelchair.” There were nods of recognition around the room. This is a common experience.

I spoke about dignity. The suffering that medically assisted dying is said to alleviate most often correlates with loss of dignity. I don’t believe that anyone should take a position on medically assisted dying without first understanding what dignity is, and what it is not.

Link to the full article