Webcast archive: Doctor finds problems with MAID compliance

This week, we discuss three MAID case histories from a lecture given by a Toronto doctor, the latest news with the New Zealand bill, and an upcoming special edition of our webcast.

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

  • A Toronto doctor finds problems with MAiD compliance
  • New Zealand parliament sends euthanasia to a referendum
  • Announcement: Details for December 6th online discussion

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

A DOCTOR FINDS PROBLEMS WITH MAiD COMPLIANCE

  • Recently, Taylor attended a conference for medical students, where a few lectures on euthanasia were presented. She was impressed by the talk given by Dr. David D’Souza, a chronic pain specialist in Toronto. His talk focused on eligibility for euthanasia, and he included the stories of three people considering euthanasia whom he had seen in his practice. Dr. D’Souza expressed concern that the safeguards around euthanasia eligibility were being flouted in all three cases.
  • When visiting a nursing home, Dr. D’Souza met an elderly lady with dementia named Janice. Her condition had progressed “to the point where she [couldn’t] recognize her own family and [had limited] communication abilities.” Janice’s family asked to meet with the doctor, and requested that she be euthanized. They brought a will that Janice had written 10 years before, while in the early stages of her dementia, which stated that she would want to be euthanized. Dr. D’Souza told the family that Janice was not a candidate for euthanasia.  According to the eligibility criteria, the person must request MAiD themselves; no one can do it on their behalf. He also told them the law requires the person be able to give consent at the time of the procedure, which Janice was not competent to do. Dr. D’Souza also pointed out that, “[Janice] may have sufficient quality of life that she still enjoys.”
  • The second incident took place “shortly after euthanasia was legalized” in 2016. A middle-aged man named Eddie, who spent two months on a waiting list for palliative care, came to Dr. D’Souza. He was a wheelchair user and amputee, and he was on dialysis.  Eddie had only his wife for support, and had “[decided] to discontinue dialysis completely.” By the time Eddie saw Dr. D’Souza, he hadn’t had dialysis for over three weeks, and so had “nausea, fatigue…uncontrolled pain, [and] shortness of breath.” He also reported a “low mood” along with feelings of hopelessness. Eddie had submitted a request for euthanasia.
    • Eddie’s first words to the doctor were “Are you here to relieve my pain? Are you here to relieve my suffering?” Dr. D’Souza said yes. Then, Eddie asked him whether he was “here to end my life.” Upon hearing “no,” Eddie asked “Why not? Isn’t that part of your job? I heard about this MAID thing on TV … isn’t that what you do?” Dr. D’Souza provided palliative care to Eddie, who then withdrew his MAiD request. Dr. D’Souza reported that “although [Eddie] chose to decline further dialysis sessions, he later died peacefully and comfortably, and of natural causes, with the assistance of genuine palliative care.”
  • The last story is about a man in his 70s named Jim. He was concerned about hardness in his abdomen. Early tests suggested gastrointestinal cancer as a possible cause. The first thing Jim said after receiving these test results was “I want to be euthanized.” Dr. D’Souza “tried to steer the conversation in a different direction and said ‘Jim, you don’t qualify for that. You don’t even have a diagnosis. Let’s first figure out the diagnosis and we can talk about all that later.’” Jim was then sent for the scan.
    • A few weeks later, Dr. D’Souza received a report from the hospital: Jim had gone there the day after his initial appointment and “demanded to be euthanized.” He was admitted to the hospital, but “refused further testing;” he also turned down meetings with a surgeon, oncologist, and psychiatrist. Instead, Jim met with the euthanasia team, including a nurse practitioner and a physician. They determined that he met the eligibility requirements for MAiD.
    • Dr. D’Souza visited Jim on the day he was euthanized. Dr. D’Souza recalled that “he was in no apparent pain [or] distress. He was smiling. He was excited for the big event, and so was his family. His family was surrounding him and they had dressed him up in a very nice suit, and they were very, very excited. He told me he wanted to have a dignified death” not caused by unknown and unpredictable factors.
  • Dr. D’Souza pointed out eligibiity criteria that were were disregarded and safeguards that were overlooked when Jim’s request for euthanasia was approved:
    • First, the person must “have a serious and incurable illness, disease, or disability.” Jim did not have a definitive diagnosis. “He refused investigations and specialist assessments; therefore, he did not know if he had an incurable illness.”
    • Next, the person must “be in an advanced state of irreversible decline.”  Not knowing his condition, it was impossible to know whether it was in decline. Even if further tests confirmed that he had cancer, his prognosis “would depend on a number of [factors, including] the primary source of cancer, presence of metastases, [and] type of tumour. These factors would then [suggest treatment] options, such as chemotherapy and/or surgery.”
    • The person must also have “physical or psychological suffering that is intolerable to them.” The MAID team reported “that he was in no pain, but he was deemed to be in intolerable suffering.”
    • Dr. D’Souza also mentioned that Jim did not see a psychiatrist, so it is impossible to know whether emotional issues may have played a role in his decision to request euthanasia.  Asking to die while refusing to obtain an accurate diagnosis suggests an impulsive and emotional choice, or that he was already prone to suicidal feelings. The doctor also believes the 10-day waiting period is arbitrary and inadequate. He doesn’t know “any physician who has been able to completely cure anxiety or depression in 10 days.”
  • These potential violations were discovered by someone with extensive experience in the medical field and knowledge of the Canadian euthanasia program, who took the time to share his insights. These case histories give us a glimpse into how the MAiD program works on the ground. Multiply Dr. D’Souza’s experience by the number of practitioners performing MAiD, and a frightening picture emerges.  It also raises troubling questions: Was Jim’s euthanasia seen as compliant with the law upon review by the designated authorities? How many ineligible people are being euthanized when MAiD evaluation teams don’t completely grasp or strictly apply the eligibility criteria and safeguards? If this isn’t a slippery slope, what is?

NEW ZEALAND PARLIAMENT SENDS EUTHANASIA TO A REFERENDUM

  • The following article by Wendi Wicks appeared on the website of The Guardian on November 14, 2019.
  • On [November 13], New Zealand MPs voted to adopt the end of life choice bill despite any number of warnings that it is a dangerous piece of work. It is risky to disabled people and unsafe to all.
  • In 2016, Canada passed euthanasia legislation and a consortium of appalled disabled Canadians fought a desperate rearguard action to bring in a vulnerable person’s standard (VPS). “We’d not need that sort of thing,” I thought. Clearly I was complacent. Disabled Australians, Canadians and Americans are appalled at euthanasia bills while British, Irish and Scots are incandescent.
  • I feel betrayed by Parliament’s vote. Do we need something like a VPS here, for disabled New Zealanders I wonder?
  • Now all that stands between us and this bill is a referendum scheduled to coincide with our next general election, in 2020. Then there may be no way for the community of disabled people like me (25% of New Zealand’s population), to feel safe from wrongful death.
  • The law creates a risk to individuals in our community of disabled people and to our community as a whole. How can any MP be able to agree to a measure that endangers a whole community that they are not a member of? Our legislative safeguards have stepped into the shadows and too many MPs think that’s an acceptable trade-off. A friendly QC commented on my vulnerability to the law thus: “You’re toast.” Me and how many other disabled people?
  • Our concerns about the bill are many. They include that the bill cannot and does not make firm distinctions between terminal illness and disability or between terminal illness and chronic conditions, or between terminal illness and depression or other mental illness. It relies on prognosis and diagnosis, which are imprecise arts. It doesn’t protect against coercion or consent abuses, or prevent euthanasia where the person is incompetent.
  • It doesn’t allow for a cooling-down period like Oregon or Victoria have. Safeguards are vague and lax. Worse still, there’s a sense that a certain level of wrongful death is acceptable.
  • Nearly 39,000 people wrote public submissions as the bill went through the parliamentary processes, and over 90% of them said: “No, no legalising euthanasia thanks.” From a total population of nearly 5 million, it was the largest number of submissions ever to any proposed New Zealand law. But even this clear response had painfully little impact on MPs, who seemed to respond to other stimuli or were mired in their individualistic tragedy narratives. The suffering they knew of somewhere else, the individual stories or the 10% who said “Yes change it” was much more important.
  • Yes, there are many individual stories both for and against this bill. All deserve respect because telling them takes effort. But there’s more to good law than basing it on individual stories. It’s about the collective impact on our community. It should be a good, safe law for all. That’s what MPs are there to do but didn’t.
  • And there’s the referendum to come. The question in it just says, “do you support this bill?” Too vague.
  • It’s to be hoped that the population at large can do a sound job, but that depends on the quality and range of information they get. MPs had a huge range of sound, factual information. But judging from their voting record, many clearly disregarded heaps of it. Instead leaving Janet and John Voter to do the work.
  • Who knows if the public will get good information to enable choice. Maybe they’ll vote yes because they think this bill allows things that are already legal, like adequate pain relief. Polls on the issue show worrying levels of awareness. So I hope the information providers can do a great job for Janet and John Voter, who really need it.
  • I convene Not Dead Yet Aotearoa, the nationwide disabled-people-run network. We have opposed the legalisation of euthanasia for some years now. The opposition we express is consistently based on concerns that society is full of negative, biased and discriminatory attitudes and behaviours, so that people think disabled lives are less worthy. Given this attitude as a basis, the state provides really limited support for us to live well. So it’s disturbing when laws are put up that mean the state will provide the means to die, not live. But that’s where we are now. We aren’t dead yet and we don’t want state-sanctioned death support.

DETAILS OF OUR DECEMBER 6 ONLINE DISCUSSION

  • TVNDY will present our December 6 webcast as an online discussion, using the Zoom teleconferencing system.  Our goal is to mobilize and support the people who are fighting back against the pressure to accept medical assistance in dying (MAiD).
  • During our online discussion, we hope to:
    • Learn about how people are being pressured to “request” MAiD:
    • Look at political and legal options to challenge or modify the MAiD law;
    • Build a supportive community of people who’ve faced pressure to end their lives.
  • We were inspired to do this by the Truchon decision, parliament’s plan to modify the MAiD law, and the growing number of cases highlighting problems with life-ending practices that have come to light over the past few months. (See our webcasts of August 23, September 20, November 1, and November 8.)
  • When we launched our webcast in 2013, we imagined it as an online discussion, but we’ve never had a big enough audience to make it happen that way.  We hope that, with a few years’ experience and more than 400 English and French webcasts (available at https://tvndy.ca) to draw on, we can create a supportive environment to talk about what assisted suicide and euthanasia mean for disabled Canadians.
  • The English online discussion will be held on Friday, December 6, 2019 at 3 p.m. EST, and the meeting should last between 30 and 60 minutes, depending on how many people participate.  Zoom conferencing software allows people to participate by audio or video, and includes a chat function for people to submit questions or comments.
  • All points of view, expressed respectfully, are welcome. For more information, or to request CART transcription, please email info@tv-ndy.ca.
  • To participate online, click the link to join the meeting (audio or video): https://zoom.us/j/548964260
  • To participate by phone:
    • Dial by your location:
      • +1 647 558 0588 Canada
      • +1 646 876 9923 US (New York)
      • +1 669 900 6833 US (San Jose)
    • Enter the Meeting ID: 548 964 260
  • To participate using the One Tap mobile app:
    • Dial the OneTap number: +16475580588, 548964260# (Canada only)

PLEASE NOTE we’re off next week, so our next webcast will be on December 6.

TVNDY