Isabelle and Ward O'Connor of the Vivere Group offer questions to ponder about Quebec's new Euthanasia legislation.

1. Do euthanasia and palliative care go together?

The palliative care philosophy is based on respect for the natural process of death. Matching induced death by euthanasia ("medical aid in dying") with palliative care in a "continuum of end of life care" is it logical? Doing so risks creating conflict and confusion. This is the view of, among others, le Réseau de soins palliatifs du Québec (RSPQ), as recorded in its deposition regarding the subject legislation. The RSPQ affirms that "Euthanasia is not a treatment." Further, it is important to know that the Fédération du Mouvement Albatros of Québec (FMAQ) adopted unanimously a resolution in support of the RSPQ position.

2. Is End of Life Care Legislation valid?

It is important to know that induced death, either by euthanasia or assisted suicide, is a crime in Canada, although the authors and promoters of the legislation on end-of-life care categorically deny that "medical aid in dying" means "euthanasia", hoping that their semantic game will evade Canada’s Criminal Code. You should know that Canada’s Attorney General announced that he will challenge the 

validity of this legislation, pending the Supreme Court of Canada ruling in the case Carter-Taylor case heard October 5, 2014, with a decision expected within six months – i.e., no later than April 2015. The Carter-Taylor case challenges the validity of criminalizing death induced by euthanasia or assisted suicide.

3. Would government induced death jeopardize the right to personal security?

Consent and intent are difficult to prove, and the weak, vulnerable, disabled, elderly, depressed, illiterate or otherwise physically or mentally vulnerable are very easy to manipulate. Their consent can also be difficult to interpret. Substituted consent is another important issue, appearing in the Quebec law (Articles 47, 48, 55) as does presumed consent (Articles 57 and 58 ). The mistreatment of these large segments of the population, especially from relatives and institutions, being widely and well documented, as are discrimination and other social exclusionary pressures of exclusion, is such a precarious secure environment in our health care facilities acceptable?

The Quebec legislation in no way restricts euthanasia for people diagnosed with terminal illness. It is applicable to anyone with a chronic degenerative disease, whether that person is dying or not.

In addition, each year in Quebec, more than 350,000 medical errors are reported, the vast majority of which are injection errors (Ménard report). As euthanasia is done via an injection, do not the number of medical errors argue against the practice of euthanasia?

Finally, the end-of-life care legislation leaves it to the physician to ensure that consent to euthanasia is not the result of undue pressures arising from different sources. What training in psychology and police detection methods will the doctor receive for this purpose? What budget he will have to conduct the needed investigation? Abuse is both pernicious and very clever thing to detect for he seeks to detect it.

A highly interesting lecture on Bill 52 and palliative care (vs. Euthanasia) will be given by Dr. Manuel Borod on November 18, 2014 @ 7:00 pm.

Where:

Segal Centre
5170 Chemin de la Côte-Sainte-Catherine
Montreal, QC H3W 1L5
Canada

Dr. Manuel Borod is vehementlt opposed to Bill 52, the bill which has passed earlier this year and proposes to legalize euthanasia in Quebec.

Dr. Manuel Borod practiced family medicine for 20 years prior to embarking on a career in palliative medicine.

He developed the home care program at Mount Sinai Hospital prior to coming to the MUHC on a full-time basis. He served as Clinical Director of Palliative Care there from 2003-2009 and since then has been the Division Director.

He has been very active in improving and developing different programs such as out-patient services which include a palliative care day hospital, cancer rehabilitation and a multidisciplinary program on cancer pain. He has long been a dedicated teacher and mentor to medical students, residents, and colleagues.

Dr. Borod has given many presentations at local, national and international conferences on a number of subjects including cancer pain, ethics, palliative sedation and euthanasia as well as the role of humour in palliative care.

The event is $12, payable at the door.

For more info.

Dear Friends of Life,

Please respond negatively to the The Calgary Herald survey on assisted suicide.

You will find the the poll under the heading "The Question of the Day," on the right hand side of the page, mid-way down.

The question reads: Are you in favour of Canada legalizing assisted dying?

Please VOTE NO. The NOs were ahead but only marginally.

Dr Paul Saba shares a personal story of diagnosed illness and a success against the odds.

//www.youtube.com/embed/n1Ib4NHOims

This video provides a counter argument to those advocating the euthanising of children, as Belgium has enacted earlier today; click here for this story.

 The following letter came to my attention from one of our faithful QLC readers. The author, David Benrimoha, a McGill medical student, (pictured left) argues against the proposed legislation permitting the practice of euthanasia in the province - bill 52. He argues that our ability to form meaning is central to human beings and to deny this is not right. Euthanasia denies this right and an important time of one's life.

I have never experienced what it is like to see a terminally ill family member in pain, and so I do not for one moment pretend to judge or criticize the choices or beliefs of patients or their families. Instead, I want to offer a philosophical argument against euthanasia and in favour of alternative practices, such as expanded access to palliative care.

There is a character in Harper Lee’s classic novel To Kill a Mockingbird called Mrs. Dubose, an old woman who is terminally ill and addicted to the morphine that she takes for her terrible, fitful pain. As a punishment for misbehaving, Jem (the narrator’s brother and the son of lawyer Atticus Finch) is made to read to her every day. At the end of every reading session a bell is rung and Mrs. Dubose receives her dose of morphine. But every day the bell is rung a little later, and in this way, even though she faces the return of her pain, Mrs. Dubose weans herself off the morphine and dies free of the mind-clouding painkillers.

It has taken me a long time, but I now realize why I find this story so powerful. It is because it is an expression of what I consider to be the most human of all desires: the desire to create and hold onto meaning in one’s life. Mrs. Dubose could probably have convinced her servants to give her a lethal dose of morphine — a common practice in assisted suicide — but instead chose a course of suffering that led to her final, though short-lived, victory over her addiction. Outwardly this may seem pointless: Why, if she was going to die anyway, should she have suffered so much?

In my opinion, our society has become preoccupied with pain and suffering and preventing it at all costs. It is of course logical and just to prevent and ease pain and suffering when we can, and to develop and use medications and technologies that can do this. But is death preferable to pain? In a video that was shown to us in class (not directly related to euthanasia) Viktor Frankl — philosopher, neurologist, psychiatrist and Auschwitz survivor — speaks of the extreme suffering he and his fellow inmates were subject to in the concentration camp, and of how, even in the midst of all that suffering, he was able to find meaning in choosing his own attitude to his situation, and in thinking of his love for his wife, who had been sent to another camp. He is far from the only example of a person who, through extreme suffering such as that caused by the Holocaust, has been able to create and find meaning.

In Quebec, euthanasia is being considered for persons suffering from a terminal illness who are still able to make competent decisions. Yet these are the very people who are most likely to be able, with the right support, to find or create meaning at the end of their lives. This is why I am against euthanasia: because allowing it is saying that we are willing to sacrifice our potential to find meaning in order to end suffering; that we have allowed pain to conquer the pursuit that most defines our humanity.

The best counter-argument to all this is that we as a society have no right to demand that people keep on living in terrible pain when they, as competent adults, would prefer a quick death. My response is that this choice is not the one we are faced with. We have, as has been pointed out by many doctors, technologies and medications that can allow us to manage pain; we have psychologists, chaplains and other guides who can help people find and create meaning in their final days. All of this is brought together in the discipline of palliative care, which aims to help patients find the peace and dignity they want at the end of life, on their own terms. These technologies and approaches are not perfect, of course; they cannot prevent all suffering. But I have seen them work, seen that despite their suffering patients continue to love, to reconcile with estranged family members, to play music, to eat favourite foods, to reflect, and to find meaning in life.

As a society we should be putting our efforts into improving end-of-life care. Palliative care in situations where an illness cannot be cured has proven to be less resource-intensive compared to aggressive treatment, or repeated stays in an intensive-care unit — both of which entail expensive medications and procedures, and the time of large numbers of specialized staff. As such, palliative care is a sustainable option, a responsible use of our health-care resources that ensures patients are able to die with dignity. Even though the process may be painful and draining for patients, families, doctors, nurses and other health professionals, I believe that the beauty and power of the human experience of creating, finding and holding onto meaning is worth it.

David Benrimoh is a first-year medical student at McGill University. He lives in Côte-St-Luc.

The war aimed at swaying Quebecers to favour bill 52 turned its rhetorical canons today at the anglophone community.

The Gazette Quebec Bureau Chief, Kevin Dougherty hands a bouquet to the bill's proponents in a  complimentary article - "Bill 52: Veronique Hivon's long battle," about the legislation that will permit the practice of euthanasia of our fellow citizens.

(Above: Quebec minister Veronique Hivon waves as she is applauded by members of the legislature after she tabled Bill 52. Photo by Jacques Boissinot, CP)

Dougherty (pictured below) argues that the inter-party concord that has prevailed over the process leading up to the tabling of the proposed law is a sign of the merit of this legislation.

Unfortunately Mr. Dougherty's professionalism is lacking on three fronts.

• His logic. It does not follow that if political parties agree on a particular law, then that law is a good one. History is rife with examples: apartheid, segregation, ...
• His objectivity. He subordinates his journalistic duty to that of being a mouth-piece for the government as he spouts the bill's objectives of solidarity, compassion, and respect. Is one really being compassionate when killing a patient to end his pain? Is this really respectful of their dignity?
• His ethics. Finally, through his copious references to anglophone MNA Geoffrey Kelley who endorses the bill, our columnist wishes to sway readers by appealing to a kindred authority figure.

Dear Mr. Dougherty, no institution or government agency should be given the right or power to take the life of an innocent human person.

(Bill 52, entitled "An Act respecting end-of-life care," was tabled this past June 12, 2013, and will be debated when the provincial legislature reopens this Fall, at the conclusion of the Summer recess. You may consult the 20-page proposed legislation by clicking here as well as leave your comments about it.)

 The title for this blog is taken from Shakespeare's tragedy Romeo and Juliet. Juliet, the speaker, is saying that names of things do not matter, only what these things "are."

This is pertinent to the current discussion about Bill 52 - "An Act respecting end-of-life care" tabled by the Quebec government this past June 12, 2013. 

Bill 52 is not about the sweet smell of roses but rather euthanasia or as the Quebec government prefers to call it, "medical aid in dying," or MAD to use an acronym coined by Margaret Somerville.

Ambiguity in language is one example that Somerville, founding director of the Centre for Medicine, Ethics, and Law at McGill Univeristy, noted in her commentary on Bill 52 which appeared in The Globe and Mail this past June 19, 2013.

Somerville's commentary about this dangerous bill (her descriptor) is "intended simply to identify some of the arguments, reasoning and strategies that it manifests and issues it raises."

 Bill 52 - "An Act respecting end-of-life care," was tabled this past June 12, 2013, in the National Assembly, days prior to the end of the legislative session.

In today's opinion section of the Gazette, two professionals speak out against this legislation, arguing that its goal is nothing other than active euthanasia.

A couple points which Dr. Marc Beauchamp and Me. Michel Racicot make about the bill include:

1. its use of misleading language 

 [T]he government terminology is not based on any semantic recognition in known literature, or in our country's case law. (...)

Bill 52 introduces the concept of "terminal palliative sedation" a concept not defined in the bill, and one that causes a lot of confusion. Inasmuch as the goal of such sedation is to cause death, not to relive pain, it is also another form of active euthanasia.

It therefore appears clear that the bill essentially aims, using this newly invented terminology, to eliminate a prohibition ... on a physician voluntarily ending a patient's life.

2. mistaken notion of compassionate

[The government argues that not permitting] euthanasia would be a sign of a lack of compassion on the part of medical staff. Such an affirmation, false and otherwise improper, undermines the recognition of all those who provide care, with humanity and dedication, to suffering patients in Quebec, and who believe the medical staff should not offer euthanasia to end-of-life patients, or cause their death.

The writers, one representing the Physicians' Alliance for Total Refusal of Euthanasia and the other a board member of Living with Dignity Citizens' Network, make several more points before urging elected officials to "share the responsibility for protecting the population" and vote against this law.

Dr. Frank Humphrey may play an important role in discussions about Bill 52 - "An Act respecting end-of-life care."

In a previous blog, I noted that on Wednesday, June 12, 2013, days prior to the Summer recess, the Quebec provincial government introduced Bill 52, a bill if passed will permit euthanasia.

Section 26 of the 20-page bill presents four criteria authorizing euthanasia. These are:

1. be of full age, be capable of giving consent to care and be an insured person within themeaning of the Health Insurance Act;
2. suffer from an incurable serious illness;
3. suffer from an advanced state of irreversible decline n capability; and
4. suffer from constant and unbearable physical or pyschological pain which cannot be relieved in a manner the person deems tolerable.

Dr. Humphrey, a quadriplegic, may play an important part in the discussions because he fulfills all four of these criteria.

Dr. Humphrey has amyotrophic lateral sclerosis (ALS or Lou Gerig's disease).

ALS is a neurodegenerative disease, akin to muscular dystrophy. In Dr. Humphrey's case it has progressed over the past eight years.

Further after a recent six-month stay in a hospital dealing with pneumonia, his wife Daria was told by a number of physicans that maybe it was time for her husband to die.

Yet, Dr. Humphrey, until recently pastor with the Peoples Church of Montreal, is an accomplished author. He has recently published a text on origins of the universe, melding science with faith.

Bill 52 is a failure for it ignores the giftedness of the person as manifested not only by those who have published works of science but also by simply being a member of the human family.

For a couple of stories about Dr. Humphrey and issues related to the proposed legislation, see Coalition of Physicians for Social Justice and the Suburban newspaper.

This past Wednesday, June 12, 2013, the Quebec government tabled Bill 52 - "An Act respecting end-of-life care," legislation aimed at permitting euthanasia.

Not a law yet, it will debated this Fall for the purpose of becoming law.

In an effort to bring clarity to the discussion, within my own mind at least, I've come across a couple of good commentaries.

(To view the 20-page proposed legislation, learn about the stages of consideration, and leave a comment about the bill, visit the provincial website.) 

First, the following points come from Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition, appearing in a letter and then in a subsequent blog.

• Contrary to the comments by many media outlets and some media releases from prolife groups, Bill 52 does not authorize assisted suicide (Section 241 of the Criminal Code).
• Bill 52 legalizes euthanasia under the euphemism medical aid in dying. Euthanasia is a form of homicide. The difference between euthanasia and assisted suicide is: Euthanasia is an act whereby the physician or someone else causes your death (homicide) and Assisted suicide is an act whereby the physician or someone else provides the means (lethal dose) and you take it yourself (assisting a suicide).
• The bill is clear, the doctor administers, that means euthanasia. Assisted suicide is when the doctor prescribes.
• The supposed safeguards that the Quebec government have chosen are nearly identical to the current Belgian model.
• The Belgium model differs from the Netherlands model in the way it is administered and paid for. The Belgian model administers and pays for the act of euthanasia through its palliative care system. The Belgian model only authorizes euthanasia by physicians, but assisted suicide does occur sometimes.
• The Quebec government is defining euthanasia as a medical act, within the continuum of palliative care.
• The palliative care system may or may not accept euthanasia within Quebec, but it is being defined in that manner.

In the blog, his introductory note on why we should oppose the practice of euthanasia is well worth repeating. These are:

1. No person, institution or government agency should be given the right or power to take the life of a human person.
2. The power of one person, to cause the death of another person, will be abused. Human interaction often includes some level of abuse. In this circumstance the abuse results in the death of a human person.
3. Discrimination exists towards identified groups of people or individuals. Legalizing euthanasia, for instance, threatens the lives of people with disabilities.

Regarding the second of these three points, Schadenberg cites in this blog several studies indicating as much in Belgium.

A second writer who provides commentary on different sections of the bill ist into the nitty-gritty of Bill 52 is Wesley Smith. He has written two pieces found here and here. In these two articles he examines sections - 3, 8, 26, and 29.

Once again, Bill 52 - "An Act respecting end-of-life care," may be viewed here.