{"id":4693,"date":"2020-01-17T18:55:55","date_gmt":"2020-01-17T18:55:55","guid":{"rendered":"https:\/\/tvndy.ca\/?p=4693"},"modified":"2020-01-17T19:14:17","modified_gmt":"2020-01-17T19:14:17","slug":"webcast-archive-quebec-panel-recommends-euthanasia-by-advance-request","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2020\/01\/webcast-archive-quebec-panel-recommends-euthanasia-by-advance-request\/","title":{"rendered":"Webcast archive: Qu\u00e9bec panel recommends euthanasia by advance request"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/XPPrQu6DwZA?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 &amp; Taylor Hyatt discuss:<\/p>\n<ul>\n<li>Qu\u00e9bec panel recommends euthanasia by advance request<\/li>\n<li>Online consultation for medical assistance in dying law<\/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>A QU\u00c9BEC PANEL RECOMMENDS EUTHANASIA BY ADVANCE REQUEST<\/strong><\/p>\n<ul style=\"font-weight: 400;\">\n<li>Welcome to our first webcast of 2020. For the next couple of weeks, we\u2019re looking at a\u00a0<a href=\"https:\/\/publications.msss.gouv.qc.ca\/msss\/fichiers\/2019\/19-828-04W.pdf\">report<\/a>\u00a0written for Quebec\u2019s Minister of Health and Social Services, on the possibility of allowing advance requests for euthanasia for people who are unable to consent. This report is important because it is part of the evidence used by the federal government to justify expanding eligibility for medical assistance in dying (MAiD) to people who cannot consent when euthanasia is given.<\/li>\n<li>As with the Council of Canadian Academies reports published in December of 2018 (see our webcasts for\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2019\/01\/webcast-archive-the-cca-reports-part-i-overarching-problems\/\">January 11<\/a>,\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2019\/01\/webcast-archive-the-cca-reports-part-ii-advance-requests\/\">January 18<\/a>,\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2019\/02\/webcast-archive-the-cca-reports-part-iii-mature-minors\/\">February 1<\/a>, and\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2019\/02\/webcast-archive-the-cca-reports-part-iv-mental-disorders\/\">February 8<\/a>\u00a0of 2019) , it does not appear that any people with disabilities were included on the panel who wrote this report; nor did it reflect a disability rights perspective.\u00a0 This creates flaws in the report:\n<ul>\n<li>Language used to describe disability is biased and evokes images of tragedy and pity.\u00a0 The report refers to some disabled people as \u201cbed-bound\u201d \u201cprisoners of their bodies\u201d and without \u201chope of a cure.\u201d Such language gives the lie to the panel\u2019s claim (on page 21) that they have no preconceived idea of what constitutes a \u201cgood life.\u201d<\/li>\n<li>The lack of a disability rights perspective also means the report does not take into account the effects of social policy on disabled people\u2019s life choices. The panel talks about the \u201cvalues that guided their reflection,\u201d (such as dignity, liberty and autonomy) and celebrates Qu\u00e9bec as a \u201cfree and democratic society.\u201d Yet they fail to mention that disabled people are often forced into institutions for lack of home-based services.<\/li>\n<li>The report cites the Law on Health and Social Services, which says such services must be provided in a way that respects the \u201cdignity\u201d and \u201cautonomy\u201d of the person.\u00a0 But there is no mention of community integration, nor the\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2019\/09\/webcast-archive-details-on-the-truchon-decision\/\">pending lawsuit<\/a>\u00a0against the province\u2019s health ministry over\u00a0 inhumane conditions in nursing homes.<\/li>\n<\/ul>\n<\/li>\n<li>The authors proposes changes to the eligibility criteria related to suffering:\n<ul>\n<li>Under the current law, the person must experience \u201cconstant and unbearable physical or psychological suffering which cannot be relieved in a manner the patient deems tolerable.\u201d<\/li>\n<li>The panel proposes that the person must have physical, psychological or existential suffering that is \u201csignificant and difficult to relieve.\u201d<\/li>\n<\/ul>\n<\/li>\n<li>The experts also propose new wording for the \u201cend of life\u201d eligibility criterion which is supposed to clear up any confusion.\n<ul>\n<li>Under the current statute, the person must be \u201cat the end of life.\u201d<\/li>\n<li>The panel proposes that the person must be \u201con a trajectory toward the end of life for which the doctor can reasonably foresee their death.\u201d<\/li>\n<\/ul>\n<\/li>\n<li>The panel justifies the changes by saying suffering from dementia is different from what happens with cancer, and that they\u2019re trying to clarify what \u201cend of life\u201d means.\u00a0 But that doesn\u2019t explain why they have also made the standards more relaxed:\n<ul>\n<li>from \u201cunbearable\u201d to \u201csignificant\u201d;<\/li>\n<li>from \u201ccannot be relieved by a means the person finds tolerable\u201d to \u201cdifficult to relieve;\u201d and<\/li>\n<li>from \u201cat the end of life\u201d to \u201con a trajectory toward the end of life for which the doctor can reasonably foresee their death.\u201d (after all, why use five words when 17 will suffice.)<\/li>\n<\/ul>\n<\/li>\n<li>The expert group described five situations in which people may be unable to consent to euthanasia:\n<ul>\n<li>They have a condition that causes cognitive abilities to decline, like Alzheimer\u2019s or Huntington\u2019s disease;<\/li>\n<li>They have a sudden brain injury (such as a stroke, aneurysm or head injury) causing a coma or other changes in consciousness;<\/li>\n<li>The person has never been competent to consent to medical care, and thus is unable to consent to euthanasia (such as people with severe intellectual disabilities);<\/li>\n<li>They have a mental illness that impairs a person\u2019s ability to make logical judgments about their situation;<\/li>\n<li>The person loses capacity because of secondary effects of their illness or medication.<\/li>\n<\/ul>\n<\/li>\n<li>The panel doesn\u2019t address the difference between the ability to consent to \u201chealth care\u201d versus consenting to a life-ending procedure. Nor do the authors deal with barriers to consent caused by discrimination or other factors, such as:\n<ul>\n<li>lack of communication access;<\/li>\n<li>learned helplessness and compliance;<\/li>\n<li>lack of stimulation leading to cognitive deficits, or poor education causing an inability to read;<\/li>\n<li>an unmet need for supported decision-making;<\/li>\n<li>professionals\u2019 use of jargon;<\/li>\n<li>negative judgments about a disabled person\u2019s quality of life that limit options offered to the person.<\/li>\n<\/ul>\n<\/li>\n<li>In its description of capacity to consent to care, the report mentions the work of Thomas Grisso and Paul Appelbaum as the \u201cstandard\u201d in the field, but fails to list the\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2018\/05\/webcast-archive-new-study-on-euthanasia-of-people-with-intellectual-disabilities\/\">Appelbaum criteria<\/a>; four cognitive abilities needed to make medical decisions. They include being able to:\n<ul>\n<li>Understand information;<\/li>\n<li>Apply the information to one\u2019s own situation;<\/li>\n<li>Weigh the benefits and risks to arrive at a decision; and,<\/li>\n<li>Express one\u2019s choice.<\/li>\n<\/ul>\n<\/li>\n<li>The authors state that this is not the test used in Qu\u00e9bec.\u00a0 Instead, courts in the province look at:\n<ul>\n<li>Whether the person understands the nature of their illness;<\/li>\n<li>Whether the person understands the nature and goal of the proposed treatment;<\/li>\n<li>Whether the person understands the risks associated with the treatment;<\/li>\n<li>Whether the person understands the risks of not receiving the treatment;<\/li>\n<li>The ability to consent is not impaired by their illness.<\/li>\n<\/ul>\n<\/li>\n<li>The experts refer to some precedents from the U.S., including the\u00a0<em>Cruzan<\/em>\u00a0case and the Patients\u2019 Bill of Rights, which established that a person may refuse treatment. But the authors skip over the U.S. Supreme Court cases that found there was no constitutional right to assisted suicide.<\/li>\n<li>Chapter five focuses on the philosophical question, summed up by Maxime Huot Couture of\u00a0<a href=\"https:\/\/vivredignite.org\/en\/2019\/12\/alzheimer-and-dementia-am-i-still-the-same-person\/\">Living with Dignity<\/a>: should the present self be allowed to force the future self to commit suicide? Though the arguments presented in the report suggest the answer should be \u201cNo\u201d the panel recommends allowing advance requests for euthanasia anyway.\n<ul>\n<li>The authors dismiss the fact that people adjust to their disabilities (\u201cthe disability paradox\u201d) by saying that this process depends on relationships, and since the mental decline of dementia makes a person unable to maintain relationships, then they can\u2019t adjust.<\/li>\n<li>The panel also feels obliged to point out that there is disagreement in the disability community over these issues, without recognizing that disability rights groups oppose AS\/E based on policy concerns, while disabled individuals usually support MAiD for personal reasons.<\/li>\n<\/ul>\n<\/li>\n<li>Like the CCA report on advance requests, this document includes the kind of problems of fact, logic and consistency that result from excluding the disability rights perspective on an issue that is, at heart, a disability rights issue.<\/li>\n<li>Next week we\u2019ll focus on the specific recommendations offered in the report.<\/li>\n<\/ul>\n<p><strong>FEDERAL CONSULTATION TO MODIFY THE MAiD LAW<\/strong><\/p>\n<ul style=\"font-weight: 400;\">\n<li>This week, the Canadian government opened a public consultation on potential modifications to the MAID law following the\u00a0<em>Truchon<\/em>\u00a0decision.<\/li>\n<li>The questions in the online survey focus on effectiveness of the current safeguards, ideas for future ones, and circumstances under which advance requests should be allowed. Some questions have multiple-choice answers, while others allow short answers.<\/li>\n<li>The questions, and the framework of the whole project, reveal a bias in favour of euthanasia and expanding eligibility, and a poor grasp of disability rights. For example, rather than saying \u201cmore than 6,700 people have chosen MAiD since 2016\u201d the review of MAID in Canada states that \u201cmore than 6,700 Canadians who were suffering unbearably chose to die peacefully with the help of a physician or nurse practitioner.\u201d One of the questions asks whether those who seek euthanasia should be\u00a0made aware of disability supports, rather than ensuring that people receive the supports they need to avoid forced placement in institutions.<\/li>\n<li>We encourage everyone to have their say in the consultation.\u00a0 For more information,\u00a0<a href=\"https:\/\/www.justice.gc.ca\/eng\/cons\/ad-am\/index.html\">visit the website<\/a>. Besides the online questionnaire, you will find a PDF version which can be filled in and sent as an email attachment, or printed, filled out by hand and mailed in. The deadline for submissions is the end of the day on January 27.<\/li>\n<\/ul>\n   ","protected":false},"excerpt":{"rendered":"<div class=\"entry-summary\">\n<div class=\"entry-summary\">\nToday, we discuss a report being used to inform the government&#8217;s response to the Truchon decision.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2020\/01\/webcast-archive-quebec-panel-recommends-euthanasia-by-advance-request\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Qu\u00e9bec panel recommends euthanasia by advance request&rdquo;<\/span>&hellip;<\/a><\/div>\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2020\/01\/webcast-archive-quebec-panel-recommends-euthanasia-by-advance-request\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Qu\u00e9bec panel recommends euthanasia by advance request&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":[461,668,121,53,98,582,118],"class_list":["post-4693","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-advance-requests","tag-council-of-canadian-academies-en","tag-euthanasia-disability","tag-quebec-en","tag-suffering","tag-truchon-en","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4693","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=4693"}],"version-history":[{"count":4,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4693\/revisions"}],"predecessor-version":[{"id":4699,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4693\/revisions\/4699"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=4693"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=4693"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=4693"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}