By Susan Martinuk. June 13, 2013.

Quebec is prepared to bring euthanasia (and all of its inherent problems) to Canada.

This past Wednesday, Social Services Minister Veronique Hivon presented what she calls the “continuum” of health care for Quebecers who are suffering. Bill 52, An Act Respecting End-of-Life Care, gives Quebec residents the right to request what the bill euphemistically refers to as “medical aid to die.”

Needless to say, this so-called right is not supported by the Quebec Medical Association. A full 88 per cent of doctors who belong to the Canadian Society of Palliative Care Physicians (doctors who deal with dying patients) oppose euthanasia. In Quebec, the Physicians Alliance for Total Refusal of Euthanasia (a name that leaves little doubt as to their stance) says the bill pushes Quebecers onto “a dangerous path.” The Coalition of Physicians for Social Justice calls it “immoral and unconscionable,” and says it opens the door to “abuse.”

These groups are concerned about the potential for abuse because they understand what has happened to well-meaning euthanasia laws in other countries, and know that society and medicine are not best served by allowing access to euthanasia.

But after several years of commissions, Quebec is confident that its law has sufficient controls to avoid the inevitable slippery slope and bypass the potential for abuse. It will avoid such issues because it has, not just rules, but “special rules,” “specific requirements” and “special functions” that will all operate to create a “framework for the organization and regulation of end-of-life care.”

Patients who request “medical aid to die” must meet the following criteria: they must be 18 and older, “suffer from an incurable, serious illness, suffer from an advanced state of irreversible decline in capacity, and suffer from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.”

Patients must make the request in writing, “in a free and informed manner.” A second physician (independent of the patient and the doctor making the initial request) must give his/her medical consent in writing.

The province is going to establish a commission on end-of-life care to oversee/evaluate the process. It will be composed of four health or social services professionals (at least two physicians), a jurist, a member of an institution and an ethicist.

It’s hard to imagine that such stringent controls could possibly be ineffective.

But a decade of euthanasia in Belgium suggests these regulations are certainly fallible and, over time, will do little to prevent euthanasia from becoming a common and trivial exercise.

Belgium adopted a euthanasia law in 2002, with essentially all of the same controls in place — the patient has to be an adult or a minor with adult legal status, the request has to be voluntary and repeated, no hope of recovery, constant and unbearable physical or psychological suffering, and the proper paperwork and consultations must happen.

Ten years later, Belgium has broadened the scope of eligibility and made headlines for euthanizing those who are chronically depressed, an anorexic who was sexually abused by her psychiatrist, and identical twins who were told they would go blind. They are currently discussing euthanizing those with dementia, as well as premature and handicapped newborns. The Belgian senate is voting on a law to euthanize children because “age should not be … a decisive criteria” for euthanasia.

In 2012, the European Institute of Bioethics looked through reports by the commission that oversees euthanasia and evaluated the effectiveness and enforcement of its controls. Quebecers should run, not walk, to the nearest computer and see what it has to say: The commission has admitted it cannot determine the number of euthanasia cases that go unreported, even though the purpose of the law was to make euthanasia transparent and regulate it. The Lancet (2012) reports that almost one-quarter (23 per cent) of euthanasia deaths in the Netherlands are not reported; Belgium is likely similar.

The commission looks the other way when written declarations by patients are missing from files. The requirement for a “life-threatening and incurable illness” has somehow morphed to include patients suffering from various non-fatal pathologies.

“Unbearable pain” is now considered too subjective to be a requirement, so the commission no longer verifies suffering.

Medically assisted suicide (the doctor provides lethal drugs to the patient, but is not present at death), not included in the initial law, is now assumed to be legal. The law requires any surplus of the lethal drug to be returned to the pharmacy, but this has never happened.

The law assures all that the oversight commission will be a “pluralistic” representation of medical, legal and social professions. Yet, nearly half of the commissioners are also members of right-to-die groups.

In spite of all this, Quebec is convinced these same control mechanisms will be effective when deployed in Canada.

My one comment to all the well-meaning groups and legislators who are charging into this ethical black hole because they want to die an easy death: Be careful what you wish for; it may come true. Death may soon be all too easy to attain.

Source: The Calgary Herald