Vulnerable Persons Standard aims to protect the vulnerable from euthanasia

OTTAWA (CCN)



A broad alliance of groups has issued a Vulnerable Persons’ Standard to guide government in providing adequate safeguards in euthanasia or assisted suicide legislation.

The groups include L’Arche Canada, the Catholic Health Alliance of Canada, the Catholic Organization for Life and Family (COLF), the Canadian Association for Community Living, Living with Dignity, the Physicians’ Alliance Against Euthanasia, the Euthanasia Prevention Coalition and many more organizations that promote life and the care and protection of the mentally and physically disabled.

The Standard, released in Ottawa March 1, includes among its more than 40 advisors two of the three members of the federal external panel set up by the Harper government: Chairman and palliative care expert Dr. Harvey Chochinov, and disability rights expert Catherine Frazee. It also includes Sr. Nuala Kenny, who served on the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, McGill University bio-ethicist Margaret Somerville and the so-called “Father of palliative care in Canada,” Dr. Balfour Mount.

The presence of Dr. Chochinov and Frazee in the drafting of this Standard, raises questions of what legislative options their External Panel on Options for a Legislative Response to Carter v. Canada might have been proposed had the Trudeau government not changed their mandate to merely reporting on their findings .

Canadian Association for Community Living executive vice president Michael Bach, who was among the advisors, said he would not want to speculate on what those legislative options might have been. But he did note among the three advisory bodies: the federal external panel; the provincial territorial panel; and most recently the Parliamentary Committee on Physician-Assisted Dying, the federal panel “did by far the most extensive research.”

That research included travel to so-called Benelux countries, Belgium, the Netherlands and Switzerland, that have legal euthanasia regimes. They heard from a far greater number of witnesses than the other panel or committee, and included a survey of nearly 15,000 Canadians which showed a majority support strong safeguards including an advanced prior review by a legal panel or a judge, Bach said.

The external panel’s report, published in January, provided a “balanced review of the range of evidence,” including concerns raised by the psychiatric community and the need “to understand the range of persons who may come forward, and the need to understand the broader social factors that make people vulnerable,” Bach said.

Bach said it is reasonable to conclude the panel might have put forward a very different set of recommendations.

He said he found the report of the Parliamentary committee “dismaying.” Both the committee and the provincial-territorial panel recommended a highly “permissive” regime.

In both the provincial-territorial report and the Parliamentary committee report, all kinds of concerns were expressed about vulnerable people, but that concern “appears to be rhetorical,” Bach said. The committee suggested people will “be safeguarded in the usual way of doing business,” by engaging a second physician “with no recognition we are not talking about treatment” but about a procedure that “will bring about someone’s death.” Bach said a prior judicial or legal panel review is essential, because “this is a state authorized exception to the ban on assisted suicide.”

“There’s a health side and a legal side,” he said. One of the criteria for a physician assisted death is “not being vulnerable.

The Standard calls for “equal protection for vulnerable persons” so any Criminal Code amendments on physician-assisted death “must not perpetuate disadvantage or contribute to social vulnerability.” It called for careful regulation and public reporting so any adverse impacts “will be identified and addressed without delay.

The Standard calls for physician-assisted death to only be authorized for “end-of-life conditions for adults in a state of advanced weakening capacities with no chance of improvement and who have enduring and intolerable suffering as a result of a grievous and irremediable medical condition.”

The Standard calls for “voluntary and capable consent,” that includes support to pursue alternatives such as palliative care. It would prohibit advanced directives.

“If psychosocial factors such as grief, loneliness, stigma, and shame or social conditions such as a lack of needed supports for the person and their caregivers are motivating the patient’s request, these will be actively explored,” the Standard says. “Every effort must be made, through palliative care and other means, to alleviate their impact upon the person’s suffering.”

The Standard calls for a suffering and vulnerability assessment. “A request for physician-assisted death requires a careful exploration of the causes of a patient’s suffering as well as any inducements that may arise from psychosocial or non-medical conditions and circumstance.”

Finally, the Standard calls for an “arms-length authorization,” so that: “The request for physician-assisted death is subject to an expedited prior review and authorization by a judge or independent body with expertise in the fields of health care, ethics and law.”

“While we were not closely involved in the development of the standard, we offered our support to it in line with our concern about minimizing the harm relative to physician-assisted suicide,” said Catholic Health Alliance of Canada President and CEO Michael Shea, in an email. “We are concerned about a number of the recommendations of the parliamentary committee on this matter. The potential impact on vulnerable persons is clearly a concern.”

“The organizations that are part of the CHAC provide services to the vulnerable on a daily basis, these providers see the impact of such changes ‘on the ground’ and support efforts to minimize the harm these changes can make,” Shea said.

“We signed on because we believe it’s the best we’re able to do under the circumstances,” said John O’Donnell, director of outreach and communications for L’Arche Canada.

He noted the Community Association for Community Living was leading the way on the development of the Standard. “Morally we are opposed [to euthanasia and assisted suicide] but the Supreme Court and Parliament are forging ahead,” O’Donnell said. “We still have to be in on the conversation and signing the Standard is one way to do that.”

O’Donnell noted the Standard is supported by a range of groups, both faith-based and secular.

More information on the Vulnerable Persons Standard can be found at http://www.vps-npv.ca/