Webcast archive: The Vulnerable Persons Standard

This week, we discuss the newly-released Vulnerable Persons Standard.

In this episode of Euthanasia & Disability, Amy Hasbrouck and Christian Debray discuss:

  • The Vulnerable Persons Standard initiative is launched
  • Assisted suicide bills die in six U.S. states

Please note that this text is only a script and that our webcast contains additional commentary.

THE VULNERABLE PERSONS STANDARD INITIATIVE IS LAUNCHED

  • On March 1, 28 organizations launched an initiative called the Vulnerable Persons Standard.  This document is a series of safeguards, drawn up by 30 doctors, lawyers, and activists, including leaders in the disability rights community, to protect vulnerable persons from the dangers of assisted suicide and euthanasia.
  • According to the website, “These safeguards will help to ensure that Canadians requesting assistance from physicians to end their life can do so without jeopardizing the lives of vulnerable persons who may be subject to coercion and abuse.”
  • Authors of the standard include Disability rights activist Catherine Frazee, Palliative Care specialist Dr. Harvey Chochinov (of the federal expert panel) and David Baker, the lawyer who pled the Carter case on behalf of the Council of Canadians with Disabilities.  Organizational supporters include CCD, the Canadian Association of Community Living, and the Euthanasia Prevention Coalition.
  • The Standard is based on the idea that problems and unmet needs should not be the cause of death.  Such problems include:
    • social and mental health issues causing distorted thoughts and judgment, like depression, hopelessness, loneliness, fear, grief, shame.  Being coerced by others, and the power imbalance of the doctor-patient relationship.
    • Lack of access to disability-related supports for dignity, comfort and self-determination.
    • Insufficient or inaccessible palliative care options to alleviate pain and suffering and improve well-being of patients and their loved ones.
    • Poverty and unemployment which can cause significant mental anguish, social stigma and a sense of hopelessness.
    • Physical, mental or emotional abuse.
    • Financial abuse and fraud, especially affecting elders and people with disabilities.

The standard would address:

  • Equal protection for vulnerable persons
    • The law would include a preamble affirming that all lives, however they are lived, have inherent dignity and are worthy of respect.
    • The law will be carefully regulated and publicly reported.
    • Independent research into the social impacts of Canada’s assisted death policies will be promoted, financially supported and publicly reported. Any adverse impacts of the law which cause harm or disadvantage to Canadians, or to Canada’s social fabric, will be addressed without delay.
  • End-of-life conditions:
    • Two doctors must independently assess the medical condition as grievous and irremediable, meaning an advanced state of weakening capacities, with no chance of improvement, and that the person is at the end of life.
    • The physicians who make these decisions must have specific expertise in the person’s medical condition as well as the range of appropriate care options. They must have met with the patient and diligently explored their request.
    • The provision of palliative care options for all Canadians with end-of-life conditions will be prioritized and the impact of the practice of physician-assisted death will be subject to ongoing and rigorous attention.
  • Voluntary and capable consent
    • In looking at the request, physicians must separately attest that the person:
      1) has made the request independently, free of undue influence or coercion;
      2) has capacity to make the request;
      3) is informed and understands all alternatives; and,
      4) has been supported to pursue any acceptable alternatives, including palliative care.
    • A doctor must attest at the time when medical aid in dying is administered that the person has the capacity to give consent, and that consent is voluntary and certain.
    • In all discussions related to physician-assisted death with the patient, neutral, independent and professional interpretation services, including ASL/LSQ, must be provided as required.
    • The use of advance directives to authorize physician-assisted death would be prohibited
  • Assessment of suffering and vulnerability
    • Two physicians must, after consultation with members of the patient’s extended health care team, attest that the person’s experience of enduring and intolerable suffering is the direct and substantial result of a grievous and irremediable medical condition.
    • If psychosocial factors such as grief, loneliness, stigma, and shame or social conditions such as a lack of needed supports for the person and their caregivers are motivating the patient’s request, these will be actively explored. Every effort must be made, through palliative care and other means, to alleviate their impact upon the person’s suffering.
  • Arm’s length authorization
    • Every request along with all related clinical assessments are reviewed by a judge or an independent expert body with authority to approve or deny the request for assisted death, or to request more information prior to making a determination.
    • Decisions will be made on an expedited basis, appropriate to the person’s life expectancy and with a degree of formality and expertise appropriate to the circumstance.
    • Reasons will be recorded and reported for each decision.
    • Legal provisions for exemption to the prohibitions on assisted death are in the Criminal Code to ensure pan-Canadian consistency, including: definitions, criteria for access, requirements of vulnerability assessments, and terms for independent prior review in each province or territory.
  • The organizations supporting the Vulnerable Person standard are hoping that members of parliament will adopt it as part of the law to govern assisted suicide and euthanasia.
  • For more information about the vulnerable person standard, visit their website at http://vps-npv.ca.

ASSISTED SUICIDE BILLS DIE IN SIX U.S. STATES

  • So far in 2016, assisted suicide bills have died in six U.S. States.  According to Not Dead Yet and the Patients’ Rights Action Fund:
  • Maryland – This week assisted suicide proponents withdrew legislation, noting to the Associated Press, “it became clear the measure did not have enough votes…” The bill author further mentioned that it is unlikely a new bill will be reintroduced next year due to the strong opposition.
  • New Jersey – Following an aggressive two-year campaign effort by assisted suicide supporters, S382 was shelved. Democratic Senator Peter Barnes noted publicly, “There was never a groundswell of support for this bill.”
  • Iowa – After a brief February debate and opposition testimony from cancer survivors and others, this bill failed to move through a Senate sub-committee.
  • Colorado – A bill that would have legalized assisted suicide in Colorado failed in a Senate committee last month.   A few weeks later, the Colorado Assembly failed to take up the bill because there were not enough votes to pass it.
  • Utah – Following testimony, a bill to legalize assisted suicide was unanimously sent back to the Rules Committee, killing the bill for the remainder of the year.
  • Arizona – Similar to previous attempts to pass assisted suicide legislation, a new bill once again failed to get the support needed to pass the Senate’s Health and Human Services Committee.
  • After all the bad news from Canada, it’s nice to hear some good news, even if it only means we’re holding the line against assisted suicide and euthanasia.