Introduction

Webcast archive: Health Canada’s 3rd interim euthanasia report

A webcast on: Health Canada’s third interim report on euthanasia. We discuss the history of these reports, as well as the large amount of information that is missing.

Webcast archive: Health Canada’s 3rd interim euthanasia report

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

  • Health Canada’s third interim report on assisted suicide and euthanasia

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

HEALTH CANADA’S THIRD INTERIM REPORT ON ASSISTED SUICIDE AND EUTHANASIA

  • On June 21, 2018, Health Canada released its third interim report on assisted suicide and euthanasia in Canada. This document covers deaths that took place from July 1 to December 31, 2017. A fourth report is expected to document the program’s activities from January to June, 2018.
  • It’s unclear how health Canada intends to report Assisted Suicide and Euthanasia (AS/E) that occur between July 1 and when the final monitoring regulations take effect on November 1, 2018.  That’s assuming the permanent monitoring system is ready to go into effect; that the online portal is up and running, and practitioners and pharmacists know how to use it.  After November 1, Health Canada will only report information obtained in accordance with the monitoring regulations that we talked about last week.
  • The first and second interim reports were released in April 2017 and October 2017. They provide limited information about Canadians who died by AS/E from June to December of 2016, and January to June of 2017 respectively. The first report also includes statistics from Québec for the six months from December 2015 to June 2016. Our webcasts on May 5, 2017 and October 20, 2017 provide a summary of the federal reports, and the November 4, 2016 and November 10, 2017 webcasts describe the Québec reports.
  • Here are some highlights of the third interim report:
    • 1,525 people across Canada died by AS/E between July 1 and December 31, 2017. All of those deaths were by euthanasia; no one self-administered the lethal drug in an assisted suicide.  The numbers in each reporting period are increasing;
      • from 970 in the first period (including 167 from Québec before the federal law came into effect),
      • to 1,179 for the second report
      • to 1,525 in the third report.
    • A total of 3,714 Canadians died by AS/E between December 10, 2015 and December 31, 2017.  Of those, only four opted for assisted suicide.
    • You may have noticed that the totals from the three interim reports only add up to 3,674 people, 40 less than the grand total of 3,714.  We can only guess that the 40 missing people were euthanized in the smaller provinces and territories, and their deaths were not reported due to privacy reasons.
  • Once again, the inconsistency of data collected among the different provinces makes it impossible to compare data points in all locations.
    • Since the territories have such small populations, information about AS/E in the Yukon, the Northwest Territories, and Nunavut has been suppressed to protect the privacy of those who requested or received it.
    • Québec’s “provincial profile” is not reported, and the Atlantic provinces (NL, PEI, NS and NB) are combined into one “regional profile.”
    • A table reporting on requests that don’t end in AS/E from seven provinces (AB, SK, MB, QC, NL, PEI, and NS) shows a marked decrease in the number of people who died before the eligibility determination process was completed, even though the total number of requests increased, from 832 to 1,066.  This figure went from 24% (202 people) in the first half of 2017 to 14% (or 149 people) who died before their assessments were finished in the second half of the year.  It’s unclear whether this means that the evaluation process is becoming more efficient or that assessments are being rushed.
  • Some data remain consistent:
    • The average age of people who receive euthanasia and assisted suicide has remained stable at about 73. The percentage of women (51%) vs. men (49%) who die also remained consistent throughout 2017.
    • Cancer is still the most common medical condition affecting people who choose AS/E. It was the cause of 65% of the applications filed in the second half of 2017.
    • Here’s what we know about where the euthanasia took place:
      • 40% of the deaths happened in a hospital.
      • 43% occurred in the person’s home,
      • 5.3% of the euthanasia were performed in long term care facilities or nursing homes.
      • 3% were done in hospices (deaths in hospice were counted as a separate category for the first time in this report)
      • Notably, the location of 7.9% of the deaths (86 people) is listed as “other/unknown.” “Other” includes “retirement homes, assisted or supportive living, ambulatory setting [e.g. walk-in clinics], day program space, clinician’s office, funeral home, hotel/motel,” or another undisclosed location. The “unknown” label includes “data that was suppressed by provinces due to smaller numbers (less than 7) and associated privacy concerns.”
    • The most common reasons given for denial of AS/E requests include “loss of competency, [death is not] reasonably foreseeable, or ‘other’.” “Other” is not explained.
  • No information is provided about:
    • Incomplete or missing reports;
    • The living situation of those who died;
    • The reasons people wanted to die;
    • Whether the person needed or received palliative care or supports to live in their own homes;
    • Whether they were subject to “external pressure” to request AS/E, either from another person, or due to circumstances like financial problems or abuse; and
    • Proof that all safeguards were followed and eligibility criteria were met.
  • Looking at this report alongside the final monitoring regulations paints a pretty grim picture. Both documents have many missing pieces. Incomplete monitoring will make it nearly impossible to detect problems, predict trends, discover and improve the situations that prompt requests for AS/E. Lives will be at risk until and unless the government puts more rigorous standards in place.