Introduction

Webcast archive: Health Canada’s final monitoring regulations

In this episode of our webcast, we review Health Canada’s final assisted suicide and euthanasia monitoring regulations, and look at a new suicide prevention initiative in Switzerland.

Webcast archive: Health Canada’s final monitoring regulations

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

  • Review of Health Canada’s final assisted suicide and euthanasia monitoring regulations
  • A new suicide prevention initiative in Switzerland

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

REVIEW OF HEALTH CANADA’S FINAL ASSISTED SUICIDE AND EUTHANASIA MONITORING REGULATIONS

  • In December of 2017, Health Canada released the draft version of its regulations for monitoring and reporting on assisted suicide and euthanasia (AS/E) across Canada – 18 months after the procedure was legalized. They requested input from the public, so TVNDY submitted detailed comments which you can read on our website.
  • At the beginning of August, the final version of the regulations was published. Health Canada reported that there were 43 submissions received in total, only three of which were provided by an advocacy group. Unfortunately, Health Canada didn’t act on most of our suggestions and the final regulations contain many of the same problems as the first draft.
  • In the “background” section of the new regulations, Health Canada rejects any duty to ensure compliance with the law’s safeguards.  The regulation states: “[Monitoring] is fundamentally distinct from a process that seeks to assess individual medical or nurse practitioners’ compliance with the Criminal Code exemptions.  Investigating instances of non-compliance with the eligibility criteria and procedural safeguards set out in the Criminal Code falls outside of the scope of the federal monitoring regime, and is under the purview of local law enforcement.” If the purpose of monitoring at the federal level is not to ensure compliance with the law, what exactly are they monitoring?
  • The regulations won’t collect enough information to know whether the person who wants to die is subject to “external pressure” either from another person, or from life circumstances.
  • There is no plan or procedure to fill in incomplete information or track down missing reports. Every death needs to be completely and accurately documented.
  • A few words and phrases carried over from the earlier draft allow for ambiguity or an abandonment of responsibility throughout the assisted suicide process:
    • Information must be provided “if known.” This means medical practitioners don’t have to find out whether certain eligibility requirements are met or safeguards have been followed.
    • Practitioners must report “…to the best of [their] knowledge or belief.” Again, this relieves them of the responsibility of seeking out and verifying the information.  It loosens eligibility requirements and makes data collection more difficult. There aren’t many ways to verify what the practitioner knows for sure.
  • The regulations don’t document the role assisted suicide advocates play in the application, referral, and eligibility determination processes.
  • The demographic information collected about the person making the request is limited to date of birth, sex, health insurance number and postal code. It does not include data about:
    • The person’s race, ethnic background, first language, disability status, or other possible bases of discrimination, knowing that indigenous people are systematically discriminated against,
    • Income, assets and source of revenue (to determine whether the person is subject to economic pressure),
    • The person’s living situation, household composition and type of residence (residential care facility, private home, hospital, homeless, prison),
    • The onset of the person’s “grievous and irremediable medical condition”, needed services and supports, and costs not covered by insurance,
    • Indications of abuse or inhumane living conditions.
  • The regulations reflect the idea that being eligible for AS/E – i.e. intolerable suffering, irreversible decline, foreseeable death – is itself the reason to ask for it.  But to understand what factors prompt some eligible people to ask for death, while others don’t, the monitoring program should dig deeper.  It should gather data about:
    • Loss of autonomy;
    • Loss of ability to do favorite activities;
    • Loss of control over bodily functions;
    • Feeling tired of life;
    • Perceived loss of dignity;
    • Feeling like a burden;
    • Economic hardship;
    • Psychological, spiritual or existential distress;
    • Unrelieved pain;
    • Unrelieved physical distress;
    • Fear of pain or physical distress.
  • One positive feature of the final regulations is that they include questions about whether the person had access to palliative care and disability supports.
  • If the person’s request does not end with their death by AS/E, information about the application, eligibility assessment and compliance with safeguards may be disposed of in 90 days. This way, Health Canada will lose valuable information about people who withdraw requests, those who die before they are euthanized, or people deemed ineligible.
  • The regulations provide minimal monitoring of the deaths themselves. Health Canada makes no effort to gather data about who administers the drug (in the case of assisted suicide), problems that arise during the process, actions taken to solve those problems, time from administration to death, or the efficacy of the drug cocktail.
  • There is still no procedure in place to deal with a disagreement between the two medical practitioners who must approve the AS/E request. If the second doctor believes the person is not eligible, that should immediately derail the approval process. The request should be denied, and the person should only reapply when they meet all the eligibility criteria. But if the first doctor can keep searching for a second practitioner who agrees to the euthanasia, what is the use of having a second opinion as a safeguard?
  • In the Carter decision, the Supreme Court asked the government to create a carefully-designed system to regulate assisted suicide and euthanasia, imposing strict limits that are scrupulously monitored and enforced to protect vulnerable persons from being induced to commit suicide in a time of weakness. But as the activist Catherine Frazee said in  her recent editorial, “The regulations fall short of a good-faith effort to understand the role that social determinants of health, such as poverty, insecure housing, isolation or social stigma, may play in motivating a request to die.”
  • Ms. Frazee suggests that “to monitor MAID responsibly, we must hear more voices, consider more perspectives, probe for more answers and be more fearless in the face of what those answers might reveal.”

A NEW SUICIDE PREVENTION INITIATIVE IN SWITZERLAND

  • Earlier this week, we found a story from Switzerland: a new tool designed by the Swiss government is supposed to connect all of the country’s suicide prevention resources on one website. The site’s release is part of a nationwide suicide prevention plan; it was launched to coincide with World Suicide Prevention Day on September 10th. Their goal is “to reduce the number of non-assisted suicides in Switzerland by 25% by 2030 – in other words, to prevent about 300 suicides per year.”
  • As usual, we’re frustrated by the commitment made by many governments to reduce “traditional” suicide deaths, while assisted suicide is ignored and even applauded in Switzerland. In fact, there are almost as many assisted suicides as “traditional” suicides; 965 Swiss died by assisted suicide in 2015. Preventing one while condoning the other makes no sense.