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.

For the Sake of Families Please Do Not Go Down Canada’s Dark Road of Euthanasia and Physician Assisted Suicide

Open letter to Governor Hassan of New Hampshire – From Dr Paul Saba

Dr Paul Saba

Dr Paul Saba

As the state of New Hampshire considers establishing an end-of-life choices study commission, I strongly advise against this. This will only lead down the same dark road that Canada has travelled. Although in the United States euthanasia and physician assisted suicide falls under state jurisdiction, in Canada this falls under both Federal and Provincial jurisdictions.

Presently, Canada is proposing doctor assisted suicide and euthanasia of its most vulnerable citizens including children who are “mature minors” and the depressed.

Children possibly as young as 11 or 12 could see their lives ended prematurely without parental consent or prior notification. The serious consequences of enacting such a provision is illustrated by the case of Nadine (Video Link). At 14 years old, she was diagnosed with an aggressive form of leukemia. She underwent multiple chemotherapies and a failed bone marrow transplant. She was told that she had little chance to survive. She states that without the loving support of her family, she would have given up. Today at 19 she is well and happy to be alive.

History has taught us that killing the weak and vulnerable is a formula for disaster. The Romans encouraged the weak, sick and depressed to kill themselves. In 1938, Germany started euthanizing handicapped children. Today, Belgium and the Netherlands euthanize children, the depressed and those tired of life. 

As a physician with dual USA and Canada citizenship, I have studied and practiced medicine in both countries. I presently live in Montreal. As President and Founder of the Coalition of Physicians for Social Justice my progressive ideas have included promoting quality medical care for the poor, incapacitated, the elderly and the young. However, I do not consider euthanasia and doctor assisted suicide as progressive. Presently in the province of Quebec many citizens have already been euthanized under a cloud of government controlled secrecy despite a requirement of an oversight committee. 

Link to the full article

Has euthanasia changed physician attitudes towards suicide in Québec?

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

On December 10, 2015; the province of Québec officially sanctioned euthanasia. The Québec government passed Bill 52 in June 2014 and over the next 17 months prepared their nation for doctors having the right to kill their patients.

Now we learn that some Québec physicians have been withholding life-saving treatments that could save lives with possibly no after-effects from suicide victims. In response, the Québec's College of Physicians have issued an ethics bulletin telling all physicians that there is an ethical and legal guideline to provide care even to patients seeking to end their lives.

Yves Robert, the secretary for the Québec College of Physicians told the National Post that:

an unspecified number of doctors were interpreting suicide attempts as an implicit refusal of treatment. They “refused to provide the antidote that could have saved a life. This was the real ethical issue,” 
“If there is a life-threatening situation, you have to do whatever is possible to save a life, then you treat the underlying cause.”

According to the article by Graeme Hamilton, published in theNational Post, the four page ethics bulletin states:

“From a moral point of view, this duty to act to save the patient’s life, or to prevent him from living with the effects of a too-late intervention, rests on principles of doing good and not doing harm, as well as of solidarity,” 
“It would be negligent not to act.”

According to the National Post the ethics bulletin states that treatment can only be withheld when their is irrefutable proof that the patient does not want treatment. It then states:

Once stabilized, a survivor of suicide may require psychiatric treatment, the bulletin says. “Recognition of psychological suffering can allow a person who wants to kill himself to picture his life differently,”

But the Québec euthanasia law permits euthanasia for people with psychological suffering.

Is it possible that the confusion concerning the withholding of beneficial treatment is directly related to the legalization of euthanasia in Québec?

A survey of Québec doctors (April 2015) indicated that there is significant confusion concerning withholding and withdrawing treatment and an earlier survey of Québec medical specialists (October 2009) indicated that there was significant confusion concerning what constituted euthanasia and palliative care.

The fact is that the Québec euthanasia law insists that euthanasia is a medical act, which it is not, and that patients have the right to refuse treatment and autonomy. It should not shock people when Québec physicians respond to these edicts by medically abandoning suicidal patients.

Historically Québec has a very high suicide rate. In the past few years, suicide prevention programs have led to a decreased suicide rate. Let's hope that the legalization of euthanasia will not create a suicide contagion effect, leading to higher suicide rates in Québec.

The Supreme Court of Canada gave a four month extension, it exempted Québec and it granted Superior Court judges the right to approve deaths

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

On February 6, 2015, the Supreme Court struck down Canada's assisted suicide law and it employed language that permits euthanasia in its irresponsible and dangerous decision. The Supreme Court gave parliament 12 months to legislate on the issues.

On January 11, 2016 the Supreme Court heard a request from the Federal government for a six month extension to legislate on euthanasia and assisted suicide in Canada. The Federal government suggested that Québec should be exempted from the extension to allow them to institute their own euthanasia law.

Today the Supreme Court decided to grant the Federal government a four month extension to legislate on the issues of euthanasia and assisted suicide, they agreed to exempt Québec from the extension and based on national "fairness" they have enabled Canadians to petition the Superior Court for approval to die by lethal injection. If governments do not legislate on the issues within four months, Canada's assisted suicide law (Section 241b) will be null and void leaving no protection in law for Canadians.

Link to the full article

First euthanasia death in Québec

By Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition

This is a very sad announcement. According to the media, Québec had its first euthanasia death in the the national capital region. Québec has defined euthanasia as a form of healthcare. 

The article by Simon Boivin that was published in LaPressereported (google translated):

"There was a request that was made and where end of life care was provided, have gone to the end," says Annie Ouellet, spokesperson CIUSSS Capitale-Nationale. "And there is a second application that is being evaluated." 
In the case of the patient to whom the protocol was applied in full, the assisted dying has not been given at home, but in an establishment of CIUSSS, added the spokesman.

...The person must be of age, able to consent to care, suffering from a serious and incurable illness and experiencing constant and unbearable physical and psychological suffering.

Only a doctor has the right to inject a lethal dose to a patient, after having obtained the independent opinion of a second doctor in meeting the conditions to be met.A doctor can refuse to offer assistance to die, but the institution that hiring should meet the demand of the patient."

EPC urges the doctors to treat patients with excellent pain and symptom management and not lethal injection.

On December 1, Québec Superior Court Justice Michel Pinsonneault correctly prevented the Québec euthanasia law from coming into effect until the federal government amended the Criminal Code provisions prohibiting euthanasia. On December 22, the Quebec Court of Appeal overturned the Pinsoneault decision.

Canada has a disturbing constitutional situation. The federal Criminal Code prohibits euthanasia and Québec is being allowed to ignore the law.

Medical aid in dying: the Quebec Court of Appeal judgment does not end the dispute

Today, the Quebec Court of Appeal declared that the Criminal Code provisions "that prohibit medical aid in dying cannot by themselves prevent the entry into force and implementation" of the provisions of the Act respecting end-of-life care related to medical aid in dying since they were declared invalid by the Supreme Court of Canada in the Carter decision (at para. 44). We take note of this decision but we still deplore this choice as an answer to end-of-life suffering.

It should be noted that the Appeal Court took care to mention that if the Federal Parliament "adopts a valid federal law on medical aid in dying that applies in Quebec, it will be necessary to review the provisions of the Act respecting end-of-life care related to medical aid in dying to determine if they are in conflict ... "(at para. 44).

Thus, the judgment of the Court of Appeal notes "that the respondents will be able to continue to challenge before the Superior Court the substantive constitutional validity of the provisions of the Act respecting end-of-life care related to medical aid in dying for the other reasons they raise in their amended originating motion "(at para. 45), in particular because it is a matter that falls under the exclusive jurisdiction of Parliament's criminal law.

The Physicians’ Alliance against Euthanasia will continue to promote the quality and availability of good health care for all; we will continue our work to ensure the protection of human life, especially for people in vulnerable situations; we will continue our mission for the recognition of the dignity of all citizens of our country until natural death; and we will continue to defend the right of doctors and health care providers to refuse to practice medical aid in dying or to collaborate in any way. 

The Euthanasia Prevention Coalition intervened in this case at the Québec Court of Appeal.

A five-year-old girl and family plead with the Prime Minister of Canada: say 'no' to euthanasia

Media Release - Montreal - December 16, 2015. (Link to the Canada News wire release)

As Canada moves in the direction of legalizing euthanasia, and some provinces are discussing extending euthanasia to children, Sylvain, Sherley and five-year-old Jolyanne's message to the Prime Minister of Canada is simple. For the sake of families, please do not support euthanasia. Sylvain and Sherley believe euthanasia is dangerous. They are convinced that those who cannot fight will be persuaded to give up too quickly and, in some cases, euthanize their loved ones. As Sylvain says in this heart-touching video, if he had listened to the doctors' advice when everything looked so grim, he would now be alone without the two women he loves most in his life—his wife Sherley and his precious daughter Jolyanne.

Sylvain and Sherley are a Canadian couple living near Montreal who were faced with many of these pressures. They were discouraged from continuing the pregnancy of their future daughter, Jolyanne, at 27 weeks of pregnancy because they were told she would be a Down's baby (erroneous diagnosis) with a malformed esophagus (esophageal atresia). Despite the many medical challenges, Jolyanne thrives today and is the joy of Sylvain's and Sherley's life.

Only two years after Jolyanne was born, Sherley was in a coma and on life support because of pneumonia. Sylvain was told his wife's chances of survival were extremely poor. He was also told that if Sherley survived, she would have no quality of life. The doctors pressured him to disconnect his wife from life support. Despite the pressures, he fought back to save his wife's life.

Quebec passed a law on June 5, 2014 to permit euthanasia. In 2013, prior to the law being passed, the Quebec Human Rights and Youth Commission recommended extending euthanasia to children. A recently released report from an Ontario advisory group is also recommending children be free to "choose" euthanasia.

In this controversy, physicians and patients have been speaking out against euthanasia for many reasons: 

  • Euthanasia is not medical care,
  • Euthanasia contradicts a physician's code of conduct, which does not permit a doctor to intentionally end a person's life even if that person requests it,
  • A person with a serious medical condition is often depressed and has clouded judgment,
  • There are financial and social pressures,
  • There are diagnostic errors,
  • There are errors in predicting outcomes of a medical condition,
  • Euthanasia criteria always expands. It begins with adults, then extends to children. At first only terminal illnesses are allowed, but later chronic ailments are accepted. Initially those suffering physically are selected, but the door opens wide to include the depressed.
  • Palliative care relieves pain and suffering without prematurely ending a person's life but is, unfortunately, not available to the majority of Canadians. Thus, there is no free choice.

Prime Minister Trudeau, you do have a choice. Euthanasia is currently being challenged in the courts of Quebec. It is still illegal in Canada. On behalf of five-year-old Jolyanne and her family and many others, please save Canadian lives by saying 'no' to euthanasia.

Source Coalition of Physicians for Social Justice.

For further information:
Dr Paul Saba, (514) 886-3447, pauljsaba@gmail.com