Introduction

Webcast archive: New Québec lawsuit

This week, we’re talking about a lawsuit filed in Quebec in order to expand euthanasia eligibility.

Webcast archive: New Québec lawsuit

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

  • New Québec lawsuit seeks to expand provincial and federal euthanasia laws
  • Toronto hospital study shows people request assisted suicide for existential reasons

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

NEW QUÉBEC LAWSUIT SEEKS TO EXPAND PROVINCIAL AND FEDERAL EUTHANASIA LAWS

  • Two residents of Montréal have filed suit in Québec’s superior court challenging the sections in the provincial and federal euthanasia laws that limit access to people who are at the “end of life” or whose death is “reasonably foreseeable.”
  • Jean Truchon (49) and Nicole Gladu (71) have disabilities that are worsening, and they are losing independence.  Mr. Truchon has cerebral palsy and has been in a nursing home since 2012 since he lost the use of his arms.  Ms. Gladu has post-polio syndrome which is putting her independence at risk.
  • Their lawyer, Jean-Pierre Ménard, said both suffer from incurable medical conditions that cause persistent and intolerable suffering, two of the criteria listed in the 2015 Carter decision.  However since neither is at the “end of life” they don’t qualify for Québec’s euthanasia law, nor are their deaths “reasonably foreseeable” as mandated in the federal law.
  • Ménard argues that, since the laws restrict access to euthanasia and assisted dying more than the Supreme court called for in Carter, they violate the plaintiffs’ charter rights.
  • Others argue that parliament has the right and duty to make laws to protect its citizens, and that promoting suicide prevention is an important goal of the government.  They argue that the government puts all kinds of limits on what citizens can and can’t do, for their own safety and that of others, such as speed limits and seat-belt laws.  They believe limiting access to assisted suicide and euthanasia to people who are in the process of dying is an example of such an appropriate limit.
  • State-sponsored assisted suicide is the wrong response to people’s suffering.  Effective palliative care, home based supports, and peer counselling services are essential first steps before resorting to death.
  • Supporters of assisted suicide and euthanasia are shifting public beliefs: from thinking of suicide and death as problems to be solved by society, to death being a benefit to the person and society.
  • Legalization isn’t necessary – Everyone has the option to commit suicide or to refuse medical care and have palliative sedation on demand.  Suicide is not supposed to be easy; that’s why we have a public policy against it.
  • Assisted suicide is discriminatory – While people without disabilities receive suicide prevention services if they express a wish to die, people with disabilities will be encouraged and assisted to kill themselves.  The underlying assumption is that it’s better to be dead than disabled.
  • Choice is an illusion – The choice to die cannot be free as long as people with disabilities don’t have the choice of where and how to live.  That choice is limited not by disability, but by government policies and spending priorities that limit accessible housing and force people who need personal assistance to live in institutions.
  • Safeguards don’t work – Where these practices are legal, safeguards do not prevent people with disabilities from being wrongly killed.

TORONTO HOSPITAL STUDY SHOWS PEOPLE REQUEST ASSISTED SUICIDE FOR EXISTENTIAL REASONS

  • A study published in the New England Journal of Medicine on May 27, 2017 described the first year of Toronto’s University Health Network (UNH) assisted dying program.
  • According to the study’s authors, “The Department of Supportive Care at Princess Margaret Cancer Centre, which offers psychosocial oncology and palliative care services, assumed operational responsibility for MAiD at UHN because of its staff members’ expertise in responding to patients’ and families’ suffering, assessing suicidality, and managing end-of-life care.” Other clinical departments were unwilling to be formally associated with MAiD, citing conscientious objections of staff and potential stigmatization.
  • The UHN’s program has some interesting features:
    • They chose to limit assisted death to lethal injections in a hospital setting, in order to minimize the risk of complications, and enable staff to deal with any problems that arise.  People who wanted to take drugs orally or at home were referred to other providers.
    • Euthanasia is administered in different areas of the hospitals because “no unit was willing to be identified as the de facto ‘MAiD unit.’”
  • Of the 74 people who inquired about assisted suicide to the UHN program between March 2016 and March of this year, only 29 went on to the assessment process.  “Reasons for not proceeding included withdrawal of the request by the patient, primary mental illness, delirium, and active dying, with a concomitant inability to participate in an assessment.”
  • Of the 29 people who were assessed,
    • 25 (86%) were “approved” for euthanasia.  Reasons for denial included lack of capacity to give informed consent and indecision about wanting to die.
    • 28 people were receiving palliative care, but only 15 were receiving psychosocial supports.
  • Of the 25 people approved for euthanasia, 19 were actually euthanized.
    • Reasons people did not receive euthanasia included withdrawal of the request and natural death.
    • 95% cited loss of autonomy as a reason for the request for euthanasia.
    • “Other common reasons included the wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life. Few patients cited inadequate control of pain or other symptoms.”
  • The UHN found that not only direct care workers needed education and support to deal with the new program, but also indirect staff in housekeeping, medical records and transportation.
  • Based on the program’s experience, the researchers concluded “We have now taken the position in our MAiD program that it is neither desirable nor practically feasible for MAiD to be delivered on an emergency basis at the very end of life.”
  • “As in other jurisdictions, many patients changed their minds about pursuing MAiD after making the request and receiving approval.” The researchers attributed this to people regaining a “sense of control” over their lives.
  • Launching and operating the euthanasia program has involved shifting of human and financial resources to make it possible.  While some services are paid by provincial health insurance, the time required for participating in case review and fulfilling reporting requirements is largely done on a volunteer basis.  The report said; “funding mechanisms are needed to ensure safe and effective delivery of MAiD in settings that may not be able to mobilize adequate internal resources,”