Will Johnston: The case against physician-assisted dying

This article was published by the CanadianHealthcareNetwork.ca on June 1, 2016

Discussed: The 'wedge' cases, the language of the debate, the moral culpability of the doctor, and the question of pure autonomy
Dr Will Johnston

Dr Will Johnston

By Tristan Bronca.

The Euthanasia Prevention Coalition was officially founded in 1998 in response to rising public support for physician-assisted dying. It’s made up of about 2,000 donors—both members and organizations—who began to come together in about 1993 during the Sue Rodriguez case. One of those members is Dr. Will Johnston.

Now the chair of the B.C. chapter of the coalition, the family physician took a strong stance against euthanasia about 22 years ago, when he began writing about it and speaking to high school students and church groups. He also testified opposite euthanasia advocates in the Carter case, which led to the legalization of medically assisted death in Canada. Dr. Johnston spoke with the Medical Post about his concerns with the legislation recently passed through the house of commons, the laws around the world, and why he feels Canada is about to make a dangerous mistake.

Q: Explain the impetus for a coalition of bodies who are opposed to physician-assisted dying.

The bodies that are involved in the Euthanasia Prevention Coalition might not agree on any other issue but they share in common a sense of the huge societal mistake that is being made in euthanasia and assisted suicide. We realize that there is some strength in numbers. Obviously not enough strength to stop the freight train that ended with the Supreme Court being unanimous in its decision—which I think is a troubling sign of the shallowness of the Supreme Court’s reasoning—but nonetheless more power than we would have as individual activists.

Q: Which elements of the proposed federal legislation do you personally find most troubling?

The legislation doesn’t yet allow the euthanasia of children, psychiatric patients, or mentally incapable patients long after they consent, but the preamble to the legislation promises to explore those areas further, which is deeply troubling.

Link to the full article

Québec: 50 euthanasia deaths in 5 months. No new commitment to palliative care.

Amy Hasbrouck

Amy Hasbrouck

This story is written by Amy Hasbrouck. It includes quotes and sections translated from that an article by Davide Gentile of Radio Canada that appeared in the Huffington Post online on May 4, 2016. Link to the original article.

Amy Hasbrouck - is a lawyer and the founder of the disability rights group Toujours Vivant - Not Dead Yet and is the EPC Vice President.

Five months after Québec’s euthanasia law went into effect, about fifty people have been euthanized according to health Minister Gaetan Barrette, according to an article by Radio Canada that appeared in the Huffington Post website. 

Health Minister Barrette said the rate is normal. "Many people were waiting for the implementation of the law," said Gaétan Barrette. "I do not think we are headed to unbridled growth," he said.

Some doctors who work in palliative care are concerned that more emphasis has been placed on the roll-out of the euthanasia program than toward providing palliative care. 

"We do not feel the same mobilization to increase access to palliative care," says Christiane Martel, president of the Quebec Society for Palliative Care. "The majority of people still want to just comfort care at end of life."

Martel recalls that access to quality palliative care was the primary objective of the Act concerning the end of life care adopted in June of 2014. 

"In palliative care, we do not see much improvement in resources. But we see a lot of resource mobilization for medical help to die."

Dr. Martel is concerned that meagre hospice care in some regions will affect the number of requests for euthanasia. "I think we must ensure that no one requests medical help to die because we did not have the proper care," she said.

Martel’s colleague Marjorie Tremblay believes that there is a serious problem. 

"What I see in my field every day are patients who don’t have palliative care in their area. I find it appalling!"

She believes that patients whose pain is relieved overwhelmingly reject medical help to die.

She believes Québec should develop an information campaign on palliative care. "Have you seen palliative care promoted since the implementation of the law? I have not even heard the term ‘palliative care’!"

Tremblay also deplores the confusion among some people between physician assisted dying and palliative care; they simply want to avoid suffering in the dying process. "Some people are afraid they will be given the lethal injection if they come into palliative care,” she said.

Health minister Barrette believes their findings are exaggerated. "I do not think people say, ”If I don’t get a palliative care bed, I will ask for medical help to die!" I am convinced that it does not happen," insists Barrette.

He says that with few exceptions, the number of palliative care beds in institutions is sufficient. Improvements need to be made, for example, in the Shawinigan area and in eastern Montreal.

However, the minister admitted that home-based palliative care services must be improved. Currently, about 11% of Quebecers end their days at home. Quebec wants this number to increase to 22% within 5 years.

Rushing toward death - Euthanasia in the Netherlands

Theo Boer

Theo Boer

Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

In July 2014, Professor Theo Boer, who was member, for nine years, of a euthanasia regional review committee in the Netherlands, wrote an article that was published in the Daily Mail urging the British parliament to reject the legalization of assisted suicide. Boer then gave the Euthanasia Prevention Coalition permission to publish the full text of his article entitled "Assisted Suicide: Don't go there."

Today Professor Boer published a significant critique of the Netherlands Euthanasia Law under the title: Rushing toward death?

Boer begins by explaining how euthanasia became legal, and how the law works in the Netherlands. He wrote:

In 1994 the Netherlands became the first country to legalize assisted dying. The Dutch added a clause to the Burial and Cremation Act allowing doctors to help a person die as long as the patient made an informed request and faced unbearable suffering with no prospect of improvement; a second doctor concurred in the decision; and medically advised methods were used. The clause was further codified by the Assisted Dying Act in 2001. Belgium followed suit with similar legislation in 2002. 
In the Netherlands, five regional review committees, each consisting of a lawyer, a physician, and an ethicist, were charged with keeping an eye on the practice and assessing (after the fact) whether a case of assisted dying complied with the law. 
Two forms of assisted dying are legally practiced: euthanasia, in which the action of the physician causes death, and physician-assisted suicide, in which a physician provides the patient with a lethal drink administered by the patient. The overwhelming majority of patients who make use of the law (95 percent) choose euthanasia.

Boer then explains why he originally supported the Netherlands euthanasia law.

Link to the full article

Canada: Caring Not Killing Letter writing campaign

The Euthanasia Prevention Coalition (EPC) launched the Caring Not Killing postcard campaign to members of parliament a few weeks ago. It is important to contact elected representatives to state your opposition to euthanasia, assisted suicide and the pro-euthanasia recommendations from the report of the Special Joint Committee on Physician-Assisted Dying and the report of the Provincial Territorial Expert Advisory Group on Physician-Assisted Dying.

The Caring Not Killing postcard campaign is an easy way to activate people to contact elected representatives, but letter-writing is a more effective way to get the attention of your political leaders. Order the Caring Not Killing postcards from EPC for free.

To write an effective letter - keep your letter short and use only one or two talking points. 

Links to information on topics related to euthanasia and assisted suicide:

1. A Personal story, 2. Elder Abuse, 3. Euthanasia: The theory and the reality, 4. Medical Error, 5.Euthanasia/Disability rights, 6. Euthanasia/Palliative care, 7. Euthanasia/Belgium, 8.Euthanasia for psychiatric reasons, 9. Assisted Suicide USA, 10. Abuse of euthanasia laws, 11. Conscience rights for healthcare professionals.

Send you letter to your member of parliament or to Prime Minister Justin Trudeau, Justice Minister Jody Wilson-Raybould, Health Minister Jane Philipott. Member of Parliament contact information.

Letters to federal politicians can be sent without postage.

Link to the full article

Hospice and Hospital will not participate in assisted dying

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

The recent report of the federal government's Special Committee on Assisted Dying stated (recommendation 11) that every publicly funded healthcare institution should be required to allow assisted death on its premises.

On March 5, the Windsor Star published an article by Brian Cross concerning Hotel Dieu Grace Hospital and the Hospice of Windsor and Essex County, since both institutions oppose euthanasia and assisted suicide.

Carol Derbyshire the CEO of the Hospice of Windsor stated that their philosophy of ca supports:

“respect for the dignity and sanctity of human life,” and ... that it’s (assisted death) not part of palliative care.

Janice Kaffer, the CEO of Hotel Dieu, that also operate a hospice, stated:

As a faith-based Catholic hospital, it does not believe it should participate in physician-assisted suicide.

Jean Echlin who is the President of the Euthanasia Prevention Coalition and a registered nurse who was instrumental in founding the Hospice of Windsor clinical and volunteer programs and recently co-authored a book titled: It's not that simple told the Windsor Star:

most Canadians don’t understand how dignified death can be when pain and symptoms are well managed. She fears the push for assisted suicide is being driven by a desire to control health costs. Little consideration is given to the “death squads,” the doctors and nurses expected to deliver the deadly drugs,

While Dr Brad Burke, a physical rehabilitation expert told the Windsor star:

“Whether I’m the executioner or I’m made to to refer someone to an executioner, I feel I’m still responsible,”

Burke is concerned that the Ontario College of Physicianswould revoke his medical license if he refuses to kill his patients. The Windsor Star stated:

He worries that if he follows his conscience he may contravene the rules of the Ontario College of Physicians and Surgeons and end up losing his licence.

The Canadian Medical Association recently urged the federal government to respect the conscience rights of healthcare professionals.

Healthcare professionals and institutions must not be forced to participate in killing their patients. If Canada imposes euthanasia upon the nation, there needs to be "safe havens" where people can go and not be pressured to die by lethal injection.

Senator Betty Unger: Palliative care should be the priority, not physician-assisted dying

This article was published by Senator Unger on February 22, 2016 on her website.

Senator Betty Unger

Senator Betty Unger

"Palliative care should be the priority, not physician-assisted dying.
There is something terribly wrong when a government
does more to guarantee that the living can die,
than to ensure that the dying can live."

- Betty Unger, Alberta Senator

Last year, the Supreme Court of Canada ruled that the Criminal Code sections prohibiting physician-assisted suicide violate our Charter rights. After declaring those sections to be invalid, the Court paved the way for assisted suicide and euthanasia to become legal in Canada on June 6, 2016.

This short article does not allow us to list all the concerns raised by the Court’s decision. But the experience of countries with legalized euthanasia clearly demonstrates that the road is fraught with great danger, including hundreds of cases a year where people are euthanized without their consent. Even the Supreme Court itself admitted that the risk of abuse cannot be eliminated. They stated that such risks should be identified and minimized, “through a carefully-designed system imposing stringent limits that are scrupulously monitored and enforced”. 

It is this “carefully-designed system” which the Government of Canada is supposed to be in the process of crafting. A joint committee, including both Members of Parliament and Senators, was created last December. It held 12 public meetings, heard from 62 witnesses, and received a multitude of written submissions. From this evidence, the Committee is to “make recommendations on the framework of a federal response on physician-assisted dying that respects the Constitution, the Charter of Rights and Freedoms, and the priorities of Canadians.”

The Committee’s report is due on February 26th, at which time we will discover what their recommendations are. But from the multitude of statements made and questions asked during public meetings, it appears that the majority of Committee members have little regard for safeguards which might limit access to assisted suicide. Rather than crafting a system that imposes “stringent limits” they seem to be preoccupied with how wide the doors can be flung open. Their primary concern appears not to be safeguards, but guaranteed access.

Link to the full article

Diane Coleman: Opposing the New York assisted suicide bill

This article represents one side of the debate between Diane Coleman, the founder of the disability rights group, Not Dead Yet and Dr Timothy Quill, a long-time supporter of assisted suicide that waspublished in the Democrat and Chronicle on February 18, 2016.

Diane Coleman: Opposing the aid in dying bill

“I think there is a very strong alliance of different segments of society that are really concerned about the danger of legalizing assisted suicide from the culture we have today,” Coleman said. “Policy makers have to really consider not only the idealized case that proponents put forward on assisted suicide but the real danger that affects so many elderly, ill and disabled people in this society and be sure that the protection that current law offers are still in place to benefit everyone.”

What are the main concerns of people who are opposed to aid-in-dying legislation?

I don’t think I speak for all (opponents), but the disability community's core message is that if assisted suicide is legal, some people’s lives will be lost due to mistakes, coercion and abuse, and that’s an outcome that can never be undone. 
There’s inherent discrimination in assisted-suicide laws. Most suicidal people receive suicide prevention. Assisted suicide laws would carve out an exception to that, and that exception would apply to people who are elderly, ill, disabled, and those are devalued groups in society. ... Assisted-suicide laws would say, 'these certain people, we’ll not only agree with their suicide but give them the means to carry it out.' We’re saying it comes down to social justice. Equal rights means equal suicide prevention.

Isn’t this a matter of the individual’s right to choose?

We agree that people have the right to refuse life-sustaining treatment. We do think it’s important that that be based on informed consent, that there be protections against health care providers that overrule people who want treatment. We’re also concerned about (a health care proxy) decision being based on the choice of what the person would want if the person were able to speak for themselves. 
You should have the choice to get all the pain relief that you need in order to not have any physical pain. You should have the choice to get all the home care you need so you don’t have to feel like a burden on your family or friends. 
People do have the choice to commit suicide because suicide and assisted suicide are not exactly the same. It’s the discrimination that’s inherent in assisted suicide that is our concern. But assisted suicide needs to remain illegal because of all the dangers the public policy of assisted-suicide creates of mistake, coercion and abuse. We think everyone deserves suicide prevention no matter how old, no matter how ill, no matter how disabled.

Link to the full article