NZ Herald 7 April 2019
Family First Comment: “The Canadian law has created confusion about what patient’s lives are worth living and what lives aren’t. This is directly, negatively affecting medical care. Canada has abandoned one of the most important aspects of patient-centred care.”
• Dr Sinead Donnelly is a palliative medicine specialist in Wellington.
COMMENT: As the time approaches for Parliament’s Justice Committee to report back on David Seymour’s euthanasia and assisted suicide bill, it is timely to carefully review the impact of legalisation in countries like Canada, often cited by Seymour as exemplary.
Seven Canadian doctors published a 2018 World Medical Journal article, “Euthanasia in Canada: a cautionary tale”, endorsed by 57 other Canadian doctors. They wrote, “As Canadians, we are saddened by this situation, but we hope that our experience and observations will serve as a warning for our colleagues in other countries, and their patients”.
The Canadian Supreme Court ruled in Carter v. Canada (2015) that physicians may provide euthanasia or assisted suicide (EAS) to competent adults who clearly consent, who have a grievous and irremediable medical condition (including illness, disease, or disability) that causes enduring and intolerable physical or psychological suffering, and that cannot be relieved by means acceptable to the individual.
The Canadian law’s sponsor claimed that EAS would remain “very exceptional”. However, the law also said “qualified patients had a right to euthanasia, and the exercise of a right cannot be exceptional”.
Within a year of the ruling, pressure for “Carter Plus” became so great that the federal Government legally committed to considering EAS for adolescents and children, for mental illness alone, and by advance directive (for those who lack capacity, like dementia patients). Two and a half years after legalisation, strong lobbies are intensifying their push towards expanding euthanasia as a response to those cases.
As Seymour states often in support of his own Bill, the Canadian Supreme Court believed “a carefully designed and monitored system of safeguards” would limit risks associated with allowing physicians to kill patients or help them commit suicide. Canada’s EAS death rate in the first year, about 0.9 per cent of all deaths (1,982), was not reached by Belgium for seven to eight years.
Even supplemented by provincial and professional guidelines, current criteria are so broad it permitted lethal injection of an elderly couple who preferred to die together rather than at different times by natural causes.
Other disturbing stories emerge. A 25-year-old disabled woman in acute crisis in an emergency ward was pressured to consider assisted suicide by an attending physician, who called her mother “selfish” for protecting her. Hospital authorities denied a chronically ill, severely disabled patient the care he needed, suggesting euthanasia or assisted suicide instead.
When the Quebec euthanasia law was being instituted, some Quebec emergency physicians, for a time, were letting suicide victims die even though they could have saved their lives. The president of the Association of Quebec Emergency Physicians stated that the law and accompanying publicity may have “confused” the physicians about their role.
Quebec physicians and health care practitioners now work in environments characterised by an emphasis on euthanasia as a purported “right”. The onus is increasingly on physicians to show why euthanasia should be refused, with health care administrators more anxious about being accused of “obstructing access” than about “killing people who really ought not to be killed”. This is the reality of a supposedly carefully designed system.
The Canadian law has created confusion about what patient’s lives are worth living and what lives aren’t. This is directly, negatively affecting medical care. Canada has abandoned one of the most important aspects of patient-centred care.
As Professor Margaret Somerville explains: “The informing philosophies of euthanasia and palliative care are in conflict. Palliative care is based on a commitment to help people to live as fully as possible until they die a natural death. The informing principle of euthanasia is that it is ethical to intentionally inflict death to relieve suffering or even the fear of future suffering.”
Peer-reviewed, published evidence shows most euthanasia requests are motivated by existential issues, including fear of loss of control, of what comes after death, of being a burden on others, demoralisation, and questioning the meaning, purpose and value of life. None of these can be properly addressed by euthanasia. This is hardly “patient-centred” care.
So what can we learn? “The introduction of euthanasia in Canada has caused doubt, conflict and crisis”. The authors suggest an alternative that new disciplines, new professions and new methods may arise to satisfy new social goals but not in the name of medicine.