Webcast archive: 18/06/01

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

  • The executioner’s fee
  • A new report about euthanasia in Québec

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

THE EXECUTIONER’S FEE

  • Last week we talked about people profiting illegally from assisted suicide and euthanasia. Today, we’re looking at the wages earned legally by doctors who euthanize people in Canada.
  • There is no single payment to doctors to cover every activity connected to euthanasia.  While some provinces have created specific rates and billing codes for euthanasia-related services (like eligibility assessments, administering the lethal dose, filling out death certificates and filing reports), others have included these activities under existing codes. Doctors have complained that they have not been paid, that the reimbursement rates are too low, and that travel to rural areas for home visits is not compensated.  We found that information about AS/E fees is not easy to come by.
  • According to an article in the Globe and Mail, as of July 2017, doctors could charge the following fees in various provinces (values are rounded to the nearest dollar):
    • $622 in Alberta,
    • $600 in New Brunswick,
    • $500 in Quebec,
    • $480 in Manitoba, and
    • $466 in Saskatchewan.
  • On May 1st of this year, the province of British Columbia increased the rates doctors are paid for providing euthanasia and related services. The original fee, a flat rate of $200, was raised to $280, and covers:
    • writing the prescription for the lethal drug;
    • visits to patients to explain the procedure and obtain final consent;
    • administration of the drugs through an IV; and
    • filing paperwork with the coroner’s office after the death.
  • There is a new $125 reimbursement for the doctor to pick up the drug from a pharmacy, which is usually the case when the person does not die in hospital.  In addition, doctors can charge $114 for a home visit, or up to $56 to go to the hospital at the time of the person’s death.
  • According to the provincial Medical Services Commission, the two medical practitioners who decide if the person is eligible for AS/E (called the “prescriber” and the “assessor” in the BC regulations) must be paid for the assessment visits as well, at a rate of $42.65 per 15 minute period.  The prescriber’s assessment meeting can last up to 135 minutes (nine periods) for a fee of $384. The assessor, who provides the second opinion on eligibility, can bill for up to seven 15-minute blocks, for a maximum time of 105 minutes totalling $299.
  • It’s unrealistic to expect medical practitioners to get an accurate picture of a person’s “grievous and irremediable medical condition”, their prognosis, history and circumstances, as well as their reasons for asking to die, and to fully explore options to solve those problems, all during a two-hour visit.  Nor is two hours enough time to decide whether a person is competent, if they are subject to “external pressure” or might be “vulnerable to inducement to commit suicide in a time of weakness.”
  • Under some conditions, BC doctors can be compensated for travel, with up to $250 payments for less than two hours’ travel, and $1500 for more than 10 hours.
  • If we add up the reimbursements for performing euthanasia in BC, we get:
    • $384 for the eligibility assessment;
    • $125 for the doctor to pick up the drug from the pharmacy;
    • $280 for writing the prescriptions, obtaining the person’s final consent, IV setup and performing the euthanasia, filling out the death certificate, and filing reports;
    • $114 for a home visit; and
    • $250 to $1500 for travel reimbursement.
    • The final total: $1,153 – $2,403, depending on the distance travelled.
  • These fees are much higher than the estimates offered in a study from January 2017 published in the Canadian Medical Association Journal.  The authors’ estimate (based on fees in Ontario) for a “low cost” euthanasia scenario was $268.75, while a “high cost” scenario was $751.85.  The report concluded that, although assisted suicide and euthanasia would cost Canada between $1.5 million and $14.8 million, the health care system could save up to $138.8 million per year.
  • Two questions arise: What kind of service are we paying for?  And is this how we want to count the value of people’s lives?

A NEW REPORT ABOUT EUTHANASIA IN QUÉBEC

  • Last week, the Protection of Conscience Project (PCP) released an analysis of the first two years of Quebec’s euthanasia program. This is an update of a report we described in our webcast on September 8, 2017. Before we get into the statistics, we should clarify a couple of points about the report:
    • The Conscience Project’s study doesn’t refer to the most recent report from Québec’s Commission on End-of-Life Care, which came out last fall and summarizes data only through June of last year (See our webcast from November 10, 2017.) Article 75 of the Act Respecting End of Life Care requires the Commission to report on the “status of end of life care” on December 10, 2018; we don’t know whether this report will include analysis of euthanasia all the way through December of 2018.  After this year’s status report, updates will follow every five years.
    • The PCP’s report doesn’t mention people who were euthanized despite being ineligible, other failures of safeguards, or problems with administrative procedures. This information is necessary to have a complete picture of how euthanasia is carried out in Quebec.
  • The Conscience Project’s report highlights a significant increase in euthanasia deaths in Québec through December, 2017:
    • The total number of euthanasia requests in 2016 was 714; the total for 2017 was 1,178, an increase of 65%.
    • The average number of euthanasia requests made per week across Quebec increased from about 14 in 2016 to 23 in 2017.
    • The total number of euthanasia deaths increased by about 67% from 454 in 2016 to 757 in 2017.  The number of deaths by continuous palliative sedation rose by 28%, from 618 in 2016 to 794 in 2017.
    • Throughout the province, euthanasia was provided on average about 9 times per week in 2016 and 14 times per week in 2017.
    • About 1.14% of all deaths in the province in 2017 were from euthanasia. Belgium did not reach that level until about nine years after the practice was legalized. This met the projections made in the PCP report from last fall. We have no explanation for the steep rise in euthanasia; does it have to do with the fact that Québec’s population is smaller than Belgium’s, a willingness to embrace a “more peaceful” solution to illness and aging, or something else?
    • Sixty-three percent of euthanasia requests were granted; 742 in 2017, compared to 450 in 2016.  There is no information as to how many people applied to multiple doctors before being determined eligible.  Of the 37% of requests that were not fulfilled:
      • In 11% of the cases the patient died before euthanasia was provided, up from 9% in 2016.
      • About 8% of the patients did not qualify for euthanasia, down from 11% in 2016.
  • Here are some notable numbers from specific regions of Quebec:
    • In Montérégie, the number of weekly requests jumped from 1.7 to 6.
    • In Outaouais the total number of euthanasia deaths almost doubled, from 11 in 2016 to 21 in 2017. In Chaudière-Appalaches, the total number of euthanasias more than doubled, from 18 to 40.
    • The total number of euthanasias tripled in Saguenay-Lac-Saint-Jean, moving from 6 in 2016 to 19 in 2017.
    • In two regions, the number of euthanasia deaths quadrupled. Côte-Nord had two in 2016 and 8 in 2017. Four people were euthanized in Abitibi-Témiscamingue in 2016, while 18 people were killed in 2017.
    • In the Laurentians, 24 people opted for continuous palliative sedation in 2016, while 84 people chose it in 2017; three times the number.