{"id":4182,"date":"2019-04-05T18:17:31","date_gmt":"2019-04-05T18:17:31","guid":{"rendered":"https:\/\/tvndy.ca\/?p=4182"},"modified":"2019-04-05T18:22:00","modified_gmt":"2019-04-05T18:22:00","slug":"webcast-archive-planning-for-the-maid-five-year-review","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2019\/04\/webcast-archive-planning-for-the-maid-five-year-review\/","title":{"rendered":"Webcast archive: Planning for the MAiD five-year review"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/cZG7AhFpHqQ?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<p>In this episode of\u00a0<em>Euthanasia &amp; Disability<\/em>, Amy Hasbrouck, Christian Debray, and Taylor Hyatt discuss:<\/p>\n<ul>\n<li>Planning for the MAiD five-year review<\/li>\n<li>A new report of old data<\/li>\n<\/ul>\n<p>Please note that this text is only a script and that our webcast contains additional commentary.<\/p>\n<p><strong>PLANNING FOR THE MAID FIVE-YEAR REVIEW<\/strong><\/p>\n<ul>\n<li>Welcome to our 200<sup>th<\/sup>\u00a0webcast!\u00a0 We hope you find these programs informative, and at least a little bit interesting.\u00a0 And we hope you like the visits by our four-footed friends.<\/li>\n<li>Right, back to work.\u00a0 Chapter 10 of the\u00a0<a href=\"https:\/\/laws-lois.justice.gc.ca\/eng\/AnnualStatutes\/2016_3\/FullText.html\">Medical Assistance in Dying law<\/a>\u00a0requires Parliament to review the Act, as well as \u201cthe state of palliative care in Canada,\u201d five years after the law comes into effect. \u00a0The review is to be done by a committee of the House, or the Senate, or a joint committee, and the panel is supposed to produce a report describing how the law is working, including any suggestions for changing the statute.<\/li>\n<li>The review process is supposed to begin \u201c<u>[a]t the start of the fifth year<\/u>\u00a0after the day on which this Act receives royal assent \u2026 \u201d\n<ul>\n<li>Some might interpret that to mean the review process should launch with the appointment of a committee in June of 2020, next year.<\/li>\n<li>It could also be interpreted such that the review would start when the five year mark has been reached, in June of 2021.<\/li>\n<\/ul>\n<\/li>\n<li>Either way, as advocates, we would be well-advised to start preparing now for this important opportunity to evaluate how the law is operating in practice, and how it should be changed.<\/li>\n<li>First, we need to ensure that the public will be able to have input into the review process.\u00a0 Will there be a way for the public to submit comments?\u00a0 Will Parliament hold hearings where members of the public can testify, or will testimony be by invitation only?<\/li>\n<li>Then we must decide on our goals and strategy to use the process to help restrain assisted suicide and euthanasia (AS\/E) and ensure effective safeguards and monitoring.\n<ul>\n<li>Are there improvements we\u2019d like to see to the MAiD law?<\/li>\n<li>Can we use this review as an opportunity to:\n<ul>\n<li>solve the problems with the monitoring program;<\/li>\n<li>improve access to palliative care or community-based self-directed personal-assistance services?<\/li>\n<\/ul>\n<\/li>\n<li>Do we want to try to further limit eligibility or add more safeguards?<\/li>\n<\/ul>\n<\/li>\n<li>Once we have a wish list, we need to prioritize our goals.<\/li>\n<li>We also need to anticipate and prepare to defend against likely efforts by euthanasia proponents:\n<ul>\n<li><strong>To expand eligibility<\/strong>; such as by including the groups studied in the\u00a0<a href=\"https:\/\/www.scienceadvice.ca\/reports\/medical-assistance-in-dying\/\">Council of Canadian Academies<\/a>\u00a0Reports:\n<ul>\n<li>Mature minors;<\/li>\n<li>People with dementia (via advance requests);<\/li>\n<li>Where the request is due to a psychiatric disability.<\/li>\n<\/ul>\n<\/li>\n<li>To\u00a0<strong>remove existing requirements<\/strong>, such as that death be \u201creasonably foreseeable\u201d or that the decline in capability be \u201cadvanced and irreversible.\u201d<\/li>\n<li>Or\u00a0<strong>to soften safeguards<\/strong>; for example, by eliminating the independence requirements of the second medical practitioner or the witnesses, or completely removing the 10-day waiting period.<\/li>\n<\/ul>\n<\/li>\n<li>We\u2019ll need to decide how much energy to put toward reaching our positive goals, and how much to put toward defending against potential losses.<\/li>\n<li>We also have to choose the best strategies to achieve our goals and maintain the strictest possible eligibility criteria and safeguards?\n<ul>\n<li>One possible approach might be to compare the practice of AS\/E under the MAiD statute with the expectation laid out by the Supreme Court in the\u00a0<a href=\"https:\/\/scc-csc.lexum.com\/scc-csc\/scc-csc\/en\/item\/14637\/index.do\"><em>Carter<\/em><\/a>\u00a0case that \u201cthe risks [to vulnerable persons] in permitting physician-assisted death can be identified and very substantially minimized through a carefully-designed system imposing stringent limits that are scrupulously monitored and enforced.\u201d<\/li>\n<li>Another option might be to hold up the practice of AS\/E against the gaps in Canada\u2019s compliance with the Convention on the Rights of Persons with Disabilities.<\/li>\n<li>A third approach is to go through the statute section by section and demonstrate whether it\u2019s doing what it\u2019s supposed to do.<\/li>\n<\/ul>\n<\/li>\n<li>We have to figure out what evidence or documentation we\u2019ll need to support our positions.\n<ul>\n<li>What materials and evidence already exist? It would be great if we could trust the federal monitoring system to detect how discrimination and lack of services limit disabled people\u2019s choices, causes ineligible people to be euthanized, and pressures folks into choosing AS\/E.\u00a0 But as we described in\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2018\/09\/webcast-archive-health-canadas-final-monitoring-regulations\/\">September<\/a>\u00a0and on November\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2018\/11\/webcast-archive-first-euthanasia-prosecution-in-the-netherlands\/\">16<sup>th<\/sup><\/a>\u00a0and\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2018\/11\/webcast-archive-the-federal-reporting-form\/\">30<sup>th<\/sup><\/a>\u00a0of last year, the federal monitoring system won\u2019t be gathering information that\u2019s detailed enough to show these effects on disabled people.<\/li>\n<li>We\u2019ve done webcasts that focus on several aspects of the AS\/E eligibility determination and safeguards, including:\n<ul>\n<li>Capacity determinations, external pressure and undue influence (February\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2018\/02\/webcast-archive-capacity-and-undue-influence-part-i\/\">2<\/a>,\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2018\/02\/webcast-archive-capacity-and-undue-influence-part-2\/\">9<\/a>, &amp;\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2018\/02\/webcast-archive-capacity-and-undue-influence-part-3\/\">16<\/a>, 2018)<\/li>\n<li>Conscience Rights, (<a href=\"https:\/\/tvndy.ca\/en\/2016\/10\/webcast-archive-unintended-victims-of-euthanasia\/\">October 7, 2016<\/a>)<\/li>\n<li>Informed Consent (<a href=\"https:\/\/tvndy.ca\/en\/2017\/03\/webcast-archive-new-quebec-study\/\">March 31, 2017<\/a>)<\/li>\n<\/ul>\n<\/li>\n<li>What evidence \/ documentation will we need to produce?<\/li>\n<li>What resources (individual and institutional) do we have to generate the evidence we need?<\/li>\n<\/ul>\n<\/li>\n<li>There are many claims and statements in the preamble about the goals of the law.\u00a0 But are these accurate in light of the language of the statute, the practice of AS\/E and the barriers imposed by disability discrimination?\n<ul>\n<li>\u201cParliament recognizes the autonomy of people with a grievous and irremediable medical condition\u2026\u201d Considering that discrimination prevents people with disabilities from controlling where and how they live, is this really true?<\/li>\n<li>\u201cRobust safeguards \u2026 are essential.\u201d\u00a0 There are only five real safeguards; does that add up to \u201crobust?\u201d\n<ol>\n<li>Person must meet all eligibility criteria;<\/li>\n<li>There must be a written, signed and witnessed request;<\/li>\n<li>The person must be informed of their medical condition and that they can withdraw the request at any time;<\/li>\n<li>A second independent medical practitioner must provide a written confirmation;<\/li>\n<li>Ten-day waiting period, (unless it\u2019s waived).<\/li>\n<\/ol>\n<\/li>\n<li>It\u2019s important to affirm the inherent and equal value of every person\u2019s life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled.<\/li>\n<li>Vulnerable persons must be protected from being induced, in moments of weakness, to end their lives.<\/li>\n<li>Suicide is a public health issue that can have lasting and harmful effects. (This section says nothing about preventing suicides.)<\/li>\n<li>MAiD \u201cstrikes the most appropriate balance\u201d between the autonomy of those who wish to die and protection of vulnerable persons.<\/li>\n<li>Consistent approach should be applied across the country.<\/li>\n<li>There should be no penalties (loss of benefits) or adverse legal consequences for choosing AS\/E;<\/li>\n<li>The program should reflect the principles of the Canada health act: public administration, comprehensiveness, universality, portability and accessibility.<\/li>\n<li>Freedom of conscience and religion.<\/li>\n<li>The law should address the diverse circumstances and needs of various groups\n<ul>\n<li>Access to palliative care<\/li>\n<li>Care for people with dementia<\/li>\n<li>Mental health supports<\/li>\n<li>Culturally-appropriate services for indigenous people<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>When looking at the specific provisions of the law, we can think about:\n<ul>\n<li>Whether the language in the law clearly expresses Parliament\u2019s intent;<\/li>\n<li>Whether Parliament should add a definition or state more clearly what they mean by a particular term;<\/li>\n<li>Whether Parliament should change the section to make it more limiting or more lenient.<\/li>\n<\/ul>\n<\/li>\n<li>There are some loopholes in the law that exempt people from criminal responsibility for participating in assisted suicide or euthanasia.\u00a0 When the law was being drafted we weren\u2019t able to close them with amendment. Do we want to put effort into getting rid of them now?\n<ul>\n<li><strong>Sec. 14<\/strong>\u00a0of the Criminal Code, which says a person cannot consent to their own death,\u00a0<strong>does not apply to AS\/E<\/strong>.<\/li>\n<li>No person is guilty of culpable homicide if they\u00a0<strong>do anything to help a medical practitioner<\/strong>\u00a0to provide MAiD.<\/li>\n<li>No person commits an offence \u2026 if they\u00a0<strong>do anything<\/strong>, at another\u00a0<strong>person\u2019s explicit request<\/strong>,\u00a0<strong>[to help]<\/strong>\u00a0that other person to\u00a0<strong>self-administer\u201d lethal drugs<\/strong>\u00a0for MAiD.<\/li>\n<li>the exemption in subsections (2) to (5) \u201capplies\u00a0<strong>even if<\/strong>\u00a0the person \u2026\u00a0<strong>has a reasonable but mistaken belief<\/strong>\u00a0about any \u2026 element of the exemption.\u201d<\/li>\n<\/ul>\n<\/li>\n<li>Are there changes we want to make to the current eligibility criteria, or points that we feel are especially important to defend?\u00a0 Currently, a person is eligible for AS\/E if they:\n<ul>\n<li>Are eligible for\u00a0<strong>government health services<\/strong>;<\/li>\n<li>Are\u00a0<strong>18 years old<\/strong>;<\/li>\n<li>Are capable of making\u00a0<strong>decisions with respect to their health<\/strong>;<\/li>\n<li>Have a\u00a0<strong>grievous and irremediable<\/strong>\u00a0medical condition, which means:\n<ul>\n<li>A\u00a0<strong>serious and incurable illness, disease or disability<\/strong>;<\/li>\n<li>In an\u00a0<strong>advanced state of irreversible decline<\/strong>\u00a0in capability;<\/li>\n<li>The illness, disease or disability or that state of decline causes them\u00a0<strong>enduring physical or psychological suffering<\/strong>\u00a0that is\u00a0<strong>intolerable<\/strong>\u00a0to them and that\u00a0<strong>cannot be relieved under conditions<\/strong>\u00a0that they consider\u00a0<strong>acceptable<\/strong>;<\/li>\n<li>Their natural\u00a0<strong>death<\/strong>\u00a0has become\u00a0<strong>reasonably foreseeable<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li>Have made a\u00a0<strong>voluntary request<\/strong>, which is not a result of\u00a0<strong>external pressure<\/strong>;<\/li>\n<li>Give\u00a0<strong>informed consent<\/strong>\u00a0(including being informed of\u00a0<strong>palliative care\u00a0<\/strong>options, but with no mention of alternatives to institutionalization.)<\/li>\n<\/ul>\n<\/li>\n<li>Safeguards: As mentioned above, there are really only five safeguards; two of which carry over from the eligibility criteria, one is repeated, and another is actually an accessibility accommodation.\u00a0 The medical practitioner must:\n<ul>\n<li>Be of the opinion that the\u00a0<strong>person meets all eligibility criteria<\/strong>\u00a0(1)<\/li>\n<li>Ensure the\u00a0<strong>request<\/strong>\u00a0is: (2)\n<ul>\n<li><strong>Written, signed<\/strong>\u00a0and\u00a0<strong>dated<\/strong>\u00a0by the person<\/li>\n<li>Signed by two independent\u00a0<strong>witnesses<\/strong><\/li>\n<\/ul>\n<\/li>\n<li>Ensure the\u00a0<strong>person is informed<\/strong>: (3)\n<ul>\n<li>they have a\u00a0<strong>grievous and irremediable medical condition<\/strong>;<\/li>\n<li>they\u00a0<strong>can withdraw the request<\/strong>\u00a0at any time;<\/li>\n<\/ul>\n<\/li>\n<li>Ensure\u00a0<strong>written confirmation from second<\/strong>\u00a0(<strong>independent<\/strong>)\u00a0<strong>medical practitioner<\/strong>; (4)<\/li>\n<li>Ensure\u00a0<strong>10 clear days<\/strong>, unless death or loss of capacity is imminent; (5)<\/li>\n<li>Give the person an\u00a0<strong>opportunity to withdraw<\/strong>\u00a0request before administering euthanasia (repeat 3)<\/li>\n<li>Take all necessary measures to provide a\u00a0<strong>reliable means<\/strong>\u00a0for the person to\u00a0<strong>understand<\/strong>\u00a0information and\u00a0<strong>communicate<\/strong>\u00a0their decision. (this is not a safeguard, this is an accessibility accommodation which should be seen to first, not last);<\/li>\n<\/ul>\n<\/li>\n<li>The MAiD statute sets out a standard of care:\n<ul>\n<li><strong>Reasonable knowledge, care and skill<\/strong>;<\/li>\n<li>That complies with provincial\u00a0<strong>laws, rules and standards<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li>\u00a0\u201cClarification\u201d (9) \u201c\u2026nothing in this section compels an individual to provide or assist in providing medical assistance in dying.\u201d This section does not address making referrals.\u00a0 Does making a referral amount to \u201cassisting?\u201d<\/li>\n<li>The statute mentions regulations for monitoring requests for and provision of AS\/E, but not the evaluation and approval of requests. Given the deficiencies of the regulations, would it be worthwhile trying to amend the statute to bring the monitoring system in line with what\u2019s called for in\u00a0<em>Carter<\/em>, i.e. a system that is \u201cscrupulously monitored and enforced.\u201d<\/li>\n<li>The law says death certificates \u201c<strong>may<\/strong>\u201d identify AS\/E \u201cas the manner of death.\u201d\u00a0 This has led to the classification of MAiD as other than suicide; is this something we\u00a0 want to change?<\/li>\n<li>On Friday, July 19 at 1 p.m., TVNDY and the Euthanasia Prevention Coalition will co-host a teleconference for advocates to plan for the five-year review.\u00a0 Watch our webcasts, our website and Facebook page for details, or email us to learn how to get involved.<\/li>\n<\/ul>\n<p><strong>A NEW REPORT OF OLD DATA<\/strong><\/p>\n<ul>\n<li>Qu\u00e9bec\u2019s Commission on End-of-Life Care has issued a\u00a0<a href=\"http:\/\/www.assnat.qc.ca\/depots-du-jour\/2019-04-03\/Autres\/01-Rapport%20situation%20soins%20de%20fin%20de%20vie%20au%20Qu%C3%A9bec.pdf\">new report<\/a>\u00a0on the status of end-of-life care in Qu\u00e9bec.\u00a0 The report, which includes data only through March 31 of last year (2018), discusses palliative care, continuous palliative sedation, euthanasia administered or not administered, advance directives, and the activities of the Commission itself.\u00a0 We\u2019ll look at the report in an upcoming webcast.<\/li>\n<\/ul>\n   ","protected":false},"excerpt":{"rendered":"<div class=\"entry-summary\">\n<div class=\"entry-summary\">\nThis week, we discuss the work disability advocates need to do before the federal government reviews the euthanasia law in 2021.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2019\/04\/webcast-archive-planning-for-the-maid-five-year-review\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Planning for the MAiD five-year review&rdquo;<\/span>&hellip;<\/a><\/div>\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2019\/04\/webcast-archive-planning-for-the-maid-five-year-review\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Planning for the MAiD five-year review&rdquo;<\/span>&hellip;<\/a><\/div>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[92],"tags":[269,455,256,258,121,192,193,53,96,118],"class_list":["post-4182","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-carter","tag-commission-de-soins-de-fin-de-vie","tag-council-of-canadian-academies","tag-eligibility","tag-euthanasia-disability","tag-legislation","tag-parliament","tag-quebec-en","tag-safeguards","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4182","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/comments?post=4182"}],"version-history":[{"count":4,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4182\/revisions"}],"predecessor-version":[{"id":4190,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4182\/revisions\/4190"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=4182"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=4182"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=4182"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}