In this episode of Euthanasia & Disability, Amy Hasbrouck, Christian Debray, and Taylor Hyatt discuss:
- The federal AS/E reporting form
Please note that this text is only a script and that our webcast contains additional commentary.
THE ASSISTED SUICIDE AND EUTHANASIA REPORTING FORM
- As promised in our webcast of November 16th, we’re looking at the federal assisted suicide reporting form today. We’ve already discussed the guidance document, which allows “[a] patient’s written request [to] take any form,” including text, email, or other informal means, and the likelihood that this “short-cut” will replace the formal application that is protected by safeguards.
- The reporting form states that information about whether the request is voluntary can come from family members, friends, or health care and social service professionals.
- All of these could potentially be sources of “external pressure” or coercion, and are therefore not reliable sources of whether the person’s request is voluntary.
- “External pressure” is not defined in the statute or the regulations. The definitions we did find apply to abuse or coercion, not discrimination, or social and economic stresses.
- For each eligibility criterion, the practitioner may check “yes” “no” or “did not assess.” How can “did not assess” be an option? This would make it possible for a form to be submitted where no eligibility assessments were done.
- No information is given about whether the person submitted a second application after being declared ineligible.
- There is no space for practitioners to describe how decision-making capacity was determined – in other words, what criteria, procedures or tests were used. Some psychiatric conditions can affect decision-making, so evaluation of the person’s mental health is essential.
- Following section 3 (eligibility criteria), the form asks practitioners if they “[consulted] other health care professionals, such as a psychiatrist or the patient’s primary care provider…” Two problems leap to mind:
- This is not mandatory. Health Canada does not require that the practitioner consult with, or report having consulted with, another health care professional
- There is no mention of how these other professionals would be informed about the person making the AS/E request. If the consultant does not speak to the person directly, the information on which they base their opinion will be filtered through the lens of the practitioner’s biases and prejudices.
- As well, no space is given for practitioners to discuss what evidence led them to decide the person’s condition was in an “advanced state of irreversible decline”, or why they believe death has become “reasonably foreseeable.”
- In our last webcast, we pointed out that the effect of the “second assessment” was still unclear.
- If the second practitioner believes the person is ineligible, does that stop the application process in its tracks? Or is the second practitioner’s assessment just a rubber stamp, where their opinion that the person is ineligible simply causes the first medical professional to seek another second opinion until they find someone who agrees the person is eligible.
- The monitoring form seems to clear up this question, stating that the second medical practitioner must have “provided a written opinion (second assessment) confirming that the patient met all of the criteria.” The second practitioner is expected to go along with the decision of the first. If they disagree, their opinion doesn’t count.
- The person’s description of their suffering is reduced to a “check all that apply” list, which is mostly borrowed from Oregon’s reports. Practitioners are not required to solve these problems before killing the person. They are:
- Loss of ability to engage in activities making life meaningful;
- Loss of dignity;
- Loss of control of bodily functions;
- [Perceiving oneself as a] burden on family, friends or caregivers;
- Inadequate pain control, or concern about it;
- Inadequate control of other symptoms, or concern about it;*
- Isolation or loneliness;*
- Loss of ability to perform activities of daily living (e.g. bathing, food preparation, finances);*
- Or “other,” with room for more information. (Finally!)
The three items marked with an asterisk are not in the Oregon or Washington reports.
- As we’ve often noted, most of these are disability issues, unrelated to approaching death. In the “Other information” section, the form asks about palliative care and whether “disability support services” were needed, available, received, and used.
- “Disability support services” are described in footnote 3. They include “assistive technologies, adaptive equipment, rehabilitation services, personal care services and disability-based income supplements.” Notably, “peer support” is missing. Peer support is crucial to adapting to a new disability.
- It is possible for the medical professional to declare that they “didn’t know” whether “disability support services” were required, or available.
- The form asks how long disability supports were used, and includes the option “less than six months.” That is nowhere near enough time to come to terms with a new disability, obtain equipment and services, and adjust to their everyday use.
- The federal form continues the tradition of mixing up actual pain or symptoms, with the fear of pain or symptoms. The goal of improving palliative care will not be served by allowing this confusion to continue. People are choosing assisted suicide because they fear what may happen to them in the future. The reports should record what does happen to people.
- The reporting form does nothing to lessen our fears about inadequate monitoring of the AS/E process. Adding one question about disability support services amounts to the government throwing a bone to disability rights activists. How many people will die unnecessarily before authorities decide that killing ineligible people is a problem?