Quebec euthanasia statistics: 67% increase in euthanasia deaths in second year

Introduction

Since 10 December, 2015, euthanasia has been provided by physicians in Quebec under the terms of An Act Respecting End of Life Care (ARELC).  Health and social services agencies established by the government throughout the province are state agencies responsible for the delivery and coordination of health care in the province administrative regions. These are called Centres intégrés de santé et de services sociaux (CISSS) and Centres intégrés universitaires de santé et de services sociaux [CIUSSS).  Some administrative regions (like Montreal and the Quebec City region) have more than one CISSS or CIUSSS.

These agencies are responsible for the delivery of euthanasia.  For two years beginning 10 December, 2015, they were required to make reports twice yearly to a commission established by the law to monitor the administration of euthanasia (the Commission sur les soins de fin de vie) and publish them on their websites.  These twice-yearly reports will apparently cease to be published after that time.  The Commission draws from these and other reports to make its required summary of activity to the legislature (National Assembly).

The Project has compiled the statistics provided in these reports from10 December, 2015 to 10 December, 2017.  The compilation includes tables and charts, some of which are reproduced below.

Euthanasia Requests in Quebec, 2016-2017

Euthanasia Requests in Quebec, 2016-2017

Note that, in some cases, the number of patients lethally infused is higher than the number of requests because euthanasia was provided in response to a request made in the previous reporting period.  In addition, not all euthanasia deaths are captured in these reports, as some regions with low populations do not publish reports, and euthanasia may be provided by private entities that are not subject to the statutory twice-yearly reporting requirement.

  • The number of euthanasia requests made weekly in the province increased from about 14 in 2016 to about 23 in 2017. In Montérégie the number of requests weekly doubled; they more than tripled in Bas-Saint-Laurent.
  • Euthanasia was provided about 9 times weekly in the province during 2016 and 14 times weekly in 2017.
  • The number of euthanasia deaths increased by about 67% from 454 in 2016 to 757 in 2017.  This is about 1.1% of deaths from all causes, a rate not reached by Belgium for 9 years after legalization.
    • In Outaouais the number of euthanasia deaths almost doubled (11 to 21)
    • In Chaudière-Appalaches the number more than doubled (18 to 40)
    • The number of euthanaia deaths more than tripled in Saguenay-Lac-Staint-Jean (6 to 19)
    • The number of euthanasia deaths quadrupled in Côte-Nord (2 to 8), and more than quadrupled in Abitibi-Témiscamingue (4 to 18).
  • 434 requests for euthanasia were not acted upon in 2017, up from 263 in 2016.  However, the percentage of all requests not acted upon remained constant at 37%.
    • In 11% of the cases the patient died of natural causes before euthanasia was provided, up from 9% in 2016.
    • About 8% of the patients did not qualify for the procedure, down from 11% in 2016.
  • Marked increases in rates of continuous palliative sedation occurred in a couple of regions, notably Laurentides (a 2017 reate almost six times that of 2016) 

See: full statistical summary with downloadable Excel file

B.C. doctor cleared of wrongdoing for providing assisted death to woman who starved herself

Globe and Mail

Kelly Grant

British Columbia’s physician regulator has cleared a doctor of any wrongdoing for providing medical aid in dying to a woman who did not qualify for the procedure until she starved herself to the brink of death.

A committee of the College of Physicians and Surgeons of British Columbia (CPSBC) found that Ellen Wiebe did not break the regulator’s rules when she helped a 56-year-old patient known as Ms. S to die last year.

The case is the first to be made public in which a medical regulator has ruled on the contentious question of whether doctors should grant assisted deaths to patients who only satisfy all the criteria of the federal law after they stop eating and drinking.

“It was determined that Ms. S met the requisite criteria and was indeed eligible for medical assistance in dying, despite the fact that her refusal of medical treatment, food, and water, undoubtedly hastened her death and contributed to its ‘reasonable foreseeability,'” the college’s inquiry committee wrote in a Feb. 13 report. . . . [Full text]

 

Nurse practitioners not always compensated for providing medical assistance in dying

Ministry of Health and Long Term Care does not provide fee-for-service the way it does for physicians

CBC News

Angela Gemmill

The Nurse Practitioners Association of Ontario says some of its members are helping to provide their patients with medically assisted deaths without compensation.

It wasn’t until April of 2017 that nurse practitioners (NPs) in Ontario could prescribe the controlled substances used for medical assistance in dying (MAID).

Since then about 40 NPs across the province have provided either patient assessments or the procedure itself.

A patient must be assessed by two independent health care providers. This can be either a physician or a nurse practitioner. The procedure is the same regardless of who provides it.

One nurse practitioner in Sudbury, Ont. says it’s important for her to provide support to patients who want to take this step. She admits that medical assistance in dying is rather limited in Sudbury, in that not a lot of physicians or nurse practitioners are willing to provide it for patients. . . [Full text]

 

Thousands step up in support of doctors’ conscience fight

The Catholic Register

Michael Swan

An Ontario campaign to pressure politicians over the protection of health care conscience rights is “democracy in action,” said an organizer.

The Coalition of HealthCARE has so far collected 19,000 names and e-mail addresses in its “Call for Conscience Campaign.” That does not include results from the Archdiocese of Toronto.

The non-partisan campaign was launched to oppose and raise awareness about regulations that force doctors to refer for assisted suicide and euthanasia against their moral convictions.

By the end of March, people who have signed up during the campaign should receive instructions about how to e-mail all the candidates in their ridings in the run-up to Ontario’s June 7 provincial election. . . [Full text]

Formal network of docs offering medical assistance in dying is in the works for northeastern Ontario

Informal referral network currently in place with local physicians

CBC News

Angela Gemmill

For those in Sudbury and District seeking a doctor’s help to die, it may soon get a little easier to find one who is trained.

About 40 doctors and nurse practitioners in the region are now trained to offer Medical Assistance in Dying (MAID), after they had specialized training last fall in Sudbury from the Canadian Medical Association.

The Supreme Court of Canada ruled in June, 2016  that medical assistance in dying is a constitutional right, under Bill C-14.

Between then and now, there has only been an informal network for people seeking medically assisted death, said Dr. Paul Preston, Vice President of Clinical for the North East Local Health Integration Network, and an advocate for access for those seeking a doctor’s help with dying. . . [Full text]

 

Nova Scotia: make a call for conscience

Nova Scotia Call for Conscience 2018

Coalition for HealthCARE and Conscience

Over recent months, it has become increasingly clear that the conscience rights of Nova Scotia doctors are not being adequately protected.

A leading Nova Scotia medical regulator recently told doctors they must participate in euthanasia by making an “effective referral” even if this would require them to violate their conscience. It was made clear that the penalty for refusing to comply could be discipline for “unprofessional conduct”. Performing or referring for assisted suicide and euthanasia involve killing a patient. This is directly opposed to the teachings of many faiths and the traditional Hippocratic oath. Most health care professionals embarked on their careers to heal people, not kill them. No Nova Scotian should be required to be involved against their will.

Other provinces have found ways to provide access without forcing people to act against their moral convictions.

We need to let the Minister of Health of Nova Scotia know that we need legislation to protect conscience rights in our province. In November, Manitoba legislators passed a Bill which said that Manitoba health care professionals could not be compelled to participate in assisted suicide. We need a similar bill here in Nova Scotia. Please write the Minister of Health using the form below. The letter will automatically be sent to the Premier and the leaders of the opposition parties. Conscience rights are an all party issue. We need our legislators to show their support for Nova Scotia health care professionals.

Take action here. Write to the Government of Nova Scotia.

Answering Physicians Top 5 Legal Questions

In 2017, the medical students’ forum hosted by Canadian Physicians for Life included a question and answer session about legal issues. Albertos Polizogopoulos is lead counsel in the constitutional challenge to the College of Physicians and Surgeons of Ontario (CPSO) policy that demands effective referral for all morally contested services, including euthanasia and assisted suicide.  Phil Horgan, a Toronto lawyer, is President of the Catholic Civil Rights League, which jointly intervened in the case with the Faith and Freedom Alliance and Protection of Conscience Project.  Questions have been listed below with the corresponding time segments.  Links have been provided to background material concerning subjects covered in the answers.

1. How can physicians best disclose to their patients their conscientious objections?  (00:00-11:18)

2. What happens when a patient reports a physician to their college for exercising their right to conscientious objection?  (11:18-20:00)

3. How can conscience and religious rights be exercised, practically speaking?  (20:00-23:33)

4. Is there a sense that other provinces are just waiting to see what is going to happen with these current cases going on in Ontario? (23:33-34:35)

5. Can you comment on institutions?  Do they have rights themselves?   (34:45-40:15)

The courts keep inventing new rights, turning our Charter on its head

National Post
Reproduced with permission

John Carpay

If I told you that I wanted to rob a home or store, would you sell me a gun? Presumably not. But what about giving me the name and contact info of another person who is willing to sell me a gun? If you wanted to avoid any participation in my planned robbery, you would refuse to provide a referral.

When it comes to female genital mutilation (the cutting and removal of some or all of a young girl’s external genitalia) the College of Physicians and Surgeons of Ontario (CPSO) recognizes that referring is as bad as providing. The CPSO prohibits this practice, common in many African and Middle Eastern countries. Female genital mutilation causes infection, disease and death in many girls, and life-long health problems for millions of women.

The CPSO policy prohibits physicians from performing, and from referring for, female genital mutilation procedures. Both performing and referring constitute professional misconduct. The reasoning is obvious. If mutilating a girl is wrong, then it’s also wrong to provide a referral for this barbaric procedure.

College of Physicians and Surgeons of Ontario in Toronto, Ont. on Tuesday April 9, 2013.

Sadly, the CPSO abandoned this common-sense approach in the case of Christian Medical and Dental Society vs. CPSO. This court case was about a challenge to the CPSO policy requiring all doctors in Ontario to provide referrals for abortion, assisted suicide, and other medical procedures which some doctors view as harmful to patients and morally wrong. In court the CPSO argued that “a referral is neither an endorsement of the service for which the referral is provided, nor a guarantee that it will be provided.” The CPSO argued that providing a referral is trivial and insignificant, so a doctor would not be violating her conscience when referring a patient for a procedure that the doctor considers harmful. If the CPSO’s courtroom arguments are true, then why prohibit referring for female genital mutilation?

The Ontario Superior Court of Justice ruled that the CPSO policy violates the Charter freedom of religion and conscience, but then justified this violation as necessary to ensure “equitable” access to health-care services.

Abortion and assisted suicide are both legal medical procedures. Plenty of doctors are available to provide the one, the other, or both. Having to ask two, three or more doctors for a particular medical service is inconvenient for patients, to be sure.

But does the Charter provide citizens with a legal right to be free from inconvenience? Beyond a bald declaration, the court provides no explanation as to how or why being inconvenienced is a violation of the Charter. Nor does the court explain why it is necessary to force every single doctor in Ontario to provide referrals for abortion and assisted suicide. In other words, even if many doctors refuse to provide referrals for these services, the public would still have ready access to both.

The purpose of the Charter is to protect citizens from government. For example, the Charter should protect health-care workers (and everyone else) from being pressured or coerced by a government body to do what one believes to be wrong.

Conversely, there is no Charter right to force another human being to provide a service that runs contrary to their conscience. Interactions between citizens should be free from coercion. A patient’s power to compel a doctor to do what the doctor believes to be harmful is as destructive as a doctor’s power to compel a patient to do what the patient believes to be harmful.

The doctors who challenged the CPSO policy were not merely asking the court to be spared an inconvenience. Rather, an Ontario doctor who refuses to violate her conscience risks expulsion from the medical profession.

In upholding the CPSO policy, the court confuses fundamental Charter freedoms with personal interests and desires. The court has dismissed the Charter’s protection from government coercion as less important than a newly invented “right” to compel our fellow citizens (in this case doctors) to do what we want them to do. The court has turned the Charter on its head.

Lawyer John Carpay is president of the Justice Centre for Constitutional Freedoms (Jccf.ca), which intervened in Christian Medical and Dental Society of Canada vs. College of Physicians and Surgeons of Ontario.

 

Obliged to Kill

The Assault on Medical Conscience

The Weekly Standard
Reproduced with permission

Wesley J. Smith*

A court in Ontario, Canada, has ruled that a patient’s desire to be euthanized trumps a doctor’s conscientious objection. Doctors there now face the cruel choice between complicity in what they consider a grievous wrong – killing a sick or disabled patient – and the very real prospect of legal or professional sanction.

A little background: In 2015, the Supreme Court of Canada conjured a right to lethal-injection euthanasia for anyone with a medically diagnosable condition that causes irremediable suffering – as defined by the patient. No matter if palliative interventions could significantly reduce painful symptoms, if the patient would rather die, it’s the patient’s right to be killed. Parliament then kowtowed to the court and legalized euthanasia across Canada. Since each province administers the country’s socialized single-payer health-care system within its bounds, each provincial parliament also passed laws to accommodate euthanasia’s legalization.

Not surprisingly, that raised the thorny question of what is often called “medical conscience,” most acutely for Christian doctors as well as those who take seriously the Hippocratic oath, which prohibits doctors from participating in a patient’s suicide. These conscientious objectors demanded the right not to kill patients or to be obliged to “refer” patients to a doctor who will. Most provinces accommodated dissenting doctors by creating lists of practitioners willing to participate in what is euphemistically termed MAID (medical assistance in dying).

But Ontario refused that accommodation. Instead, its euthanasia law requires physicians asked by a legally qualified patient either to do the deed personally or make an “effective referral” to a “non-objecting available and accessible physician, nurse practitioner, or agency .  .  . in a timely manner.”

A group of physicians sued to be exempted from the requirement, arguing rightly that the euthanize-or-refer requirement is a violation of their Charter-protected right (akin to a constitutional right) to “freedom of conscience and religion.”

Unfortunately, the reviewing court acknowledged that while forced referral does indeed “infringe the rights of religious freedom .  .  . guaranteed under the Charter,” this enumerated right must nonetheless take a back seat to the court-invented right of “equitable access to such medical services as are legally available in Ontario,” which the court deemed a “natural corollary of the right of each individual to life, liberty, and the security of the person.” Penumbras, meet emanations.

And if physicians don’t want to commit what they consider a cardinal sin, being complicit in a homicide? The court bluntly ruled: “It would appear that, for these [objecting] physicians, the principal, if not the only, means of addressing their concerns would be a change in the nature of their practice if they intend to continue practicing medicine in Ontario.” In other words, a Catholic oncologist with years of advanced training and experience should stop treating cancer patients and become a podiatrist. (An appeal is expected.)

This isn’t just about Canada. Powerful political and professional forces are pushing to impose the same policy here. The ACLU has repeatedly sued Catholic hospitals for refusing to violate the church’s moral teaching around issues such as abortion and sterilization. Prominent bioethicists have argued in the world’s most prestigious medical and bioethical professional journals that doctors have no right to refuse to provide lawful but morally contentious medical procedures unless they procure another doctor willing to do as requested. Indeed, the eminent doctor and ethicist Ezekiel Emanuel argued in a coauthored piece published by the New England Journal of Medicine that every physician is ethically required to participate in a patient’s legal medical request if the service is not controversial among the professional establishment—explicitly including abortion. If doctors don’t like it? Ezekiel was as blunt as the Canadian court:

Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession.

For now, federal law generally supports medical conscience by prohibiting medical employers from discriminating against professionals who refuse to participate in abortion and other controversial medical services. But the law requires administrative enforcement in disputes rather than permitting an individual cause of action in civil court. That has been a problem in recent years. The Obama administration, clearly hostile to the free exercise of religion in the context of health care, was not viewed by pro-life and orthodox Christian doctors as a reliable or enthusiastic upholder of medical conscience.

The Trump administration has been changing course to actively support medical conscience. The Department of Health and Human Services recently announced the formation of a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights, which would shift emphasis toward rigorous defense of medical conscience rights.

Critics have objected belligerently. The New York Times editorialized that the new emphasis could lead to “grim consequences” for patients—including, ludicrously, the denial by religious doctors of “breast exams or pap smears.”

The American College of Obstetricians and Gynecologists joined the Physicians for Reproductive Health to decry the creation of the new office – which, remember, is merely dedicated to improving the enforcement of existing law – warning darkly that the proposal “could embolden some providers and institutions to discriminate against patients based on the patient’s health care decisions.”

The Massachusetts Medical Society joined the fearmongering chorus, opining that the new office could allow doctors to shirk their “responsibility to heal the sick.” Not to be outdone in the paranoia department, People for the American Way worried the new office might mean that “other staff like translators also refuse to serve patients, which could heighten disparities in health care for non-English-speaking patients.”

The Ontario court ruling is a harbinger of our public policy future. Judging by the apocalyptic reaction against the formation of the Conscience and Religious Freedom Division, powerful domestic social and political forces want to do here what the Ontario court ruling – if it sticks on appeal – could do in that province: drive pro-life, orthodox Christian, and other conscience-driven doctors, nurses, and medical professionals from their current positions in our health-care system.


Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council.

Physicians seek leave to appeal Ontario court ruling against physician freedom of conscience

Introduction

Physicians and physician associations are seeking leave to appeal a decision of the Ontario Divisional Court to the effect that physicians must collaborate in providing procedures and services to which they object for reasons of conscience, even if that means collaborating in euthanasia and assisted suicide.  The appeal will be costly.  Faye Sonier, Chief Executive Office of one of the associations that brought the challenge, has issued a plea for donations to support the appeal by Canadian Physicians for Life, the Christian Medical and Dental Society, and the Canadian Federation of Catholic Physicians’ Societies.

Plea for donations to support the appeal of the Ontario Divisional Court decision

The time has come to further our fight to defend the conscience rights of doctors in Ontario. I’m asking you to support our efforts in this fight by making a donation today

As you know, the College of Physicians and Surgeons of Ontario (CPSO) decision was released on January 31. The court found the religious freedom rights of Ontario doctors are significantly violated by the CPSO’s policies, but that those violations can be justified to ensure patient access to healthcare. 

After lengthy consultation with the parties involved in our legal coalition and with over a dozen constitutional lawyers, we’ve decided to request permission from the Ontario Court of Appeal to appeal the decision.

We are pursuing an appeal as the decision was troubling and problematic on many fronts. We have numerous grounds of appeal from which to choose and we will narrow our focus in the coming days.

This is an important step in a process:

  • to ensure that policies that serve only to restrict the constitutional freedoms of physicians do not go unchallenged;
  • to dissuade other provinces from acting similarly;
  • and to communicate that patient access to healthcare is not hindered by maintaining the respect for conscientious objectors in the medical field.

The three physician groups involved in this legal fight, Canadian Physicians for Life, the Christian Medical and Dental Society, and the Canadian Federation of Catholic Physicians’ Societies, are joining together to raise the $125,000 needed for this next step of litigation.

We’re coming to you to ask for your financial support.

Much of the legal costs will be accrued up front as we must conduct research and prepare our written arguments to file the legal documents requesting the opportunity to appeal.  One-time donations made here will directly support this legal fight.

Physicians for Life is a registered charity and issues tax receipts.

Sincerely,

Faye Sonier
Executive Director & General Legal Counsel

P.S. Thank you so much for enabling CPL to continue this battle to defend conscience rights by making your donation today. This case is urgent, and we need funds as soon as possible to ensure that our legal counsel can be in the best position possible to further this fight.