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

Physician Assisted Suicide Proponents Will Say Anything to Pass the Assisted Suicide Bill

This article was published on February 22, 2016 by Maryland Against Physician Assisted Suicide.

  • Requiring a professional mental health evaluation would “unnecessarily slow down” patient’s access to physician assisted suicide.
  • Terminal patients are in pain so this bill must be passed. 
  • [Including] too many regulatory requirements [in this bill] would make it impossible for a dying person to access death with dignity. 
  • It’s not falsifying the death certificate [by only listing the underlying terminal diagnosis instead of listing assisted suicide as reason for death] because that’s the way it is done in Oregon and Washington. 

It goes on and on like this. The list of false and misleading statements that physician assisted suicide proponents said at the House hearing on HB 404 last Friday is hard to believe. But let’s take them at their word and address each of these assertions one by one:

   1. Medical studies show that terminal patients have high rates of depression: according to this study “best estimates are that between 15% and 50% of cancer patients experience depressive symptoms, and 5% to 20% will meet various diagnostic criteria for major depressive disorder.” These depressed, terminal patients have a poorer quality of life and a higher likelihood of having suicidal thoughts.

Proponents of physician assisted suicide and HB 404 are blatantly ignoring these data and argue that nothing should slow down a terminal patient’s quest to commit suicide, even if they are seriously depressed.

The 2015 data from Oregon show that an optional psychiatric evaluation does not work! Only 5 out of 132 patients receiving an assisted suicide prescription were referred for a professional mental health evaluation. That’s 3.8%. Far lower than the 15%-50% of cancer patients estimated to have depression (where 72% of OR residents receiving assisted suicide in 2015 had cancer!) 

   2. Pain isn’t even in the top 5 reasons why patients in Oregon chose assisted suicide. The 2015 Oregon “Death with Dignity” annual report shows that pain was the sixth highest reason stated for requesting assisted suicide – far behind “less ability to engage in activities that make life enjoyable”; “losing autonomy”; and “loss of dignity.”

   3. More regulatory requirements are exactly what an issue like physician assisted suicide demands and what legislators should seek in issues that are literally life and death. It’s insulting for assisted suicide proponents to argue that receiving a prescription to commit suicide should be as simple as possible.

   4. Just because Oregon and Washington “death with dignity” laws allow for the falsifying of a death certificate doesn’t mean it is OK to do in Maryland.

Contact Maryland Against Physician Assisted Suicide.

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

Colorado assisted suicide bill should be defeated

Jennifer Ballentine

Jennifer Ballentine

This article was written by Jennifer Ballentine and published in the Denver Post on Feb 13, 2016. Jennifer Ballentine is vice president of Hospice Analytics in Colorado Springs.

Colorado's legislators should be commended for hearing many hours of open testimony on the controversial End-of-Life Options Act (House Bill 1054), which would legalize physician-assisted death. At the end of the second hearing earlier this month, amendments were adopted to address concerns.

After all the wordsmithing and window-dressing, however, the amended bill still does not address the biggest problem of all, one that should worry both supporters and opponents of physician-assisted death.

In a nutshell: Although the bill lays out specific eligibility requirements and a detailed process by which people may request and receive life-ending drugs, the bill completely lacks any requirement for documentation, oversight, or enforcement.

Quite simply, all the so-called "safeguards" in the bill are a fairy tale.

Without documentation, processes can be sidestepped or skipped altogether. Without enforcement, protection is meaningless. Without reporting, no one can know whether the law has been used appropriately, misused, or even abused.

This is a significant change from last year's bill and a complete break with other enacted laws governing physician-assisted death.

In other legislation and laws, the doctor must document the process in the patient's medical record.

Not in this year's bill.

Link to the full article

Assisted Death: I never thought this day would come

Diane Kelsall

Diane Kelsall

This article was published as a CMAJ blog on Feb 3, 2016 and republished with permission.

By Diane Kelsall, Deputy Editor at CMAJ, and editor of CMAJ Open.

In June 1993 I attended my first international research meeting. WONCA (World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) was having its annual meeting in The Hague and I had gotten funding from my fellowship program to attend.

It was all very exciting for someone new to the research world to see the hustle and bustle, and feel the energy, that accompanies such a large meeting. Even Queen Beatrix attended.

But that’s not what I remember most about the meeting.

One of the sessions put on by the local organizers focused on euthanasia (that was the term used at the conference). At the time, the Netherlands was the only jurisdiction in the world where this practice was legalized. Many attended out of curiosity—and the collective response was interesting. Numerous attendees filed out of the session in silence, clutching handouts that described euthanasia protocols:

Administer this. If the patient is still breathing, administer that. If the patient’s heart is still beating, do this.

We stood in small groups, hardly able to grasp what we were reading. This was so contrary to everything we had been taught and everything we believed. How could physicians have crossed this line? When did “above all do no harm” turn into an algorithm for death?

When I returned home, I put the protocols away in my desk. Every few years, I would stumble across them—and each time, I felt chilled as I read them.

Link to the full article

Colorado Assisted Suicide Bills Recipe for Elder Abuse

FOR IMMEDIATE RELEASE - WEDNESDAY, FEBRUARY3, 2016

Margaret Dore

Margaret Dore

Dore: "Even if you like the concept of assisted suicide and euthanasia, the proposed Colorado bills have it all wrong.”

Contact: Margaret Dore (206) 697-1217

Denver, CO  --  Attorney Margaret Dore, president of Choice is an Illusion, which has fought assisted suicide legalization efforts in many states and now Colorado, made the following statement in connection with legislative hearings being held today and tomorrow on bills seeking to legalize assisted suicide and euthanasia in that state.  

"The bills, SB 16-025 and HB 16-1054, seek to legalize physician-assisted suicide, assisted suicide and euthanasia as those terms are traditionally defined," said Dore. "The bills are described as 'aid in dying,' but their reach is not limited to dying people. 'Eligible' persons may have years, even decades, to live."

Dore said, "The bills are a recipe for elder abuse. The patient's heir, who will financially benefit from the patient's death, is allowed to actively participate in signing the patient up for the lethal dose. There is no oversight over administration."  Dore elaborated, "No doctor, not even a witness, is required to be present at the death. Even if the patient struggled, who would know? The bills create the perfect crime."  

"It gets worse," said Dore. "The bills require the death certificate to be falsified to reflect a death by a terminal illness.  The significance is a loss of transparency as to the true cause of death and an inability to prosecute in the case of an outright murder for the money; the death, as a matter of law is a terminal illness."   

The Colorado bills seek to legalize assisted suicide and euthanasia for people who are "terminal," which is defined as a doctor’s prediction of less than six months to live. In real life, such persons can have years, even decades, to live.

Link to the full release

Opinion: Doctors should not Kill

There are ethical reasons why physicians are instructed to do no harm to their patients.

This opinion column was published in the Toronto Sun on Jan 23, 2016.

Opinion: Dr Irvin Wolkoff

As a doctor, I have a question about assisted suicide that has not been clearly answered: Who will perform the procedures resulting in someone else’s death?

To look at the news, you would think it will automatically be doctors.

The media refer to this voluntary ending of life as “physician assisted suicide”, or “doctor assisted death” and — this phrase makes me cringe — “medical death”.

The Canadian Medical Association has engaged in the public dialogue about assisted death, but I’m not aware that it, federal or provincial governments, doctors’ licensing and regulating bodies, or anyone else has already decreed the people who will help very sick patients to die will be doctors.

It’s just assumed doctors will do it. Why?

There are practical obstacles to engaging doctors to carry out assisted suicides. For example, where would we find the doctors we’d need?

Canada’s physician population isn’t large enough to care for our growing and aging population as it is and governments are constantly cutting back funding to the facilities, procedures, treatments, medications and working conditions we need to do our jobs properly.

Link to the full article