Euthanasia for Psychiatric reasons is complicated

Dr K Suno Gaind

Dr K Suno Gaind

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

Doctor K Suno Gaind, who is a President of the Canadian Psychiatric Association and an associate professor at the University of Toronto wrote an article that was published in the Globe and Mail on Friday May 27, 2016; where he states that there are no known standards for approving euthanasia for psychiatric reasons.

Dr Gaind questions how euthanasia fits with  - Do No Harm - ethic:

Do no harm. How do we square this guiding tenet with medically assisted death? Which is the greater harm – helping a person to end his life, or allowing continued suffering when he seeks death? 
When it comes to mental illness, it is even more complicated. The 2015 Supreme Court decision emphasized the need to protect the vulnerable from seeking suicide at a time of weakness. Less clear is how we actually do that. 
Mental illness can affect how a person thinks. Depression fuels negative self-thoughts, self-blame, hopelessness and struggling with one’s place in the world. Negative events are dwelt upon and positive ones discounted, with emotional resilience lowered until mundane stresses seem overwhelming. 
This is not to deny the real pain and suffering of mental illness, nor to imply that it invariably compromises clarity of thought. However, in severe cases, teasing apart how illness-based cognitive distortions can influence decision making is a formidable challenge. Heart disease might produce suffering but not necessarily alter thought processes; with depression, people often say they no longer feel or think like themselves. 
This predicament could be moot if suffering continued indefinitely. The value of suicide prevention is not to stay alive with intolerable suffering, but to avoid ending life during a vulnerable period. Unfortunately, cognitive distortions can lead some to decline treatment and seek death, despite the prospect of a healthy future. 

Dr Gaind explains how difficult it is to assess irremediable suffering of psychiatric patients. 

Link to the full article

Woman, in the 20's, who was sexually abused, dies by euthanasia in the Netherlands

Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

The 2015 Netherlands euthanasia report that was recently released states that there were 5561 reported euthanasia deaths in 2015, up from 5306 in 2014, there were 109 reported euthanasia deaths for dementia, up from 81 in 2014, and there were 56 reported euthanasia deaths for psychiatric reasons, up from 41 in 2014.

Shockingly, a woman who died by euthanasia for psychiatric reasons in 2015 was in her 20's and had been sexually abused.

The Daily Mail news reported:

The woman, in her twenties, was given a lethal injection after doctors and psychiatrists decided that her post-traumatic stress disorder and other conditions were incurable. 
It went ahead despite improvements in the woman's psychological condition after 'intensive therapy' two years ago, and even though doctors in the Netherlands accept that a demand for death from a psychiatric patient may be no more than a cry for help. 
The woman, who has not been named, began to suffer from mental disorders 15 years ago following sexual abuse, according to the papers released by the Dutch Euthanasia Commission.

The Daily Mail reported that the Netherlands government released information about the case to prove that the case fulfilled the requirements of the law.

Link to the full article

Dr Brad Burke: Letter to Prime Minister Trudeau

April 4, 2016

Prime Minister Justin Trudeau
Office of the Prime Minister
80 Wellington Street
Ottawa, ON K1A 0A2

To the Honourable Prime Minister Trudeau,

I am writing to you out of deep concern for the legislation that will soon be drafted regarding physician assisted suicide. I am so concerned, that I produced videos on the websites, DearGodLetter.ca and CherDieuLettre.ca, in the hope that more Canadians would be informed about the potential ramifications of such legislation.

As a medical doctor, there are many arguments I could provide detailing why physician assisted suicide is wrong for Canada. But the one argument that many have overlooked is the very real likelihood that physician assisted suicide in Canada would actually lead tomore pain and suffering in Canada—not less.

Let me explain:

As a pain specialist I have evaluated hundreds of car accident victims over the past several years.  Interestingly, the patient suffering chronic pain from injuries sustained in the crash is almost always the victim—rarely the individual(s) responsible for the crash. Many falsely believe these patients are just trying to scam the system. While this might be the case in rare circumstances, almost always these victims have legitimate chronic pain.

Research has demonstrated that when the mind is clouded by negative emotions, such as anger, hate, bitterness, or depression, the body is unable to properly “turn off” pain signals arising from lower in the body. Car accident victims are often angry at the individual(s) who hit them, and frequently develop low mood and/or anxiety. All these negative emotions play a role in the development of chronic pain by way of something pain specialists call, “Central sensitization.” Peripheral sensitization and maladaptive central nervous system (i.e. brain) neuronal plasticity are also factors in the genesis of chronic pain. 

How does this relate to physician assisted suicide? 

If the recommendations provided by the Special Joint Committee on Physician-Assisted Dying become law, there will be many teenagers, parents, and grandparents killed against the will of their family members (especially those suffering from depression). Prime Minister Trudeau, it won’t be long and your children will be teenagers. You wouldn’t want someone to kill your teenagers against your will.  Why then would you want to kill other teenagers against the will of their parents?

A family can eventually learn to forgive a member who rashly commits suicide on their own. However, it will be extremely hard—if not impossible—for Canadian families to forgive the doctors and politicians responsible for their loved one’s death. The same rage that the Goldman’s displayed against O. J. Simpson will be the same anger directed at you and many others by Canadian families. These angry family members will be at significantly greater risk of developing depression and anxiety, with a high likelihood of developing chronic pain from even minor injuries—and sometimes no injury at all. For every one person you kill against the will of the family, you run a very high risk of triggering a lifetime of mental and/or physical illness/pain in at least one family member—and possibly the entire family.

Furthermore, there are over 5,000 physicians across Canada in the Coalition for HealthCARE and Conscience, committed to protecting conscience rights for health practitioners and facilities. Many will refuse to kill their patients, and refuse to refer patients to be killed. For every doctor’s license you consequently take away, you will erase on average at least 2,000 patient encounters per doctor per year. Then there’s the doctors who will just quietly leave the country, and those who will refuse to move to Canada because of the hostile environment where doctors are forced to work against their consciences. Then add to this the number of healthcare professionals who will drop out of palliative care and Geriatrics for fear of losing their licenses. Do the math and the number of Canadians affected are staggering.

Will all this not result in even more pain and suffering for Canadians in the end?

Yes, there will always be individuals who want to kill themselves at the first diagnosis of a chronic disease. And there will always be arguments saying that not everyone has equal access to quality palliative care across Canada where adequate pain control is very often achieved. But what kind of country would rather kill its citizens than provide the necessary care and compassion they deserve?

Will the Liberal Party be popular with Canadians 1 year, 2 years, or 3 years from now? 

Will the Liberal Party be popular with the Person who created the teenagers, parents, and grandparents that you will kill? 

Thank you very much for your kind attention to this letter.

Sincerely,

Brad Burke, MD, FRCPC
Physical Medicine & Rehabilitation

Cc The Honourable Jody Wilson-Raybould, Minister of Justice
Cc The Honourable Jane Philpott, Minister of Health

Why Dr Michael Jones will not kill you!

Dr Michael Jones

Dr Michael Jones

Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition

Dr Michael Jones is a 31 year family physician in Victoria who wrote a letter to the Victoria Times Colonist that was published on April 2. In his letter he explains why he will not kill his patients by euthanasia or assisted suicide. In his letter he tells the story of a patient in 2001 that will effect him for life. Dr Jones wrote:

I met Gerald (not his real name) in 2001 soon after he had immigrated to Canada to retire in our beautiful city. He had enjoyed a very successful professional career, and although he was making big changes in his occupation and living situation, he was still very youthful in his love for life, and was looking forward to a full and active life in Victoria. 
He consulted me infrequently due to his good health, but I always enjoyed his “joie de vivre,” and we struck up a good rapport. 
One day, I received a phone call from the ER doctor that Gerald had suffered a sudden collapse on the street, and was now in the ICU with what appeared to be a devastating stroke. It turned out that he had suffered a brainstem infarction, which effectively “disconnects” the brain from the rest of the body. Gerald’s ability to think and feel emotions, sensations and pain were unaffected, but he was unable to move anything at all, except his eyes. 
Think about that for a moment: Feeling pain at a pressure point or feeling mucus pooling in the back of your throat and being unable to move, or even communicate your pain or fear. Totally dependent on machines to breathe for you and feed you, and on other people for bathing and toileting you. 
We set up an alphabet board so we could laboriously point to each letter, and Gerald would blink at the letter he wanted and spell out a word. I remember sitting for the first time with some anticipation wondering what Gerald would want to say. Slowly, the words came: “p l e a s e k i l l m e.” 
He stared straight at me, and the desperation and commitment were as clear as if he had shouted it from a rooftop. He would repeat this phrase at the start of every spelling-board conversation over the next few months. This would cut me to the heart each time, as I had to explain that there was nothing I could do except ensure the best medical care possible, and try to anticipate and alleviate any physical pain.
Slowly, over many months, Gerald’s condition stabilized and he could breathe on his own, with frequent suctioning. He was able to be transferred home with 24-hour care, and could use a computer with a controller in his mouth. He still could not talk, eat, drink or move any muscles apart from his eyes and now his lips. 
Because he had 24-hour care, my visits became less frequent, and as the months went by, his communications became more positive. In fact, he started to write articles about his experiences, and communicate with friends by email. 
One day, I summoned enough courage to ask him if he was glad to be alive. He answered: “Yes!” I then asked him if he was glad that I hadn’t killed him as he had asked me to all those times. He said: “Yes, very glad!” I think there was a little smile in his eyes, also. 
Gerald went on to live a fulfilling life before succumbing to pneumonia a few years later.

Dr Jones relates his experience with the Maurice Généreux assisted suicide case.

With regard to the present debate on assisted death, it is clear that Gerald would qualify on every possible criterion for “death by doctor.” Yet that was not what Gerald ultimately wanted. What he ultimately wanted could not have been known by anyone (including himself) at the time, no matter how many doctors were consulted to agree with the decision. 
The Holy Grail in medical ethics is “informed consent,” in that a person can give consent for any procedure on his person as long as he is fully informed. In truth, when we are dealing with issues affecting the rest of one’s life, no one is “fully informed” as to their future quality of life, or their future opinions and feelings. 
This point is well illustrated by an article in the National Post, dated March 3, about Dr. Maurice Généreux. He had prescribed lethal doses of sodium seconal to two HIV-positive patients with a view to “assisting their deaths.” Aaron McGinn died, and Mark Jewitt lived. 
Mark Jewitt subsequently received effective treatment and counselling, and 20 years later, according to the article: “He would have missed so much had he died.”
“I would have missed gay marriages. I would have missed AIDS becoming a manageable disease.” He was glad to be alive. 
Possibly, the same could have been said for McGinn had he received the correct treatment and counselling. However (and this is the point), both of these men would be eligible for assisted death under the current proposed legislation, effectively robbing them of ever having a chance at a fulfilling life, no matter how depressed they felt in the moment of making the decision.

Dr Jones ends the article by stating his commitment to his patients.

To my current patients: This is why I will not kill you, no matter how depressed or hopeless you feel, no matter how desperate your medical situation, no matter how much you may ask. 
I have learned that feelings change, desperate situations become less desperate and you don’t know what the future holds any more than I do. And as your family doctor, I am not going to be the one to lose all hope in your future, no matter how bleak it might seem today. 
When death does become imminent, as it will for all of us, you can count on me to strive to maintain your comfort and dignity until the end.

Dr Michael Jones is a doctor who truly respects the needs of his patients. Canadians need to respect his conscience rights.

Senator Denise Batters: Help the mentally ill. Don’t kill them

Senator Denise Batters

Senator Denise Batters

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

The National Post featured a guest column, on March 14, 2016, by Senator Denise Batters concerning her opposition to the legalization of euthanasia for people with psychiatric issues. Senator Batters is a lawyer and a mental health advocate.

Previous article by Senator Batters.

Batters was widowed when Dave Batters, her husband, died by suicide in 2009 while he was a sitting member of parliament. Senator Batters experience with her husband's suicide led her to strongly oppose euthanasia for people who live with psychological suffering.

Senator Batters writes in her National Post column:

Questions surrounding suicide are deeply personal to me. I lost my husband, former member of Parliament Dave Batters, to suicide in 2009, after his struggle with severe anxiety and depression. In the years following his death, I have worked to raise awareness and dispel the stigma surrounding mental illness and suicide. That has included communicating to those struggling with mental illness, particularly with those who harbour thoughts of suicide, to encourage them not to give up, but to instead reach out for help. 
This is why I have reacted so strongly against the recent majority report of the joint parliamentary committee studying physician-assisted suicide. Polls show that most Canadians agree with physician-assisted suicide, but usually those poll questions (and Canadians) assume that only those with terminal illnesses would be given the option. Canadians want strict safeguards on who is eligible for assisted dying and legislators have the responsibility to provide that clarity. The committee report failed to provide either. Instead, it threw open the door to a number of shocking scenarios.

Link to the full article

Assisted dying report goes beyond scope, ignores evidence

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition.

On February 25, the Special Committee on Physician-Assisted Dying released its report advising the government what to include in the euthanasia legislation in Canada. 

The Supreme Court struck down Canada's assisted suicide law(February 6, 2015) and have now given parliament until June 6, 2016 to implement a new law.

Similar to the Provincial-Territorial panel report that was intentionally loaded with pro-euthanasia activists, the federal committee recommended euthanasia for people with dementia, minors, for people with psychiatric conditions and without effective oversight.

EPC legal counsel and constitutional expert, Hugh Scher, called the committee proposal "a dangerous social policy experiment."

On Saturday, February 27; the Globe Mail published an excellent commentary by constitutional lawyer, David Baker, who represented national disability groups in the assisted suicide case at the Supreme Court and Trudo Lemmens, University of Toronto Professor in health law and policy at the Faculty of Law. 

Baker and Lemmens effectively argue that the Assisted Dying report goes beyond the scope of the Supreme Court decision, and that they also ignored evidence.

Link to the full article

Canadian government Assisted Dying recommendations will not protect people

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For Immediate Release - February 25, 2016

The Euthanasia Prevention Coalition (EPC) is a national organization representing groups and individuals representing medical, personal and disability perspectives since 1999 with the purpose of protecting people from euthanasia and assisted suicide.

Research proves that the misuse of Assisted Dying in jurisdictions where it is legal has resulted in deaths without an explicit request, assisted deaths of people with a wrong diagnosis, the under reporting of assisted deaths, and assisted death of people with treatable psychiatric conditions including depression.

EPC urges the federal government to:

  • devise guidelines with clear oversight that cannot be abused.
  • reject the concept that assisted dying is a form of medical treatment.
  • reject assisted death for people who are incompetent to make decisions.
  • devise clear guidelines to ensure that people, who are experiencing a vulnerable time of their life, will not die an assisted death, based on situational depression.
  • protect the conscience rights of healthcare institutions.
  • protect the conscience rights of medical professionals who reject that killing patients is an acceptable medical act. Medical professionals must not be forced, in any manner to participate in killing their patients.
  • increase support for palliative care, home care for people with disabilities, mental health services and suicide prevention.

For interviews contact:
Alex Schadenberg (London ON) EPC Executive Director, (519) 851-1434 (cell) info@epcc.ca
Hugh Scher (Toronto ON) EPC Legal Counsel, (416) 816-6115 (cell) hugh@sdlaw.ca
Amy Hasbrouck (Montreal QC) Toujours Vivant Not Dead Yet, (450) 921-3057, tigrlily61@gmail.com
Dr. Will Johnston (Vancouver BC) EPC – BC Chair, (604) 220-2042.
Euthanasia Prevention Coalition, 1-877-439-3348, info@epcc.cawww.epcc.ca