{"id":4703,"date":"2020-01-24T01:46:25","date_gmt":"2020-01-24T01:46:25","guid":{"rendered":"https:\/\/tvndy.ca\/?p=4703"},"modified":"2020-02-07T17:00:17","modified_gmt":"2020-02-07T17:00:17","slug":"webcast-archive-quebec-panel-recommends-euthanasia-by-advance-request-part-2","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2020\/01\/webcast-archive-quebec-panel-recommends-euthanasia-by-advance-request-part-2\/","title":{"rendered":"Webcast archive: Qu\u00e9bec panel recommends euthanasia by advance request \u2013 part 2"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/4R55Ph0pRyo?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<div class=\"fluid-width-video-wrapper\"><\/div>\n<p>In this episode of\u00a0<em>Euthanasia &amp; Disability<\/em>, Amy Hasbrouck &amp; Christian Debray discuss:<\/p>\n<ul>\n<li>A Qu\u00e9bec panel recommends euthanasia by advance request \u2013 part 2<\/li>\n<li>Update on the federal online MAiD survey<\/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 DIRECTIVE \u2013 PART 2<\/strong><\/p>\n<ul style=\"font-weight: 400;\">\n<li><a href=\"https:\/\/tvndy.ca\/en\/2020\/01\/webcast-archive-quebec-panel-recommends-euthanasia-by-advance-request\/\">Last week<\/a>, we talked about 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, which recommends allowing medical aid in dying (MAiD) by advance requests even if the person has lost capacity to consent at the time of death. Today, we\u2019re going to focus on the recommendations made by the expert group.<\/li>\n<li>The recommendations are meant to address the different kinds of situations where an inability to consent would prevent a person from getting access to euthanasia\n<ul>\n<li>A person who has made the request and been approved for MAiD, loses the ability to consent before the procedure can be carried out. In recommendation 1, the committee says the person \u201cretains the right\u201d to receive MAiD.\u201d\u00a0 The recommendation seems to assume that the date of the euthanasia procedure is already decided; it\u2019s silent on when the lethal dose will be given, or how that decision will be taken.<\/li>\n<li>A person who has not applied for MAiD and has a sudden loss of capacity; for example, following a stroke or a car accident.\u00a0 The panel says this person would not qualify for euthanasia. The experts encourage citizens to fill out advance medical directives (recommendation 6), which describe what life-sustaining treatment they want in case they cannot consent.<\/li>\n<li>A person who is diagnosed with a condition that will cause them to lose the ability to provide free and informed consent, can make an advance request for euthanasia while they are still capable. The request will be processed and the procedure carried out \u2026 \u201cat the appropriate moment.\u201d This two-step process is described in recommendations 3-4 and 7-10.<\/li>\n<li>Recommendation 12 says requests from people with cognitive deficits or mental illness, who have never been deemed competent to make medical decisions, should not be refused solely on the basis of their diagnosis.<\/li>\n<\/ul>\n<\/li>\n<li>Recommendation 3 proposes that an advance request for MAID should be made \u201cafter obtaining the diagnosis of a serious and incurable illness.\u201d The experts added this requirement to try to prevent people from seeking MAID out of fear of the unknown. However in practical terms, this may result in people deciding to die just after receiving a terminal diagnosis, while they are still in crisis. Thus the road to hell is paved with good intentions.<\/li>\n<li>Recommendation 4 describes the first step of the process.\n<ul>\n<li>The advance request must be \u201cfree and informed,\u201d and the form must be signed by the person in the presence of a doctor. The doctor also signs the form after confirming:\n<ul>\n<li>the diagnosis of a \u201cserious and incurable illness;\u201d<\/li>\n<li>that the person has capacity to consent to \u201ccare\u201d and make the advance euthanasia request; and<\/li>\n<li>that the consent is free and informed.<\/li>\n<\/ul>\n<\/li>\n<li>The advance request form must also be signed either \u201cbefore two witnesses or a notary;\u201d the notary is not required, and the experts don\u2019t say the witnesses have to be disinterested or impartial. Also, speaking practically, how easy will it be to get a doctor and a notary in the same room to sign the form?<\/li>\n<\/ul>\n<\/li>\n<li>Recommendations 7 and 8\u00a0allow the person to choose someone to start the processing of the advance request \u201cat the appropriate moment.\u201d However the experts don\u2019t say clearly how \u201cthe appropriate moment\u201d is decided.\u00a0 The explanation of suffering in recommendation #9 suggests the person will have written into their request some triggering condition or event, the authors offer no guidance on this question.\n<ul>\n<li>The committee emphasizes that the third party is a spokesperson, not a substitute decision-maker or guardian. Their role is only to inform the medical team \u201cthat a euthanasia request exists and to ensure that the request is duly considered.\u201d<\/li>\n<li>If the person who made the advance request didn\u2019t choose someone to trigger the approval process, \u201cor in the event of a refusal, withdrawal or impediment on their part\u201d another person \u201cwith an interest in the patient\u201d or an \u201cimpartial external authority\u201d can take on that role. It\u2019s unclear, in this sentence, what the word \u201crefusal\u201d means. Is it only about the person\u2019s unwillingness to perform the function, or does it apply if the chosen person refuses to trigger the euthanasia approval because they believe the disabled person isn\u2019t suffering?<\/li>\n<li>The goal is to act in the person\u2019s \u201cbest interest,\u201d but who decides what that interest is, and how do they make that decision? We fear such judgments will be swayed by negative views of life with dementia.<\/li>\n<\/ul>\n<\/li>\n<li>Recommendation 9\u00a0outlines the shortened list of eligibility criteria for approval of an advance euthanasia request.\n<ul>\n<li>The person must be 18 years old and have health insurance.<\/li>\n<li>They must have a \u201cserious and incurable illness\u201d which is marked \u201cby an advanced and irreversible decline in his capacities.\u201d (N.B. the English terms used in the federal law (\u201cgrievous and irremediable\u201d) are stronger than translation from the French to English (\u201cserious and incurable\u201d) of the phrase used in the french versions of both the federal law and the Qu\u00e9bec statute \u00ab grave et incurable. \u00bb)<\/li>\n<li>As we described last week, the expert panel recommends a new, lower threshold of suffering, which is \u201cassessed by the doctor and the multidisciplinary healthcare team and corresponds to what is expressed in the anticipated request for MAiD.\u201d\n<ul>\n<li>from \u201cunbearable\u201d to \u201csignificant\u201d;<\/li>\n<li>from \u201ccannot be relieved in a manner the person finds tolerable\u201d to \u201cdifficult to relieve;\u201d and<\/li>\n<li>Includes the option of \u201cexistential\u201d suffering.<\/li>\n<\/ul>\n<\/li>\n<li>On January 21, Qu\u00e9bec\u2019s Health Minister\u00a0<a href=\"https:\/\/montreal.ctvnews.ca\/medical-assistance-in-dying-will-be-extended-to-people-not-at-the-end-of-their-life-1.4777276\">announced<\/a>\u00a0that the \u201cend of life\u201d criterion will be dropped from the existing statute.\u00a0<a href=\"https:\/\/globalnews.ca\/news\/6453267\/public-consultations-medical-aid-in-dying-mentally-ill\/\">Media reports<\/a>\u00a0later in the week said the Province is planning to ask the Coll\u00e8ge des m\u00e9decins to draw up guidelines for expanding eligibility to people who want euthanasia due to mental illness.<\/li>\n<li>Again, the person doesn\u2019t have to be able to consent to euthanasia when the advance request is considered or the procedure is done, as long as they were able to give free and informed consent when they made the request, regardless of how long ago that was.<\/li>\n<\/ul>\n<\/li>\n<li>As with the federal law, the recommendation dealing with the second opinion (number 10), fails to say what happens if the second doctor doesn\u2019t agree that the person is eligible.\u00a0 In practice, this means that the primary doctor simply asks around until they find a second doctor who agrees that the person is eligible.<\/li>\n<li>Recommendation 11\u00a0says that if a person is incapacitated, someone else cannot request MAID on their behalf. However, the authors say nothing about supported decision-making, or any alternatives to guardianship.<\/li>\n<li>Recommendation 12 states that respect for the equal rights of people with intellectual disability or mental illness require that requests for MAiD from these people should be assessed on the basis of their ability to consent to euthanasia, and not on the basis of their diagnosis.\u00a0 The authors don\u2019t provide any guidelines for such assessments, however.\n<ul>\n<li>The experts cite the\u00a0<em><a href=\"https:\/\/scc-csc.lexum.com\/scc-csc\/scc-csc\/en\/item\/2064\/index.do\">Starson v. Swayze<\/a><\/em>\u00a0Supreme Court case, which established the right to refuse psychiatric medications. They don\u2019t deal with the fact that while a person can always change their mind about taking medications, euthanasia cannot be undone.<\/li>\n<li>The authors recognize that the \u201cstigma, discrimination, marginalization, oppression, violence and abuse\u201d faced by\u00a0people with intellectual and psychiatric disabilities has to be taken into account when evaluating euthanasia requests. However, they overlook the lack of community-based services that forces people into institutions. The view seems to be \u201crespect their decisions, even if they\u2019re forced into choosing between two unacceptable options.\u201d<\/li>\n<li>The authors cite a study (p. 130) showing that \u201calmost 50% of [people] who are incapable of consenting to treatment are not recognized as such by the healthcare team following a standard clinical evaluation.\u201d They mention the need for a more rigorous process because the decision to die is irreversible and suggest developing better tools for determining capacity.<\/li>\n<\/ul>\n<\/li>\n<li>Recommendation 14\u00a0calls for better access to palliative care, but doesn\u2019t mention the idea of \u201ceuthanasia-free zones\u201d where people can count on palliative care without having to worry about pressure to end their lives.\n<ul>\n<li>Insufficient palliative care could worsen symptoms causing loss of capacity (for example, agitation, pain, or depression).<\/li>\n<li>On page 133, the authors finally admit that \u201cthe ability to make a free and informed choice assumes people have a full range of options from which to choose.\u201d Yet in the same paragraph, they propose that \u201cin the absence of adequate end-of-life resources, a person who has a life expectancy of more than three months, who is losing autonomy and who is no longer able to return to live at home could consider receiving MAID.\u201d And there you have it, the right to die becomes a recommendation. How long before it becomes a duty to die?<\/li>\n<li>Palliative care is suggested as a solution to caregiver stress and exhaustion, but personal assistance services are not mentioned.<\/li>\n<\/ul>\n<\/li>\n<li>The expert panel pays lip service to disability rights by supporting the rights of people with intellectual disabilities and mental illness to be considered for euthanasia, just like everyone else, while ignoring the effects of systemic discrimination. The authors fail to wrestle with the question of what will trigger the processing of a euthanasia request, and continue the slide toward lax standards and broader eligibility.<\/li>\n<\/ul>\n<p><strong>UPDATE ON THE FEDERAL ONLINE MAID SURVEY \u201cPUSH POLL\u201d<\/strong><\/p>\n<ul style=\"font-weight: 400;\">\n<li>We wanted to give you a brief update on the federal online consultation on the MAiD program.<\/li>\n<li>There\u2019s been a lot of discussion this week on the interwebs about the\u00a0<a href=\"http:\/\/ianchadwick.com\/blog\/internet-surveys-bad-data-bad-science-and-big-bias\/\">problems<\/a>\u00a0with the online consultation survey.\u00a0 These include:\n<ul>\n<li>plumping or \u201cpoll crashing,\u201d (200,000 responses and counting.);<\/li>\n<li>poorly-worded and slanted questions;<\/li>\n<li>A linear scale that is not linear. (the scale for rating the importance of possible additional safeguards goes \u201c0, 1, 2, 3, 4, no opinion\u201d instead of using a straight 0-5 scale).<\/li>\n<\/ul>\n<\/li>\n<li>In order to prevent the voice of disabled people from being lost, activists from the Vulnerable Persons Standard (<a href=\"http:\/\/www.vps-npv.ca\/\">VPS<\/a>) are asking people to use the\u00a0<a href=\"https:\/\/www.justice.gc.ca\/eng\/cons\/ad-am\/survey_maid_eng.pdf\">PDF survey<\/a>\u00a0and to email a copy to\u00a0<a href=\"mailto:vpsstatistics@gmail.com\">vpsstatistics@gmail.com<\/a>.\u00a0 Despite the problems, it\u2019s important to give your opinion; and send a copy to the VPS. The deadline is midnight on January 27.<\/li>\n<\/ul>\n   ","protected":false},"excerpt":{"rendered":"<div class=\"entry-summary\">\n<div class=\"entry-summary\">\nThis week, we continue our review of the call for advance requests and government consultation.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2020\/01\/webcast-archive-quebec-panel-recommends-euthanasia-by-advance-request-part-2\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Qu\u00e9bec panel recommends euthanasia by advance request \u2013 part 2&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-part-2\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Qu\u00e9bec panel recommends euthanasia by advance request \u2013 part 2&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":[121,53,270,672,118],"class_list":["post-4703","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-euthanasia-disability","tag-quebec-en","tag-supreme-court","tag-vulnerable-persons-standard","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4703","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=4703"}],"version-history":[{"count":3,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4703\/revisions"}],"predecessor-version":[{"id":4706,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4703\/revisions\/4706"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=4703"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=4703"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=4703"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}