Introduction

Report #3 from the Commission des soins de fin de vie

Our summary of the latest euthanasia data from Quebec

Report #3 from the Commission des soins de fin de vie

Report #3 from the Commission des soins de fin de vie

Download these statistics in .docx format: SummaryQC3rdCSFVReportEN

Current reporting period: July 1, 2017-March 31, 2018 (The period has been altered to coincide with Québec’s fiscal year. Subsequent reports will be from April 1 to March 31.)

FORMS DOCUMENTING EUTHANASIA SUBMITTED BY DOCTORS

708 forms received 1/7/17 to 31/3/18

  • Includes 42 forms received 30+ days after euthanasia – 5 were from euthanasia in 2016

782 forms examined from 1/7/17 to 31/3/18

  • 741 were evaluated for the first time
    • 658 were received during the current period
    • 83 were received before the current period but had not yet been examined.
  • 41 forms were re-examined following receipt of more information

741 forms were examined for the first time from 1/7/17 to 31/3/18

  • 45% (334) required follow-up
    • 11% (80) needed phone follow up for information
    • 38% (281) written follow-up for more information
      • 4% (70) forms required a second written request for info.
    • 34% (255) were evaluated upon receipt of additional information.

On 31/3/18, 50 forms were waiting to be examined.  All but one have since been examined.

727 cases were decided from 1/7/17 to 31/3/18

  • 713 cases received and examined for the first time this year
  • 14 cases held over from last year
  • 44% (320) required more information

On 31/3/18, 69 cases were waiting to be decided.

If you add 727 (cases decided) to 69 (cases awaiting decision) this does not equal 782 (cases examined during the period)

Of 727 cases decided:

  • 90% (658 cases) complied
  • 7% (50 cases) – no determination possible
    • 23 cases – additional information was not provided
    • 27 cases – Information was still insufficient
  • In 13 cases, the doctor said s/he had no further information.

3% (19 cases) did not comply:

  • 6 cases – Second doctor signed off before euthanasia request was signed
  • 3 cases – The person who countersigned the request was not a health care professional.
  • 3 cases – Person did not have a “serious and incurable illness” and so was not eligible (p. 16).
  • 3 cases – The person did not have health insurance
  • 2 cases – Doctor only met with person the day euthanasia was administered. (didn’t speak to the person on different occasions to ensure persistence of suffering and wish to die, and capacity). (see p. 16)
  • 2 cases – Doctor did not ensure compliance with safeguards.

INFORMATION SUBMITTED BY THE CMQ AND INSTITUTIONS

745 Continuous Palliative Sedations were reported from 10/6/17 to 31/3/18. This is in addition to euthanasia requests.

1,225* requests for euthanasia received from 10/6/17 to 31/3/18

  • 35% (431) euthanasia not administered
  • 65% (845) euthanasia administered
  • 805 reported by institutions
  • 40 reported by CMQ

*431 + 845 = 1,276.  The report does not account for the discrepancy of 51 cases.  Since the table of reasons euthanasia was not administered adds up to 431, we can only presume that the 1,225 or the 845 figure is wrong.

More worrisome, however, is that the report address the difference between 708 Euthanasia report forms received from doctors (including five from previous years), and 845 euthanasia reported by the CMQ and institutions (a total of 137 deaths).

Reasons euthanasia was not administered:

  • 6% (162) died before evaluation was completed or euthanasia was given.
  • 36% (155) were not eligible, or became ineligible
  • 14% (61) withdrew the request
  • 3% (27) opted for another treatment option
  • 3% (14) requests were in process of evaluation
  • 8% (12) went home or were transferred to palliative care or another facility.

The report admits that it is not possible to say how many people are receiving palliative care services:  « Considérant qu’il n’est pas possible actuellement d’identifier les personnes en fin de vie ayant reçu des soins palliatifs, le MSSS a précisé au réseau que l’information demandée, obtenue à partir des banques de données nationales, est le nombre de personnes en soins palliatifs et de fin de vie par milieu de soin. »

Cumulative statistics – December 10, 2015-March 31, 2018

FORMS DOCUMENTING EUTHANASIA SUBMITTED BY DOCTORS

1,493 forms received 10/12/15 to 31/3/18

  • 161 – 1st period (12/15-6/16)
  • 280 – 2nd period (7/16-12/16)
  • 344 – 3rd period (1/17-6/17)
  • 437 – 4th period (7/17-12/17)
  • 542 – 5th period (1/18-6/18) (estimate based on 271 – 1/18-3/18)

1,443 forms were examined from 10/12/15 to 31/3/18

1,374 cases were decided from 10/12/15 to 31/3/18

  • 793 – No further information was required
  • 581 – More information was required to render a decision

Of 1,374 cases decided:

  • 90% (1,245 cases) complied
  • 4.8% (67 cases) No determination possible
  • 4.5% (62 cases) Did not comply
  • 29 cases – second doctor wasn’t independent*
  • 9 cases – Doctor didn’t speak to the person on different occasions to ensure persistence of suffering and wish to die, and capacity
  • 6 cases – Second doctor signed off before euthanasia request was signed
  • 7 cases – Person was not eligible
    • 5 cases – Person did not have a “serious and incurable illness”.
    • 2 cases – The person was not at the end of life,
  • 5 cases – The person who countersigned the request was not a health care professional.
  • 4 cases – The person did not have health insurance
  • 2 cases – Doctor did not ensure compliance with safeguards.

*Note that the second doctor is no longer required to be independent as of February of 2017.

INFORMATION SUBMITTED BY THE CMQ AND INSTITUTIONS

  • 1,831 Continuous Palliative Sedations were reported
  • 2,482* requests for euthanasia received
  • 36% (887) euthanasia not administered
  • 64% (1,664) euthanasia administered
  • 1603 by institutions
  • 61 by the CMQ.

*887 + 1664 = 2551.  The report does not account for the discrepancy of 69 cases.  Since the table of reasons euthanasia was not administered adds up to 887, we can only presume that either the 2,482 or the 1664 figure is wrong.

More worrisome, however, is that the report address the difference between 1493 Euthanasia report forms received from doctors, and 1664 euthanasia reported by the CMQ and institutions (a total of 171 deaths).

Reasons euthanasia was not administered:

  • 8% (344) were not eligible, or became ineligible
  • 6% (289) died before evaluation was completed or euthanasia was given.
  • 4% (128) withdrew the request
  • 1% (72) opted for another treatment option
  • 5% (31) requests were in process of evaluation
  • 6% (23) went home or were transferred to palliative care or another facility.

Summary of report from webcast

THIRD REPORT FROM QUÉBEC’S EUTHANASIA COMMISSION

  • Three years ago, on December 10, 2015, Québec’s euthanasia program went into effect. Unlike the federal law, Québec provides euthanasia upon request to eligible persons, as well as  “Continuous Palliative Sedation” without the eligibility requirements and safeguards connected to a euthanasia request.
  • The Commission on End of Life care released its third report on the province’s euthanasia program on December 7, covering the period from July 1, 2017 to March 31, 2018, with cumulative data from December of 2015. The Commission adjusted the reporting period to coincide with Québec’s fiscal year, which runs from April 1 to March 31.
  • As in previous reports from Québec, the most striking fact in this third report is the difference between the number of euthanasia reports submitted by doctors, and the number of euthanasia reported by institutions and the Collège des médecins du Québec. During the reporting period, the Commission received 708 forms (including five for deaths administered in previous years) while this second stream of information showed 845 cases of euthanasia (a difference of 142 deaths during the reporting period).  The report does not acknowledge, or attempt to explain this difference.
  • We did a summary of the report’s statistics, which we will put up on our website in the documents/reports section.
  • The Commission reported that 45% of the forms filed by doctors needed follow-up for additional information. Letters and telephone calls were required for 334 forms, and 90 doctors received a second letter when they failed to provide the information the Commission asked for.
  • The Commission examined a total of 782 forms during the reporting period,
    • 741 were looked at for the first time.
    • 41 were given a second look, in light of additional information received.
    • 658 were forms that came in during the current period.
    • 83 cases were held over from year.
  • 727 cases were decided during the reporting period. Of those, the Commission found:
    • 90% (658) complied with the Québec eligibility criteria and safeguards;
    • In 7% of cases (50) no determination of compliance was possible, because:
      • Additional information was not provided (23 cases)
      • In 27 cases, the information provided was still not enough to decide whether the doctor complied with the law.
    • 3% (19 cases) did not comply with the eligibility criteria and safeguards. This included:
      • three people who were not eligible because they did not have a “serious and incurable illness;” and
      • two instances where the doctor who approved and performed euthanasia only met with the person on the day euthanasia was provided.
    • Similar figures are shown in the cumulative statistics of Québec’s program for the period from December 10, 2015 to March 31, 2017. While the Commission states that 1,493 euthanasia reporting forms were received from doctors during the period, Institutions and the CMQ report 1,664 euthanasia deaths.  Thus, 171 deaths are unaccounted for, probably unexamined and may or may not comply with eligibility requirements and safeguards.
    • In the past three years, the number of euthanasia has increased steadily in every six month period.
      • 161 – 1st period (12/15-6/16)
      • 280 – 2de period (7/16-12/16)
      • 344 – 3rd period (1/17-6/17)
      • 437 – 4th period (7/17-12/17)
      • 542 – 5th period (1/18-6/18) (estimate based on 271 from 1/18-3/18)
    • Of the 1,374 total cases decided up until March 31 of this year,
      • 90% (1,245 cases) complied with the eligibility requirements and safeguards;
      • In 4.8% (67 cases) no determination of compliance was possible:
      • 5% (62 cases) did not comply:
        • 9 cases – Doctor didn’t speak to the person on different occasions to ensure persistence of suffering and wish to die, and capacity;*
        • 7 cases – Person was not eligible:
          • 5 cases – Person did not have a “serious and incurable illness”;
          • 2 cases – The person was not at the end of life;
        • 6 cases – Second doctor signed off before euthanasia request was signed;*
        • 5 cases – The person who countersigned the request was not a health care professional;*
        • 4 cases – The person did not have health insurance;
        • 2 cases – Doctor did not ensure compliance with safeguards.*
        • In the 29 remaining cases, the second doctor was not independent of the first. However this legal requirement was removed by the minister of health in February of 2017.

*In these cases, the failure of administrative safeguards could put the person’s life at risk.

  • So to recap, we have:
    • A “medical treatment” that was supposed to be an exceptional option in exceptional cases, that is now in regular use, regardless of whether palliative care is in place;
    • Substantial increases in the number of people being euthanized every six months, for a total of 1,664 (as of last March); not counting 1,831 continuous palliative sedations performed since 2015;
    • 171 deaths unaccounted for;
    • 67 deaths where compliance could not be determined;
    • 22 deaths where important procedural safeguards were not followed;
    • 7 deaths of people we know were not eligible for euthanasia; and
    • Hundreds of instances where doctors don’t file reports, refuse or were unable to provide information necessary to determine whether they complied with safeguards or the person was eligible for euthanasia.
  • Isn’t that enough evidence to show that something’s amiss?