End-of-life ‘medical aid’ is euthanasia

  • June 19, 2013

On June 12, the Quebec national assembly introduced a bill to legalize euthanasia that is rife with false claims, euphemisms and ambiguous language.

Bill 52 (“An Act respecting end-of-life care”) defines end-of-life care to mean palliative care provided to persons at the end of their lives, with palliative care defined to include terminal sedation and medical aid in dying. But make no mistake, medical aid in dying is a euphemism for euthanasia.

The bill states that doctors would “administer” medical aid in dying. Therefore the bill is decriminalizing euthanasia in Quebec. This is not about assisted suicide, where a person self-administers death. Euthanasia is a form of homicide because it involves someone (in the case of Bill 52, a doctor) directly and intentionally causing the death of another person, usually by lethal injection.

Under this bill, the very definition of palliative care is being changed to include terminal palliative sedation and medical aid in dying. In other words, euthanasia. This is a frightening prospect.

The bill also creates a “right to receive palliative care.” A right to receive palliative care would be good, except that under Quebec’s new definition of palliative care these care options include euthanasia. Therefore the bill creates a right to receive euthanasia.

The definition of terminal sedation is clear, but the rules concerning terminal sedation are distressingly vague. Sedation for the purposes of palliation is good. The danger is that, lacking firm rules governing terminal sedation, euthanasia without consent could occur and be disguised as terminal sedation.

But that’s not all. The bill states that end-of-life care (euthanasia) may be done at a palliative care hospice. It also allows nurses to perform euthanasia, when it is done in a person’s home. Euthanasia is not even limited to people who are terminally ill. The bill defines the criteria for euthanasia as an incurable serious illness. Many people live with chronic conditions that are incurable and serious, for example diabetes.

People with disabilities would also qualify for euthanasia under the bill. A criteria for euthanasia is having an advanced state of irreversible decline in capability. Many people with disabilities live with an advanced state of irreversible decline.
Nor does the bill protect people suffering from depression or mental illness. A criteria for euthanasia is having physical or psychological pain which cannot be relieved in a manner the person deems tolerable. So people who live with chronic depression or mental illness can qualify for euthanasia simply by rejecting effective treatment that, in their opinion, is intolerable.

The criteria that doctors must follow to approve euthanasia are similar to provisions in Belgium, where there have been several documented cases of abuse. The criteria fails to include: a waiting period, a medical exam by the doctor who receives the euthanasia request, a psychological evaluation, and preventative measures, such as pain control.

Doctors will not be forced to perform euthanasia, but will be required to honour the euthanasia request of a patient by notifying authorities who will find another doctor to do it.

The bill also states that euthanasia procedures must be reported, but only after the death has occurred. That opens the door to possible abuse.

Also, the report is to be submitted by the doctor who euthanized the patient. Will a doctor self-report abuse?

The bill establishes a commission that will be charged with producing annual and five-year reports. But the bill does not specify what data is mandatory in those reports.

The commission will assess compliance with the law but there is no indication of how a non-compliant physician would be sanctioned. The commission will not have the power to investigate problems.

To try to avoid a constitutional battle with the federal government, the bill classifies euthanasia as health care and part of a continuum of care.

The Quebec government contends that, as a health-care matter, “aid in dying” does not fall under Canada’s Criminal Code, which classifies euthanasia as homicide.

In response, federal Justice Minister Rob Nicholson said the government will “review the implications” of the bill, adding that, “The laws that prohibit euthanasia and assisted suicide exist to protect all Canadians, including those who are potentially the most vulnerable, such as people who are sick or elderly, and people with disabilities.”

Bill 52 is a very dangerous bill. It is a masterful example of false claims, euphemisms and ambiguous language that should be opposed because it gives the state the power to end life, creates a framework that has been shown in other countries to lead to abuse and it poses a particular threat to people with disabilities.

Rather than fostering so-called aid in dying, Quebec should abandon Bill-52 and re-commit to improving true palliative care for all of its citizens.

(Schadenberg is the Executive Director and International Chair of the Euthanasia Prevention Coalition.)

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