Jocelyn Downie calls for facts, not fiction, to guide public policy on Bill 52.
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On November 5, 2013, the Montreal Gazette published an opinion piece about Quebec’s Bill 52 written by Derek Miedema. This piece, published with the inflammatory headline “ ‘Medical aid in dying’ leads to more and more killings” makes a number of false claims about what happens in the Netherlands, Belgium, Oregon, and Washington State – places that have legalized various forms of aid in dying. In this, it is similar to a number of other recent opinion pieces, letters to the editor, and press conferences and so it warrants a response.
Miedema writes: “As some MNAs have pointed out, this does not increase access to palliative care.”
In fact, Bill 52 (An Act respecting end-of-life care) explicitly addresses the issue of access to palliative care and would provide Quebeckers what nobody else in the rest of Canada would have – the right, explicitly recognized in law, to receive end-of-life care which includes palliative care. It requires health care institutions to “offer a private room to every patient who is receiving end-of-life care in its facilities and whose death is imminent”, it compels institutions to offer palliative care to everyone requiring it, and it introduces transparency re: accessibility of palliative care by requiring reporting on the number of patients who received palliative care.
Miedema writes: “Many MNAs have noticed that the current wording is not at all limited to cases of exceptional suffering.”
In fact, Bill 52 is limited to cases of exceptional suffering. To access medical aid in dying, a patient must: “suffer from an incurable serious illness; suffer from an advanced state of irreversible decline in capability; and suffer from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.” (s.26) It is essential to note that this list is cumulative –Miedema mistakenly assumes (and suggests in his 8-page paper on the topic) that each element alone could be sufficient.
Miedema writes: “Legalization around the world has always been followed by shifting criteria to include more and more people. This is as true in the Netherlands, where euthanasia has been legal since 2002, as it is in Oregon and Washington State, where assisted suicide was legalized in 1997 and 2009 respectively.”
In fact, the legal criteria for accessing aid in dying in the Netherlands, Belgium, Oregon, and Washington State have not changed since the legislation was introduced in each of these jurisdictions.
Canadians who are troubled by the blizzard of conflicting claims about slippery slopes in jurisdictions that permit aid in dying would do well to turn away from opinion pieces from non-experts in favour of more reliable sources of information. Derek Miedema’s profile on the Gazette website states “He is the author of No Second Chances, a book about international experience with legal euthanasia.” When the opinion piece was first published, this statement was also made in his byline. It is repeated elsewhere on the web. In fact, No Second Chances is not a book, nor is it even a peer-reviewed paper. It is, rather, an 8-page paper disseminated through the website of the Institute of Family and Marriage.
A much more reliable source of information is Justice Smith’s decision in Carter v. Attorney General (Canada). Both sides in the debate about medical aid in dying (including interveners representing the same position as Derek Miedema) presented Justice Smith with contemporary evidence from around the world. In reviewing this data, Justice Smith became one of the most well-informed people in Canada on the international evidence about the consequences of legalizing medical aid in dying. She also had a professional obligation, in her role as judge, to provide “an independent and impartial assessment of the facts and how the law applies to those facts.” Justice Smith concluded that:
“I find that the empirical evidence gathered in the two jurisdictions [Oregon and The Netherlands] does not support the hypothesis that physician-assisted death has imposed a particular risk to socially vulnerable populations. The evidence does support Dr. van Delden’s position that it is possible for a state to design a system that both permits some individuals to access physician-assisted death and socially protects vulnerable individuals and groups.” (at para 667)
“[T]here is no evidence that persons with disabilities are at heightened risk of accessing physician-assisted dying in jurisdictions where it is permitted.” (at para 852)
Justice Smith’s analysis of the evidence is set out in her judgment which is available here. The legislation from the Netherlands, Belgium, Oregon, and Washington State are available here. Official sources of data on the consequences of medical aid in dying are available here.
Before coming to conclusions about whether Bill 52 should be passed, Quebeckers (legislators and the public alike) should carefully consider available, reliable sources of information. Facts, not fiction, should guide public opinion and public policy.
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Jocelyn Downie is a Professor of Law and Medicine at Dalhousie University, Halifax, Canada
Impact Ethics 
These are all reliable sources :
1) The abuse :
In its report of August 25 2009, the Human Rights Committee of the United Nations denounces the extent of euthanasia and assisted suicide in the Netherlands and highlights the gap that exist between the reality and the safeguards provided by the law of 2002 which decriminalized voluntary euthanasia :
“The Committee remains concerned at the extent of euthanasia and assisted suicides in the
State party. Under the law on the Termination of Life on Request and Assisted Suicide,
although a second physician must give an opinion, a physician can terminate a patient’s life without any independent review by a judge or magistrate to guarantee that this decision was not
the subject of undue influence or misapprehension”.
Source : United Nations, Human rights committee, Considerations of reports submitted by states parties under article 40 of the covenant : concluding observations of the human rights committee, ninety-sixth session, Netherlands, 25 august 2009, par.7 (CCPR/C/NLD/CO/4).
2) Link between the economy (finance) and the legalization of euthanasia :
According to Jean-Louis Baudouin, a former judge of the Court of Appeal of Quebec, “the explosion of health care costs and the resulting economic pressure may favor euthanasia programs for certain categories of people more vulnerable, whose preservation compromises the finances of the state”(our translation). A large part of this explosion of health care costs will come from the ageing population of Quebec. According to Ménard 2005 report on the sustainability of the health care system, the ageing of Quebec’s population is “the third fastest of industrialized countries after Japan and Italy”. The report adds :
“The age groups called to grow most quickly are the ones for which the use of social services and health cares is the highest. The resources per capita dedicated to the elderly aged 65 or more are about 3.7 times higher than the average of age groups. For people aged 85 or more, it is 7.7 times more per capita than the average population. The concentration of health care and social services spending at the end of life is particularly obvious for the services mainly offered to the elderly in loss of autonomy (…) which costs drastically increase from age 70″(our translation).
Robert Evans, a professor of economics at the University of British Columbia, recognizes that non-voluntary euthanasia would be a way to improve the country’s finances, but believe that it would NOT BE THE BEST WAY:
“I would not suggest that the best way to improve the fiscal situation of Canada is to introduce a non-voluntary program of euthanasia for people over the age of 70”.
Source: Senate of Canada, Special Senate Committee on Aging , IMPLICATIONS OF AN AGING SOCIETY IN CANADA, Testimony of Mr. Robert Evans, December 10 2007, p.2: 34 , online: http://www.parl.gc.ca/Content/SEN/Committee/392/agei/02eva-e.htm?Language=E&Parl=39&Ses=2&comm_id=600
In its predictions and foreseeable scenarios for the years 2007 to 2036, the ” Development, Concepts and Doctrine Center ” ( DCDC ) of the Ministry of Defence of the United Kingdom stresses that euthanasia of the elderly could become the political instrument to serve the young to reduce the economic burden of care for the elderly. I quote:
« Declining youth populations in Western societies could become increasingly dissatisfied with their economically burdensome ‘baby-boomer’ elders, among whom much of societies’ wealth would be concentrated. Resentful at a generation whose values appear to be out of step with tightening resource constraints, the young might seek a return to an order provided by more conservative values and structures. This could lead to a civic renaissance, with strict penalties for those failing to fulfil their social obligations. IT MIGHT ALSO OPEN THE WAY TO POLICIES WHICH PERMIT EUTHANASIA AS A MEANS TO REDUCE THE BURDEN OF CARE FOR THE ELDERLY ».
Source : United Kingdom, Ministry of Defence, Development, Concepts and Doctrine Center, The DCDC Global Strategic Trends Programme : 2007-2036, 3d ed., 2007 à la p.79, en ligne : http://www.cuttingthroughthematrix.com/articles/strat_trends_23jan07.pdf
See also:
Japan is considering euthanasia as a solution to the economic burden posed by population aging on society.
See the following article : Annabel Claix , “A Japanese minister asks its citizens to die , and quickly” (January 22 2013) , online: http://www.ibtimes.com/japans-finance-minister-suggests-elderly-should-die-quickly-ease-health-care-burdens-1031418
Already in 1958, Glanville Williams , who was vice-president of the “Voluntary Euthanasia Society” and regarded as “Britain’s foremost scholar of criminal law”, stated :
“Kamisar expresses distress at a concluding remark in my book in which I advert to the possibility of old people becoming an overwhelming burden on mankind. I share his feeling that there are profoundly disturbing possibilities here ; and if I had been merely a propagandist, intent upon securing agreement for a specific measure of law reform, I should have done wisely to have omitted all reference to this subject. Since, however, I am merely an academic writer, trying to bring such intelligence as I have to bear on moral and social issues, I deemed the topic too important and threatening to leave without a word”.
Source: Glanville Williams, « “Mercy- Killing” Legislation – A Rejoinder » (1958) 43 (1) Minn . L. Rev . 1 p.11 .
Eric Folot
Lawyer and bioethicist
Professor Downie, paragraph by paragraph, shows how biased a majority of opponents are concerning medical aid in dying and Bill 52, since much of what Mr Miedema wrote simply echoes the half-truths or false informations repeatedly written or voiced by those who want their beliefs be the law of all.
This is a great service to both Quebecers and Canadians who wish to reflect on this serious matter with an open mind and compassion.