Health Canada reported that across the country there were 1,179, medically assisted deaths between Jan. 1 and June 30, 2017. That’s approximately 0.9 per cent of all deaths, up from 0.6 per cent in the previous six months. Pixabay

Can a doctor-assisted death be ‘natural’ and ‘suicide’?

By 
  • August 8, 2018

Whenever a doctor assists in a suicide in Ontario by injecting a patient with chemicals to stop the heart, it is recorded on the death certificate as a natural death. 

That fact has at least one medical examiner worried that the truth about how some people have died is being concealed.

“First we’re killing, and now we’re lying about it,” Dr. Gail Churchill of Barrie told The Catholic Register. “It’s just kind of odd, don’t you think?”

However, Ontario Chief Coroner Dirk Huyer rejects the accusation, saying that while it’s true there is no record of a doctor’s intervention on the death certificate, every assisted death in the province is immediately reported to the coroner.

“Ontario has the strongest oversight of any province or territory in Canada,” Huyer said. “Every case is reported. Everybody has scrutiny on all of these cases. From an oversight point of view, trying to understand when it happens and how it happens, we’re probably the most robust in Canada.”

Ontario doctors and nurse practitioners who administer the drugs ending a patient’s life have been instructed not to write “medical assistance in dying” on the death certificate and not to record the drugs used to stop the heart. They must check the box that classifies the death as “natural.” 

Attending physicians have been instructed to record “the illness, disease or disability leading to the request for medical assistance in dying,” says the Ontario Ministry of Health and Long-Term Care.

In Churchill’s mind, the new instructions on filling out death certificates have created a legal fiction at odds with medical reality.

“(The doctors) put the IV in, give you the drugs. You’re out within seconds, right? You’re dead,” Churchill said. “That’s the cause of death, no matter what triggered it…. They’re calling it natural, which is … it’s not really natural.”

In October, Health Canada reported that across the country there were 1,179, medically assisted deaths between Jan. 1 and June 30, 2017. That’s approximately 0.9 per cent of all deaths, up from 0.6 per cent in the previous six months. Updated statistics are expected this summer, but Churchill claims the Ontario Coroner’s office is fielding three calls a day reporting assisted deaths.

When euthanasia became legal in June 2016, Saskatchewan was recording assisted deaths as suicides, though that policy has since been challenged. In many provinces the immediate cause of death is recorded as “toxicity” and the underlying condition recorded as a contributing factor under cause of death. In Alberta, assisted deaths are listed as “unclassified” rather than “natural.” 

British Columbia has a two-part death certificate where doctors are instructed to record so-called medical assistance in dying in “Part 1 (a)” and then report the underlying illness or disease which the doctor determined was “grievous and irremediable” (the legal pre-condition for any assisted death) in “Part 1 (b).” 

Ontario law also says the government can’t publicly release the name of the doctor who performs an assisted suicide.

The biggest worry behind the policy is the potential for activists opposed to assisted suicide to harass physicians, said Huyer. 

“I have observed some very significant debate and some very significant discussion that became heated around this topic, including in smaller communities,” said Huyer. 

Euthanasia Prevention Coalition director Alex Schadenberg shares Churchill’s worry about death certificates that mislead or obscure the truth.

“Any time you’re having a medical certificate lie, that’s a problem,” Schadenberg said. “They’re a legal document.”

Huyer disputes the charge that the reporting system lies just because assisted death is not recorded on the death certificate. 

“They (doctors) have to report every detail to us and they also are going to have to report every detail to the federal government,” he said. 

Even though a medically-assisted death isn’t recorded on a death certificate, the coroner’s office puts a lot of effort into recording a full, complete and truthful account of each death, Huyer said.

“Whether it’s a lie or not I think will be up for you and your readers to decide,” he said. 

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