Large assisted suicide rate increase as 34% cite concerns of being a burden

The number of assisted suicide and euthanasia deaths in Canada rose by more than 25% in 2019 and made up 2% of all deaths in the country last year, according to a report released by the Canadian Government.

Health Canada’s first annual report on Medical Assistance in Dying (MAID) found 5,631 Canadians chose to have an assisted suicide in 2019. This is an increase of 26.1% when compared to the 4,467 deaths in 2018, where assisted suicide accounted for 1.57% of the total number of deaths in Canada.

More than a third (34%) of those who opted for “medical assistance in dying” cited concerns of being a burden to family or carers. A further 13.7% cited “isolation or loneliness” as their reason for procuring an assisted suicide.

Last year, 92.2% of requests for MAID were approved out of a total of 7,336 applications.

No conscientious objection

The report claims: “it should be noted that there is nothing in the federal MAID legislation that compels a practitioner to provide or assist in providing MAID.”

However, last year, the Ontario Court of Appeal ruled that doctors who oppose euthanasia had to participate in the act by doing an effective referral. In March 2020, the Physicians Alliance Against Euthanasia reported that a growing number of physicians are being bullied into participating into providing euthansia or assisted suicide.

Further expansion of assisted suicide and euthanasia in Canada

Earlier this year, the Canadian Government tabled a bill seeking to expand the country’s assisted suicide and euthanasia regime to include people without a terminal illness.

The legislation, titled Bill C-7, comes after the Quebec Superior Court ruled last year that a safeguard requiring patients to prove their natural death was “reasonably foreseeable” was unconstitutional.

According to Reuters, the bill will now “remove the requirement for a person’s natural death to be reasonably foreseeable in order to be eligible for medical assistance in dying,” opening up assisted suicide and euthanasia to those who aren’t terminally ill.

Disability advocates, including the Council of Canadians with Disabilities, have said the court’s decision sent the message that “having a disability is a fate worse than death”.

Troubling concerns over assisted suicide in Canada

Earlier this year, it was revealed the legalisation of assisted suicide and euthanasia in Canada has led to a surge in organ donations and the open solicitation of those considering medically assisted death, raising ethical concerns.

A recent report from a disability rights expert has highlighted very troubling concerns about the impact Canada’s assisted suicide laws are having on people with disabilities.

According to the report, “The Special Rapporteur is extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective. She has learned that there is no protocol in place to demonstrate that persons with disabilities deemed eligible for assistive dying have been provided with viable alternatives.”

The report goes on to say: “moreover, she [the special rapporteur] has received worrisome information about persons with disabilities in institutions being pressured to seek medical assistance in dying and of practitioners not formally reporting cases involving persons with disabilities.”

During her visit, the Special Rapporteur said people with disabilities told her “they are being offered the ‘choice’ between a nursing home and medical assistance in dying”.

More than 13,000 Canadians have been given a medically-assisted suicide or euthanasia since it was legalised in September 2016, according to the data from the justice department.

Ethical concerns were raised earlier this year when it was revealed the legalisation of assisted suicide and euthanasia in the country had resulted in a surge of organ donations and the open solicitation of those considering assisted suicide or euthanasia. Additionally, an alarming study found that the legalisation of assisted suicide and euthanasia could save the Canadian health care system up to $138 million per year.

Doctor defends euthanasia on vulnerable patient who said ‘no’ three times

A doctor cleared of murder for euthanising a vulnerable woman with dementia has waived her anonymity to declare she did the “right thing”, even though her patient said “no” three times. 

In an interview with Dutch current affairs programme Nieuwsuur, Marinou Arends attempted to justify her actions saying they were “for the best”.

On April 22, 2016, the now-retired doctor euthanised a 74-year-old woman with Alzheimer’s who had been admitted to Mariahoeve care home in The Hague seven weeks before.

The vulnerable patient had earlier written a directive asking for euthanasia in the event that she was admitted to a nursing home due to dementia, but indicated she wanted to determine when “the time was right.” 

But, once in the nursing home, she gave “mixed signals” about wanting to die.

And in the days leading up to her death, the patient affirmed her desire to live, saying, “I don’t want to die,” on several occasions. 

Arends asked the woman three times if she wanted euthanasia, but on each occasion, she answered that she did not.

“I couldn’t get this confirmation, and without it I had to take this step,” said Arends.

“If you asked her: ‘What would you think if I were to help you to die?’, she looked bewildered and said: ‘That’s going a bit far!’ I saw in her eyes that she didn’t understand it anymore.”

She added: “It was tremendously difficult, but for the best. I believed I was working within the boundaries of the law.”

Despite her requests, Arends judged her mentally incompetent and in “close consultation” with her family decided that she should be euthanised because of her prior directives – a decision that the Dutch courts eventually ruled was legal.

The doctor slipped a sedative into the woman’s coffee to relax her before administering the lethal injection. 

During the assisted suicide, the patient awoke and started to resist the procedure causing the doctor to ask the family for help in holding down the vulnerable woman while she finished the procedure.

In the court case that followed, prosecutors argued the doctor did not properly consult with the 74-year-old patient.

However, in 2019, a district court in The Hague ruled that doctors in the Netherlands can no longer be prosecuted for carrying out euthanasia on dementia patients who have previously given written consent.

Previously, those with dementia would need to reconfirm their earlier request.

in a summary of its decision, the Dutch Supreme Court stated: “A doctor can carry out an (earlier) written request for euthanasia from people with advanced dementia”.

The ruling, which was upheld earlier this year, not only exonerated Arends’ actions but means another legal safeguard protecting vulnerable people from euthanasia has been removed.

The case attracted critical attention when details were reported to the Regional Euthanasia Review Committees, which assesses all of the Netherlands’ roughly 6000 annual cases.

Over 200 Dutch doctors took out a newspaper advert saying they would not perform euthanasia for a patient with dementia without their confirmation.

However, Arends mantains she did the “right thing”, saying: “This was [a] unanimous [decision], a choice between an average residency of seven years, seven years of suffering, or – on the basis of the fundamental message in her living will – giving her the euthanasia she longed for.”

The country’s only euthanasia clinic recently revealed that it had seen a 22% increase in requests from people seeking assistance to end their lives last year compared to 2018.

There was also a 37% rise in requests from dementia patients, from 70 in 2018 to 96 in 2019.

(Image credit: The Dutch Broadcasting Foundation (Nederlandse Omroep Stichting – NOS))

UN official criticises ‘liberal eugenics’ of disability abortion

A United Nations human rights expert has brought fresh attention to some of the many negative consequences of disability-selective abortion and assisted suicide in a wide-ranging report on disability rights to the Human Rights Council on people with disabilities.

Special rapporteur Catalina Devandas-Aguilar is a Costa Rican lawyer who has spina bifida and has three children with the condition.

Unfortunately, Catalina Devandas Aguilar’s report has been overlooked because of the current focus on the coronavirus pandemic. 

Beginning of life: Prenatal screening

In the report, Catalina shares how technological advances in prenatal screening has resulted in a steady rise of prospective parents choosing to abort children like her own. 

She revealed how “in some high-income countries, high uptake rates for screening have already been associated with significant reductions in the number of children born with some congenital disabilities.”

Evidence of this can be seen across the UK, which recently reported a 150% rise in disability-selective abortions relating to cleft lip. Additionally, figures show 90% of babies with Down’s syndrome are aborted and estimates show the figure is around 80% for babies with spina bifida.

Catalina, who herself has spina bifida, suggests the use of prenatal screening is a cost-saving measure – as it is often cheaper to abort a baby than offer life-affirming treatment. She says: “Genetic screening must never be considered to be a cost-effective alternative to providing the highest attainable standard of care or service for persons with disabilities.”

In 2013, it was revealed a staggering £30 million had been spent in the UK on prenatally screening babies for Down’s syndrome. In comparison, less than £2 million was spent on research that would improve the lives of those who survive the eugenic screening process. 

Catalina rightly points out that such practices “may reinforce and socially validate the message that persons with disabilities ought not to have been born,” a concern shared by disability rights activists.

“Legislative frameworks that extend the time frame for a lawful abortion or,

exceptionally, permit abortion in the presence of fetal impairment aggravate this message,” she adds. 

“In addition, as the consequence is a smaller number of persons with disabilities being born, some fear a reduction in disability advocacy and social support for persons with disabilities.” 

End of life: Assisted suicide

Catalina is even stronger on the issue of assisted suicide saying “an impairment should never be a reason for assisted dying to be permitted.”

The Costa Rican lawyer, highlights how legalising assisted suicide will place at risk the lives of persons with disabilities.

“If assisted dying is made available for all persons with a health condition or impairment, regardless of whether they are terminally ill or not, a social assumption might follow that it is better to be dead than to live with a disability,” she says. 

“Generally, when life-ending interventions are normalized outside the end stage of terminal illness, persons with disabilities and older people may increasingly feel the need to end their lives.”

The report states how those with disabilities are vulnerable to explicit and implicit pressures to undergo an assisted suicide ‘procedure’, including expectations from family members, financial pressures, cultural messages and even coercion.

During life: ‘Futile treatment’?

In addition to highlighting the discrimination disabled people face at the beginning of life and at the end of life, Catalina reveals how disabled people are discriminated during their life.

“It has been reported that physicians may exert pressure on critically ill patients and their families to withhold or withdraw life-sustaining treatment based on the belief that further treatment would be futile, non-beneficial or potentially inappropriate, particularly for patients with severe impairments.

“That subjective assessment, based on the physician’s opinion and values, includes an assumption on the resulting quality of life of the individual and thus involves a risk that it is influenced by ableist views of living with a disability.”

She adds: “Similarly, cost-effectiveness considerations may also result in the denial of life-sustaining treatments to some persons with disabilities.” 

Catalina concludes her report by suggesting countries who are member states of the UN should: “Conduct a comprehensive legislative and policy review to abolish all laws, regulations, customs and practices that discriminate against persons with disabilities, including in the context of medical or scientific procedures, research and experimentation.”

Before the publication of Catalina’s report, a campaign was launched in the UK to stop abortion being available up to birth for disabilities such as cleft lip, club foot and Down’s syndrome. 

Heidi Crowter, a 24-year-old woman who has Down’s syndrome, has launched a landmark case against the UK Government over the current discriminatory abortion law that singles out babies with disabilities allowing abortion right through to birth.

Cheryl Bilsborrow, whose two-year-old son Hector has Down’s syndrome, has also joined Heidi in bringing forward the case.

The UN Committee on the Rights of Persons with Disabilities’ concluding observations on the initial report of the United Kingdom of Great Britain and Northern Ireland made a key recommendation that the UK change its abortion law on disability so that it does not single out babies with disabilities. However, the Government has decided to ignore this recommendation.

Additionally, a 2013 Parliamentary Inquiry into Abortion for Disability found the vast majority of those who gave evidence believed allowing abortion up to birth on the grounds of disability is discriminatory, contrary to the spirit of the Equality Act 2010 and that it affects wider public attitudes towards discrimination. 

The Inquiry recommended Parliament reviews the question of allowing abortion on the grounds of disability and should consider repealing section 1(1)(d) of the Abortion Act which allows for it.

Disabled peer Lord Shinkwin has previously had a Bill in the House of Lords that would have repealed section 1(1)(d) of the Abortion Act – the Bill was undefeated but unfortunately ran out of time. Lord Shinkwin’s Bill was supported by Disability Rights UK.

Royal College of Physicians clarifies it does not support assisted suicide

In a move welcomed by pro-life groups, The Royal College of Physicians (RCP) has released a statement on its website clarifying that it does not support a change in the law on assisted suicide.

The RCP, which represents more than 35,000 doctors, dropped its long-standing opposition to assisted dying in favour of neutrality following a controversial survey of its members last year.

In a highly contentious move criticised by over 1,500 doctors, the RCP’s Council said ahead of the vote that the College would go neutral unless 60% of its members voted either in favour or against assisted suicide.

The resulting survey revealed 43.4% said the organisation should be opposed to a change in the law to allow assisted dying, while nearly a third (31.6%) said it should support a change in the law and a quarter (25%) said it should be neutral.

Despite continued opposition to assisted suicide being the most favoured position among those surveyed, the RCP adopted a neutral position to assisted suicide.

The change in stance and the irregular framing of the poll prompted a legal challenge.

Professor John Saunders, a Fellow of the RCP and the former chair of its Ethics Committee labelled the survey as a “sham with a rigged outcome”.

Peer and Former Paralympian Baroness Grey-Thompson had warned that the RCP’s survey was: ‘A travesty of a consultation and… it risks bringing the college into disrepute as professional body’.

Now, in a statement on its website this week, the RCP has clarified that it does not support a change to the law.

“Neutrality was defined as neither supporting nor opposing a change in the law, to try to represent the breadth of views within its membership,” it said.

“Regrettably, this position has been interpreted by some as suggesting that the College is either indifferent to legal change or is supportive of a change in the law.

“So that there can be no doubt, the RCP clarifies that it does not support a change in the law to permit assisted dying at the present time.”

The clarification was welcomed by Dr Gordon Macdonald, Chief Executive of Care Not Killing.

He said: “This extensive and unusually frank statement from the UK’s oldest medical organisation, rightly puts a sword to the lie that RCP supports a change in the law – it does not. 

“The current laws on assisted suicide and euthanasia exist to protect those who are sick, elderly, depressed or disabled from feeling obliged to end their lives. This is not an imagined risk.

“As we have seen in places like Oregon and Washington, a majority of those ending their lives cite the fear of being a burden on their families and carers as a reason for the decision to end their life.”

Earlier this year, The Royal College of General Practitioners (RCGP) announced it will continue to oppose a change in law on assisted suicide following a consultation of its members.  

The RCGP’s consultation, conducted independently by Savanta ComRes, was sent to almost 50,000 members, who were asked whether RCGP should change its current position of opposing a change in the law on assisted dying.

Just under half (47%) of those surveyed said the College should not change its position, while 40% said it should support a law change providing there is a regulatory framework and appropriate safeguarding processes in place. 11% of respondents said the RCGPs should be neutral, while 2% abstained.

The British Medical Association (BMA) recently polled its member’s views on assisted suicide. The results of the first-ever BMA survey on assisted dying, which closed on 27 February, were due to be discussed at this year’s annual representatives meeting in June and could see the professional body changing its current policy on assisted suicide.

However, due to the coronavirus crisis all BMA events have been cancelled for the foreseeable future meaning any announcement is likely to be postponed.

Activists have been attempting to introduce assisted suicide legislation to the UK through the courts, through parliament and through pressuring medical bodies but continue to face obstacles.

Last year, the High Court rejected to hold a judicial review of the current law on assisted suicide, with judges stating the court was “not an appropriate forum for the discussion of the sanctity of life”. The Court of Appeal rejected an attempt to challenge this decision last month.

Similarly, in 2018, the Court of Appeal ruled that Parliament was a “better forum” than the courts for determining the issue of legalising assisted suicide.

Parliament has consistently rejected attempts by the assisted suicide lobby to introduce assisted suicide, with 330 to 118 voting against introducing assisted suicide in 2015. 

In January, strong opposition from MPs resulted in the Government rejecting a call for review on assisted suicide, despite the best efforts from large pressure groups in favour of assisted suicide.

Additionally, the Lord Chancellor Robert Buckland QC has recently confirmed the Government has “no plans” to introduce assisted suicide legislation, saying: “Personally, I have grave doubts about the ability of legislation to be watertight when it comes to the potential for abuse.”Assisted suicide pressure groups cite a poll that shows there is widespread support for legislation of assisted suicide, yet experts have heavily criticised the polling as deeply flawed. In fact, when asked questions that drill down into the merits of the debate, the percentage of those in support drops dramatically.