Two reports renew debate on end-of-life care
Parliamentary committee says improve care,
Royal Society of Canada calls for legalization of assisted death
Just days apart in mid-November two reports dealing with end-of-life care came to diametrically opposed conclusions with a Royal Society of Canada panel calling for full legalization of euthanasia and assisted-suicide while the Parliamentary Committee on Palliative and Compassionate Care made recommendations to improve palliative and end-of-life care, develop suicide prevention strategies, and prevent elder abuse which, according to a lawyer for the Euthanasia Prevention Coalition, “should eliminate any further call for legalized assisted suicide or euthanasia.”
EPC legal counsel Hugh Scher said if the recommendations of the report, “Not to be Forgotten: Care of Vulnerable Canadians,” are implemented, it would “vastly improve care for every Canadian, especially those who are vulnerable.” EPC executive director Alex Schadenberg said studies show those considering euthanasia or doctor-assisted suicide fear pain, suffering, and isolation, and that the parliamentarians have developed a strategy to address those issues.
The Parliamentary Committee on Palliative and Compassionate Care (PCPCC) is an all-party committee formed in 2010 following the defeat of Francine Lalonde’s private member’s bill that sought to legalize euthanasia and assisted suicide. More than 50 MPs from the Conservatives, Liberals, and NDP support the committee’s effort to find concrete ways to improve care for the sick, elderly, and disabled and provide protection for vulnerable persons.
According to the report’s executive summary, the PCPCC received “testimony from hundreds of people at 24 hearings and local round tables” and reflects the MPs’ “personal concern for compassionate care for vulnerable people.” As such, PCPCC made 14 recommendations including urging the federal government to re-establish a palliative care secretariat to support research and facilitate collaboration between various levels of government and to develop a “national palliative and end-of-life care strategy;” greater flexibility in the provision of palliative care services; a palliative care awareness campaign; the improvement of home care palliative services for rural and Indian communities; establishing a National Pain Strategy to properly control pain; creating “a right to home care, long term care and palliative care” for all Canadians; expanded support for caregivers through Employment Insurance, refundable tax credits and the Canada Pension Plan; developing a National Suicide Prevention Strategy; and establishing an Elder Abuse Awareness and Prevention Office to work with various ministries to reduce elder abuse.
The PCPCC was co-chaired by Conservative Harold Albrecht (Kitchener Conestoga), NDP Joe Comartin (Windsor Riverside) and Liberal Michelle Simson (Scarborough Southwest), although Simson was defeated in May and replaced by Frank Valeriote (Guelph).
The three co-chairs each spoke at a press conference on Nov. 17 at the report’s release. Comartin noted that only 16-30 per cent of Canadians have access to palliative care because of regional disparities in the provision of such services. Comartin said Canada’s health care system needed better local palliative care services and improved chronic care for people who live with pain. Albrecht called for a National Suicide Prevention Strategy and Valeriote said that with as many as one in ten – and perhaps one in five – elderly being abused, mostly by caregivers, family members, and friends, an elder abuse awareness and prevention strategy including a permanent office was necessary.
Also speaking at the press conference was Rene Ouimet of the Canadian Association for Suicide Prevention who endorsed the report’s recommendations on suicide prevention and Dan Demers of the Canadian Cancer Society who supported the report’s recommendations on improving palliative care. Jean Guy St. Gelais of the Canadian Network for the Prevention of Elder Abuse endorsed the abuse prevention strategy of the committee, while Dr. John Haggie, president of the Canadian Medical Association, spoke in favour of improving palliative care and increased patient-centred care, both of which are promoted within the report. In response to a media inquiry, Haggie stated, “requests for euthanasia usually reflect a failure to access adequate palliative care.”
The Euthanasia Prevention Coalition endorsed the PCPCC’s report and recommendations. The EPC’s Alex Schadenberg said, “the Parliamentary report represents a blueprint of proactive positive steps that will improve end-of-life care for all Canadians.” He told The Interim the recommendations “point out us in the right direction.”
However, the EPC took exception with the Royal Society of Canada’s (RSC) report, “End-of-Life Decision Making,” which was released two days before the parliamentarians’ report. Schadenberg said the RSC panel “appeared to be made up of advocates from the euthanasia lobby” and indeed it included Jocelyn Downie, a pro-euthanasia philosophy professor and author of Dying Justice: A Case for Decriminalizing Euthanasia and Assisted Suicide in Canada. The panel was chaired by Queen’s University philosophy professor Udo Schuklenk, an atheist and declared euthanasia support. Another philosopher, Sheila McClean, is the author of The Case for Assisted Suicide.
Wesley Smith, an anti-euthanasia lawyer and author, predicted in October 2009 that the panel would endorse full legalization of euthanasia based on its members, saying the RSC “stacked the deck” and when the report was issued he said “the fix was in.”
Schadenberg correctly predicted what the report said before it was released based on the make-up of the panel and noted the RSC “should be embarrassed” a report published under their auspices was so biased. He said it was always clear “they want unlimited euthanasia on demand.”
The seven-member panel unanimously supported discussion points and nearly two dozen recommendations. The report says, “both assisted suicide and euthanasia should be available” and calls on the federal government to “modify the prohibitions on assisted suicide and voluntary euthanasia in the Criminal Code so that, in carefully circumscribed and monitored circumstances, they are legally permissible.” It called for limits on euthanasia for those who were competent to decide for themselves, a 24-hour waiting period between a written or oral request for euthanasia to “allow confidence all conditions and procedural requirements have been met,” and for provincial minor laws to dictate age restrictions on the practice. Schadenberg said that every jurisdiction that permits assisted death has seen the so-called safeguards violated.
Conservative MP Maurice Vellacott (Saskatoon-Wanuskewin) said, “jurisdictions that have legalized euthanasia have yet to develop a law that effectively protects elderly, sick, and disabled persons from euthanasia without their consent.”
The panel also said that “a diagnosis of ‘terminal illness’ should not be required for access to” an assisted death.
The RSC panel also called for improved palliative care services, noting that the focus on such services in Canada relates to cancer patients. It said improvement must be made to deal with patients who are suffering from other maladies.
In other pro-assisted death recommendations, the panel also called for information campaigns on advanced directives, a limited right for health care workers to refuse to carry out assisted death requests, and liability protections for health care workers who participate in euthanasia, assisted suicide, and terminal sedations.
Dr. Daren Heyland, a professor of medicine at Queen’s University and a critical care physician at Kingston General Hospital, told the Globe and Mail, he does not support the RSC’s findings and said “we have issues around the quality of end-of-life care that can’t be solved with euthanasia.”
While insisting that the report served to “trigger a national conversation on end-of-life issues and contribute material for those discussions,” the panel also called for provinces to take matters into their own hands in the absence of federal action and ignore the Criminal Code prohibition on assisted death by instructing prosecutors to not pursue charges in so-called compassionate homicide cases. Currently, only B.C. formally takes a lenient stance having issued a directive in 2004 on murders “motivated by compassion.”
The RSC panel denied that legalizing assisted death leads to a slippery slope from voluntary euthanasia to involuntary euthanasia, pointing to safeguards in jurisdictions that have legalized euthanasia and assisted suicide and dismissed permissive assisted death as a “threat to vulnerable people.” It also denied “dignity” as a consideration in either “supporting or rejecting a permissive regime” of assisted death. Instead, its paramount concern was “autonomy” or “the capacity for self-determination” which, it argued, required “respect for competent individuals’ free and informed decisions with respect to how and when they die.”
Schadenberg said the panel takes autonomy very seriously finding “No reason to prevent the killing of a human being as long as they want it.” Yet, he said, such radical autonomy is not possible. “The purpose of the law is to allow people to live safely among one another,” he said. “Society limits individuals’ rights all the time – unlimited autonomy is not possible because we live with others.”
Canadian polls generally show support for euthanasia, but they also illustrate support for life-affirming alternatives. In October, an Environics Research Group Poll commissioned by LifeCanada, found that two-thirds of Canadians think government should place a high priority on improved access to palliative care and 74 per cent were concerned that legal euthanasia would lead to involuntary euthanasia. Furthermore, 76 per cent of Canadians are concerned that abused elderly people would be pressured to consent to euthanasia.
Schadenberg said the two reports could not be more different. “One report is about we care and protect people in society,” he said, “and the other is about how we kill others.”