Mr. Speaker, we are debating a bill today that strips away safeguards from the existing regime for euthanasia and assisted suicide. Debate started yesterday, and I want to continue in the line I was talking about.
Yesterday, I spoke about some of the philosophical problems underlining the government's desire to remove safeguards. Those philosophical ideas are clearly best understood in the realities of life under legal euthanasia and assisted suicide, in the experience of people and families who have been affected by it and in the concerns of people who will be further impacted by the proposed expansion of the practice and removal of safeguards.
The fact is that the expectation at the time of the Carter decision was for a legal regime that would apply narrowly. However, we have seen the alarmingly rapid process of expansion at the level of policy and practice continuing with this legislation. Given that this bill comes ahead of a scheduled statutory review, it looks like the pace of expansion of removal of safeguards and enlarging eligibility will continue apace even after this. Rates of identified euthanasia and assisted suicide have gone up dramatically every year since legalization, from about a thousand in 2016 to over five times that in 2019. Those rate increases show no sign of abating.
More and more horror stories are coming out about how the current regime has already changed the dynamics of our health care system. My grandmother was a Holocaust survivor, so I know about the long-standing traumatic effects that stay with many survivors for the rest of their lives. One instance of euthanasia at the Louis Brier nursing home in Vancouver, a Jewish facility that has Holocaust survivors among its clientele, was particularly traumatic for residents and staff.
Doctor Ellen Wiebe met with Barry Hyman and his family in the spring of 2018 and determined that he met all the criteria. She later went to the nursing home and closed his door without informing or consulting with nursing home staff. Hyman was killed by Dr. Wiebe on the evening of June 29, without any consultation with his primary caregivers at the nursing home. Perhaps Dr. Wiebe had good intentions, but someone sneaking into a nursing home and then asking us to trust her own notes as evidence of consent raises serious concerns.
Dr. Keselman, CEO of the Louis Brier nursing home, agrees. He said:
Imagine the implications for our staff and our residents and their families. We have a lot of Holocaust survivors. To have a doctor sneak in and kill someone without telling anyone. They’re going to feel like they’re at risk when you learn someone was sneaking in and killing someone.
Clearly Dr. Wiebe, in this case, was pushing the envelope. I doubt most doctors would behave in such a fashion, but we do see from analyses that have taken place in other countries that a small number of activist, pro-euthanasia physicians are overrepresented in cases with problems. A majority of doctors are trying to do the right thing, but a lot of death can flow from the choices of a small number of envelope-pushers.
In a paper studying cases of euthanasia in Holland between 2012 and 2016, bioethicists David Miller and Scott Kim of the U.S. National Institutes of Health noted significant problems in the application of these laws for vulnerable people, if the screws were not tightened properly.
During that period, Miller and Kim found 33 cases in which doctors had broken at least one rule while killing someone, though apparently none of these justified prosecution. Miller and Kim specifically identified the overrepresentation of certain activist doctors in cases that raised red flags.
I spoke in the House in 2016 about another case in Canada, where a physician declared a depressed person eligible for euthanasia even before examining that person, because the patient “could easily get bed sores and then die of infection”. A person's death was, prior to examination, declared reasonably foreseeable because the person could theoretically die from an as-yet-uncontracted bedsore infection.
It is striking that we have these cases to look to at all in Canada, given the massive data collection gaps. There is no requirement for advance legal review to determine if criteria are being met. There are no national standards on tracking data. In fact, in many cases when a patient dies as a result of euthanasia, their death certificate will not even indicate that as the cause of death.
People who have had bad experiences cannot tell their stories in most cases. The data that the government refers to is severely constrained by these realities. We tried, during the debate on the last euthanasia bill, to push for mechanisms for better data collection and reporting to ensure evaluation and protection was possible, but at the time unfortunately the government did not listen.
Those who have had negative experiences and have lived are understandably reluctant to speak out. However, I want to share one story, with permission, of someone close to me who had a negative interaction with the system after this regime began. This is Taylor's story.
Taylor Hyatt is a twentysomething former member of my staff. She has cerebral palsy. She is vibrant, accomplished and full of life. She went to the hospital a couple of years ago with cold symptoms. She was told that she would probably need some oxygen and was asked if she wanted that. She replied, “Yes, of course”, but then the doctors pressed her on the point by asking if she was sure. Taylor was asked if she was sure she wanted oxygen. She just had pneumonia.
When we look at the government's proposal to further expand euthanasia and assisted suicide, and to expand eligibility criteria and remove the small number of safeguards that exist, we need to ask the same question: Is it sure?
As these cases illustrate, we have particular reason to be concerned about cases in which people receive euthanasia or assisted suicide immediately or alone. If multiple family members and health care staff can see, over a period of time, that a person is clear in the desire to have life end, then there is less risk of vulnerability or abuse.
Imagine a case, though, in which children visit their mother in hospital on a Monday. It seems like she is having a good day and she makes no mention of wanting to die. She is experiencing some pain, but the nurse says she has promising ideas about how to manage that pain. The nurse says she thinks she needs to adjust the levels of a few things that should settle the pain down, and she will work on that as soon as the doctor has a chance to see her. The children leave on Monday feeling reassured.
Then the children are informed on Wednesday that their mother is dead. They are told that when she met with the doctor, she was in extreme pain and expressed the desire to die, so she was killed right away. They did not get a chance to say goodbye and they do not know if the doctor got it right or wrong.
Perhaps their mother really wanted to die, but maybe she was just experiencing a temporary low point from which she would have recovered. Her children will never know the details or the situation. Because of the absence of witnesses and legal review, there is very little evidence left behind. If their mother really wanted to die, she could, but would it be so unreasonable for the doctor to have given it a few days for the children to have been able to talk to her about her wishes?
This particular case is exactly where we should focus our concerns as we look at this legislation. The current legal system requires at least two independent witnesses who are not paid personnel, and there is a 10-day reflection period. I would underline, as members have said and as the government has generally failed to acknowledge, that there is already a mechanism by which the 10-day reflection period can be waived.
However, the 10-day period sets out a rule of general practice that is open to variation. It establishes the general and important principle that people should not have their lives taken as a result of a fleeting sense of hopelessness or because their medication levels are off for a period of time.
It makes no sense, as the government is proposing to do, to reduce the number of witnesses and remove the reflection period when there are already provisions for waiving it and managing that effectively in different situations.
Other members may have had these same experiences. I can tell them I had a close friend dealing with depression a few years ago and his state of mind would fluctuate dramatically from day to day. On certain days, he could not imagine going on, while on other days he would feel, in his words, like himself again.
Recognizing the realities of fluctuations and the development of people's experiences, it is horrifying to me that someone could opt for, and receive, euthanasia or assisted suicide within a few hours without independent witnesses or any reflection period. Therefore, the government must remove the clauses of this bill that reduce witnesses and eliminate that reflection period.
The government has included a clause in this bill dealing with so-called advance consent. The mechanism is that I, as a patient meeting the criteria, might ask to die on June 1, even if I had lost capacity. My consent right now would suffice for the taking of my life on June 1. However, the legislation contains no requirement that I be asked how I feel on June 1.
Suppose that I am facing a loss of capacity and I am afraid of the implications of that loss of capacity, not knowing what it would be like to mentally regress in the way that doctors have predicted that I will. Suppose that, in light of this fear, I sign on to advance consent but then, on June 1, while I have indeed lost substantial capacity, I actually have a much higher quality of life than I expected to have.
Should the advance consent that I have provided, in ignorance of my future circumstances, overrule my feelings in that moment? This is not just idle speculation.
Let me read from an article in the The Washington Post about a Dutch case involving an advance directive. It states:
The patient, referred to in official documents only as “2016-85”, had made an advanced directive requesting euthanasia in case of dementia. But the directive was ambiguously worded, and she was no longer able to clarify her wishes by the time she was placed in a nursing home—though her husband did request euthanasia for her.
Despite the lack of a clear expression from the patient, a physician concluded her suffering was unbearable and incurable—though there was no terminal physical illness—and prepared a lethal injection.
To ensure the patient's compliance, the doctor gave her coffee spiked with a sedative, and, when the woman still recoiled from the needle, asked family members to hold her down. After 15 minutes were spent by the doctor trying to find a vein, the lethal infusion flowed.
The government has tried in this legislation to avoid this most extreme case by saying that advanced consent would only apply to a particular date and that the procedure should not proceed if the patient was clearly refusing euthanasia. Unfortunately, the space left for abuse is still massive.
In the case just given, suppose the patient was given stronger sedatives so she was completely unaware of what was happening, and therefore offered no resistance. That would be allowed under the framework established by this legislation. It does not require that patients be informed or consulted at the time of their death. If they have provided advanced consent, that is considered sufficient.
In virtually every case, the requirement for contemporaneous consent is important in our law and is a necessary part of autonomy. If I am to be truly free, then I must be free from the directives of my past self. My past self should not irrevocably be able to bind my future actions.
Even so, it may be possible to still allow advanced consent, but to have some mechanism through an amendment to ensure that a patient, even with limited capacity, is informed and consulted at the time when his or her life is to be taken. I would encourage the government to consider that.
The government should be open to considering these problems and these fixes, taking out sections of the bill that dangerously remove safeguards and strengthening the section on advanced consent to ensure a patient is informed and consulted contemporaneously.
Finally, on the point of safeguards, let us go back and reflect on what the purposes of safeguards are.
Some members will feel that meaningful safeguards are not necessary because we should trust medical professionals and patients to get it right. The parliamentary secretary has used general data about trends in this area to suggest that there are no problems with abuse.
Let us be very clear that the reason we have safeguards is not to deal with general cases, but is precisely to deal with exceptional cases. Even if there are not problems in the vast majority of cases, we try to introduce reasonable verification mechanisms, because those verification mechanisms will catch instances of abuse and cases where vulnerable people might be pushed toward a death they do not want.
The reason we need law enforcement is not because most people are lawbreakers, but because some people are lawbreakers. The reason we have fire departments and expansive rules and protocols around fire prevention is not because most houses are on fire, but it is because some houses could catch fire.
I hope we will see through this debate that the safeguards in the current legal region really are a minimum and that we can provide reasonable safeguards like a short reflection period that can be waived and a requirement for independent witnesses which, like sprinkler systems in this room and security guards watching over us, insulate us against the possibility of something going very wrong.
For the sake of the vulnerable, let us not fire the security and rip the sprinklers out of our system just to make an ideological point.