Euthanasia and assisted suicide – Let’s not go there!

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Action Life sent this submission to the Provincial-Territorial Expert Advisory Group on Physician Assisted Dying, at the end of October 2015:

Action Life Ottawa is a non-denominational, non-profit, educational pro-life organization founded in 1971. We count 4,000 supporters in Ottawa and the surrounding region.  Our guiding principles are that the right to life is the basic human right on which all others depend and that society has a duty to uphold and protect that right.  We believe that life at every stage has inestimable value regardless of level of development, size, mental capacity, state of health and physical ability.  We hold that all human beings are equal before and after birth. Members of Action Life maintain that we must solve human problems using positive, constructive means without destroying human life.

Action Life is greatly concerned about the protection of vulnerable persons from euthanasia and assisted suicide in the aftermath of the Supreme Court decision in Carter v. Canada. A regime permitting euthanasia and assisted suicide will affect not only individuals but will have a profound societal impact as well.  Allowing the deliberate taking of a human life by physicians may undermine trust in the medical profession.  While euthanasia and assisted suicide advocates present lethal injections and prescriptions for a lethal dose of drugs as medical treatment, they are the very opposite. Euthanasia and assisted suicide are not medical treatment or health care, they are killing.  Permissive regimes also place at risk, the most vulnerable in society:  Persons with disabilities, elderly persons and persons with chronic and mental illness.  Behind these calls  for the ‘right to die’  lies the view that some lives are not worth living.

While much is said about autonomy and safeguards to advance the legalization of euthanasia and assisted suicide, they have been ineffective in protecting patients from euthanasia without explicit request or consent in the Netherlands and Belgium. The failure of safeguards has been amply demonstrated by the euthanasia experience in these jurisdictions.

Euthanasia Cases with no Explicit Request

Netherlands

 

The very first government commissioned report on euthanasia in the Netherlands, the 1990  Remmelink report found that 1,000 patients a year were “terminated without explicit request”.  Subsequent studies published in 1995 and 2001 showed that at least 1,000 euthanasia deaths a year were done without  explicit request.  Thousands of patients have been euthanized without explicit request in the Netherlands over the years.   An examination of later data reveals that this practice continues.  In 2005, there were approximately 550 deaths  without explicit request.  In 2010, there were 310 euthanasia deaths without explicit request. 23% of euthanasia deaths were not reported to the Review Committee in 2010 according to a 2012 Lancet study.

The Dutch experience shows that euthanasia is not limited only to those who ask and consent to it but it is also extended to those who did not make a request or give consent.  Even prior to the legalization of euthanasia in the Netherlands and Belgium, cases of neonatal and infant euthanasia by lethal injection occurred.  Infants cannot request or consent to being killed by lethal injection.

The promises of safeguards and strict controls are an illusion.

Reasons for euthanasia

Once euthanasia is allowed, reasons for euthanasia and the number of euthanasia requests granted  increase over time.  It is granted for psychological suffering, including  patients with depression, dementia and those tired of living.

In 2006, there were 1,923 reported euthanasia deaths. In 2013, there were 4,829 reported euthanasia deaths.

 

The  Belgium experience

Physician assisted deaths under the euthanasia law in Belgium: a population based survey- Canadian Medical Association Journal, June 2010.

This study identified a vulnerable patient group:

“Our finding that the use of life- ending drugs without explicit patient request occurred predominantly in hospital and among patients 80 years or older who were mostly in coma or had dementia fits the description of “vulnerable” patient groups at risk of life- ending without request.”

 

Euthanasia deaths without explicit request

Why was the decision for euthanasia not discussed with the patient? Reasons offered among others were that:

In 70.1% of cases, the patient was comatose.

In 21.1% of cases, the patient had dementia.

In 17% of cases, the physician thought “the decision  was clearly in the patient’s best interest. ”

In 8.2% of cases,  the physician thought “the discussion  would have been harmful to patient.”

So we ask where is consent and choice in these decisions? Choice and consent are an illusion: sometimes the physician decides when the patient dies. In some instances, it is also the wish of the family to end the patient’s life.  31% of euthanasia deaths were done without the patient’s explicit request in the Flanders region of Belgium.

Unreported euthanasia deaths

British Medical Journal, November 2010

Reporting of euthanasia in Medical Practice in Flanders, Belgium: Cross Sectional Analysis of Reported and Unreported cases

From this study, we know that:

47.2% of euthanasia deaths were unreported.

“According to these documents, physicians who reported cases, practiced euthanasia carefully and in compliance with the law, and no cases of abuse have been found. However, concerns exist that only cases of euthanasia that are dealt with carefully are being reported. ”

Reasons given for not reporting euthanasia death were:

In 11.9% of  cases, physicians responded that the “legal due care requirements had possibly not all been met. ”

9%  said that “euthanasia is a private matter between physician and patient.”

2.3% “did not report the case because of possible legal consequences.”

In 76.7% of the cases, “physicians answered that they did not perceive their act as euthanasia.”

Another ‘safeguard’ which was ignored in unreported cases of euthanasia was the requirement to consult another physician:

“Consultation occurred in almost all reported cases, whereas it occurred in only half of all unreported cases. This association was also found in the Netherlands where the most important reason for not consulting was the physician did not intend to report the case.”

 

It is our belief that only an absolute prohibition on euthanasia and assisted suicide protects patients.

The latest study on euthanasia in Belgium found:
The New England Journal of Medicine (NEJM) (March 19, 2015) Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium.

  1. An increase in the  percentage of euthanasia deaths: in 2007, 1.9% of all deaths were due to euthanasia.  In 2013, 4.6% of all deaths were due to euthanasia, which represents a substantial  increase in 6 years.

 

Euthanasia deaths without explicit request from the patient continue to happen in spite of safeguards.

In 2007, 1.8% of all deaths were euthanasia deaths without explicit request.

 

In 2013, 1.7% of all deaths were hastened deaths without explicit request.

 

Given a total of 61,621 deaths in 2013 in Flanders Belgium with  1.7% of all deaths being due to euthanasia without explicit request, this means at least 1,000 deaths were euthanasia deaths without explicit request.

Assisted Suicide

In the states of Oregon and Washington, where assisted suicide is legal, the primary end of life concerns mentioned in the annual reports are loss of autonomy and dignity and decreasing ability to participate in activities the individual once enjoyed.  Being a burden on family and friends is also a concern for some individuals. We need to reaffirm that dependence does not imply a loss of dignity. On the one hand we will have suicide prevention and on the other suicide affirmation. The two cannot co-exist.  Media reports have documented cases of violations of the assisted suicide law in Oregon.

Palliative care

Dame Cicely Saunders, who founded palliative care at S. Christopher’s Hospice in London said that “a request for euthanasia is primarily, the response to health care and social service systems that do not meet the needs of most people who are dying.”

When the reasons behind this cry for death are addressed, when the proper care is received, such demands usually dissipate.

Canada must increase and provide greater access to palliative care for all Canadians. At present, estimates are that only 30% of Canadians have access to palliative care. We are concerned that some are pushing for euthanasia and assisted suicide to be included in palliative care centres, a move which would cause some patients to fear these centres.

Suffering wears many faces: physical, emotional, and spiritual. A person’s request for death may be the result of loneliness, abandonment, poor pain relief, familial or financial pressure. Death with Dignity doesn’t come from a syringe or a prescription for a lethal dose of drugs.

Impacts on conscience rights

Lastly, we turn to the question of  conscience rights of physicians. The College of Physicians and Surgeons of Ontario in its new policy Professional Obligations and Human rights  states that in spite of conscientious, moral or religious objections, the physician must provide an effective referral to another physician. Asking a physician to refer for euthanasia or assisted suicide in spite of his moral objections  is a violation of his Charter right to freedom of conscience and religion.  We oppose any measure which would force physicians to refer for euthanasia and assisted suicide. The conscience rights of nurses must be respected as well.

The American Medical Association’s view on euthanasia is one we wholeheartedly agree with: “Euthanasia is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

Canada should direct its energies to increasing access to palliative care rather than allowing euthanasia and assisted suicide. Again, we stress that only a prohibition on euthanasia and assisted suicide can protect vulnerable persons.   To die with dignity, patients do not need doctors to kill them.

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