Jocelyn Downie calls for facts, not fiction, to guide public policy on Bill 52.
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.
Jocelyn Downie is a Professor of Law and Medicine at Dalhousie University, Halifax, Canada