Introduction

Webcast archive: Truchon update, federal election, & Expert Report Part II

This week, we discuss disability-related promises made by the new Liberal government, as well as Dr. Madeleine Li's thoughts on euthanasia and psychiatric conditions.

Webcast archive: Truchon update, federal election, & Expert Report Part II

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

  • No appeal of Truchon decision
  • The federal election – what next?
  • Excerpts from the Expert, Part II: Psychological conditions and Julia Lamb’s case

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

NO APPEAL OF TRUCHON DECISION

  • Despite a major social media campaign by disability rights activists, the caretaker government of Justin Trudeau did not appeal the Truchon decision.  There was no public announcement of the decision last Friday, which was the deadline for an appeal.
  • Under the constitutional rules for what a government can do during an election period, the attorney general could have taken action that was “urgent and in the public interest.”  Since the appeal deadline fell before the election date, and the question of assisted suicide and euthanasia is definitely a matter of public interest, activists believed the Trudeau government should have filed the request in order to keep the option open for the next government to appeal the Truchon decision, if it chose to do so.

THE FEDERAL ELECTION: WHAT’S NEXT?

  • Now that the Liberals lead a minority government, they will have to get support for any legislation they want to pass from one of the other political parties.  An early test of their ability to work in coalition will be the changes to the Medical Aid in Dying or MAiD law. The Québec superior court in the Truchon case gave Parliament six months, or until March of 2020, to remove the eligibility requirement that the person’s natural death has become reasonably foreseeable, which it declared unconstitutional.
  • During the campaign, in the French-language debates, Mr. Trudeau said MAiD was a new and evolving law that required a balance between protecting the most vulnerable people and individual rights and choices.
  • The Liberal party released two documents that mention disability; their party platform, and a separate “Disability Equality Statement.” Under the heading “public health care,” the Liberals pledge to “continue to make home care and palliative care more available across the country.”
  • There are three disability-related points in the platform:
    • The Liberals announced a workplace accessibility fund to match contributions from employers and school boards, providing up to $5,000 to cover the cost of an accommodation. “Employers and schools will continue to be required to meet their accessibility obligations under provincial and federal law,” even though most employers and schools are not covered under federal law and provincial accessibility legislation is uneven and difficult to enforce.
    • The Liberal platform promised to double the monthly Child Disability Benefit payment made to families of some “special needs kids.”  Eligibility is limited to children with certain diagnoses.
    • Finally, veterans will receive “up to $3,000 in free counselling services before a disability claim is required.” The platform also promises “we will move forward with automatic approval for the most common disability applications, including depression, post-traumatic stress disorder.”  What “move forward” and “automatic approval” mean in practice is unclear from the text.
  • The Disability Equality Statement is mostly a bunch of platitudes. The Liberals praise themselves for holding “the first ever national summit for youth with disabilities, attended by the Prime Minister,” creating the Accessible Canada Act, and signing on to the UNCRPD optional protocol. They claim to have moved beyond “Nothing About Us Without Us”, to “Nothing Without Us.”  It says a lot about the Liberals that they (a bunch of non-disabled politicians) would co-opt and change a motto of the disability rights movement about disability control for their sales pitch.

EXCERPTS FROM THE EXPERT, PART II: PSYCHOLOGICAL CONDITIONS AND JULIA LAMB’S CASE

  • Finally, we return to the Expert Report for the Lamb case submitted by Dr. Madeline Li. We’ll examine what Dr. Li has to say about providing assisted suicide and euthanasia (AS/E) to people with psychiatric disabilities, as well as her findings concerning Julia Lamb’s individual situation.
  • Doctor Li expresses concern about whether AS/E is the right response to mental suffering, given the poor record of doctors who don’t have a mental health background to assess “even clearly irrational suicidal ideation,” let alone “more complex suicidality, such as the undue internal influence of mild to moderate depressive symptoms.”
  • Dr. Li describes several factors that can lead doctors to wrongly decide someone is eligible for euthanasia:
    • “It is not clear in mental illness when a disorder is truly irremediable.” Resistance to treatment is about what happened in the past, not what might happen in the future. When psychiatrists talk about “Treatment resistant depression” for example, they usually mean symptoms that don’t respond to antidepressant drugs, without regard to other therapies or supports. Clinical trials can’t predict each person’s unique experience of the disorder, or their response to a treatment.
    • “Unlike cancer which can be either cured or not, response to treatment for mental illness falls on a spectrum … described as symptom reduction;” a person might feel somewhat better, but still be suffering.  Also, cancer can be measured and observed objectively, while emotional distress can only be described as a person’s own experience.
    • Psychiatric conditions do not always lead to “irreversible decline.” Even without treatment, some conditions get better or worse over time. The person’s desires may change along with their symptoms. Dr. Li says the “reflection period” should be longer than 10 days to account for these situations.
    • In some cases, refusing treatment may even be harmful to the person. Dr. Li has seen people who know that AS/E is an option “refusing to even try treatments which may relieve their suffering, and in one case refuse” a possible cure. She says some conditions, like depression, cause a “lack of insight, perceived stigma” and reduce motivation. She cites a 2016 study of 66 completed Dutch psychiatric euthanasia where more than half of the people had refused at least some treatment.
    • When a therapist evaluates a client’s eligibility for euthanasia, it raises issues of caring, protection, abandonment, control and respect. This can harm the therapist-client relationship and make treatment less effective. By approving the request, the clinician agrees with the client’s belief that they will never feel better, reinforcing their hopelessness.
    • Equal numbers of men and women request euthanasia for non-psychiatric reasons. However, the ratio of women to men seeking euthanasia for a psychiatric condition in the Netherlands is more than 2 to 1. In Belgium, over 75% of euthanasia done for psychiatric reasons involve women. “This exceeds the known sex differences in mood disorders and personality disorders, and matches the sex ratio in suicide attempts in the general population.”
    • Finally, Dr. Li says allowing AS/E for mental illness could make some doctors less vigilant in their suicide prevention efforts. She points to the advocacy of VSED (voluntarily stopping eating and drinking) by some AS/E supporters as a “blurring of what constitutes a suicidal act.” She believes this contributes to the “social contagion effect on suicide rates from legalizing MAiD for mental disorders.”
  • Here is what Dr. Li has to say about Julia Lamb’s circumstances:
    • Dr. Li believes Julia Lamb would meet all MAiD eligibility criteria. Her condition is clearly “progressive [and] incurable.” She believes Ms. Lamb’s mobility impairment, swallowing and breathing problems, and need for help with everyday activities are signs of “an advanced state of irreversible decline.”  Dr. Li states that, since the definition of “intolerable suffering” is up to the person, “when she says she is suffering enough to proceed with MAiD, that satisfies the criterion.”
    • Dr. Li said that, during the first year the MAiD program was in effect, when Ms. Lamb filed her lawsuit, practitioners used “shorter prognoses for interpreting reasonably foreseeable natural death.” However with the AB decision in 2017 and the guidelines from the Canadian Association of MAiD Assessors and Providers (CAMAP), clinicians “gained comfort with extending prognostic timeframes out to many years.” She believes that Ms. Lamb’s natural death would be considered “reasonably foreseeable.”
  • She suggests that, if Ms. Lamb is unable or unwilling to undergo the “onerous” MAiD evaluation process, palliative sedation – whether continuous or intermittent – would be an option, and could be “specified [in] an advance directive or authorized by a substitute decision maker.”