Canadian bishops warn Trudeau over new assisted dying laws

The president of the Canadian Conference of Catholic Bishops has written to Prime Minister Justin Trudeau decrying the effort to further expand euthanasia within the country. 

“We strongly urge the Government of Canada, before proceeding further, to undertake a more extensive, thorough, impartial, and prolonged consultation” on Medical Assistance in Dying (MAiD) legislation, Archbishop Richard Gagnon of Winnipeg wrote in a letter dated Jan. 31.

The archbishop told the prime minister that a delay in further legal changes was urgently needed “in order to ensure all pertinent factors--social, medical and moral--are carefully and thoroughly considered,” wrote Archbishop Richard Gagnon of Winnipeg. 

The letter was also addressed to three members of Trudeau’s cabinet as well as the leaders of the other four parties represented in Parliament. 

Archbishop Gagnon called the proposed changes to MAiD legislation, which include advance directives and allowing those who do not have a reasonably foreseeable death to be euthanized, “deeply troubling.” 

“Further attempts to make (MAiD) available to mature minors, the mentally ill, and the cognitively impaired are evidence that the current safeguards are inadequate and can be legally challenged and overturned,” he said.

In September, the Quebec Superior Court ruled that MAiD should not be restricted to those with a terminal illness or a “reasonably foreseeable death.” The federal government announced that it does not intend to appeal the decision and will let it stand. The law will go into effect in March. 

Prior to this decision, a Canadian would have to be an adult with a “reasonably foreseeable death” in order to be eligible for an “assisted death.” There is no legal requirement for a patient to possess a prognosis of a certain number of months or weeks left to live in order to receive “assisted death.”

Archbishop Gagnon said that the bishops were “disappointed and deeply concerned” by this decision, as well as by a Department of Justice questionnaire that provided Canadians an opportunity to weigh in on the legalization and eligibility criteria for MAiD patients. 

Although the bishops “agree in principle with consulting Canadians,” they found the questionnaire to be flawed on multiple levels. 

It is “inappropriate and superficial to use a survey to address grave moral questions concerning life and death,” wrote Gagnon. He added that he believed that the two-week for responses was “entirely insufficient” to study the issue of euthanasia. 

Archbishop Gagnon also raised concerns that the questionnaire was biased towards increased eligibility for MAiD, and neglected to address concerns regarding the outside factors that may cause a person to wish to end their life. The archbishop said that consultation on the euthanasia question “should take account of the full rage of factors that can influence a decision to request euthanasia/assisted suicide,” such as loneliness, inadequate medical support, a lack of family and community assistance, or psychological crisis. 

Instead of MAiD or euthanasia, Archbishop Gagnon said that Canada should expand access to palliative care services.

This, he argued, would result in fewer people seeking to end their lives. Presently, most Canadians do not have access to palliative care, and it is not guaranteed to be fully funded by the country’s Health Act. Conversely, Canadians have both a right to widely-available MAiD services, and the procedure is fully funded. 

Archbishop Gagnon said the Church’s ministry of attending to the sick and protecting the sick means that Catholic institutions, in addition to everyday Catholics, dedicate their lives to assisting the sick and suffering. This history is motivating their opposition to euthanasia and the proposed expansions. 

“We listen to those who, gripped by a physical or psychological crisis, see no reason for going on,” he said. “All of these people are endangered by euthanasia/assisted suicide. They need our steadfast support, our advocacy, and indeed the protection afforded by the very safeguards this government is trying to overturn.”

The vast majority of Canadians continue to die among strangers in institutions, either without palliative care or with too little palliative care delivered too late in their disease trajectory, palliative care experts told The Catholic Register.

Of Canadians who died at home in 2016-17, even though two-thirds (66 per cent) received home care during their last year, less than one-in-six (15 per cent) received palliative care at home, according to a 2018 Canadian Institutes of Health Information (CIHI) report.

Only six per cent of people in long-term care, and just 22 per cent of long-term care residents with less than six months to live, received palliative care.

Only 15 per cent of Canadians die at home, even though 75 per cent say they would prefer to spend their final hours with family at home. In contrast, over 40 per cent of Medical Aid in Dying procedures provide death at home.

“Before you can even start looking at the data for MAiD, you have to make palliative care a consistent and equal access for everybody,” said palliative care specialist Dr. Sheri Bergeron. “Because if you don’t, then are people making this choice because there isn’t any other choice?”

Canada’s Catholic bishops and other opponents of MAiD aren’t wrong to suggest greater access to palliative care might keep voluntary euthanasia down to a dull roar, according to Bergeron.

“Are people still going to choose MAiD, even if they have access to palliative care? Probably,” she said. “But the bigger shame would be people choosing MAiD because of lack of access.”

“Experience has shown that patients are more likely to request euthanasia/assisted suicide when their pain is not properly managed by palliative care,” said the CCCB letter.

“Health care practitioners, elected officials and policy makers must not have recourse to euthanasia/assisted suicide as an answer to pressures and deficiencies in the current health care system given that an alternative already exists, namely palliative care.”

Governments have been talking about alternatives to medicalized and institutionalized dying for at least 25 years, points out Sister Nuala Kenny, a doctor, retired professor of medicine and bioethicist.

The first major report on the availability of palliative care, tabled in the Senate in 1995 by Senator Sharon Carstairs, was called “Of Life and Death.” In June 2000, Carstairs tried again with an even bigger, more detailed report called “Quality End-of-Life Care: The Right of Every Canadian.”

The courts, however, have not ruled Canadians have a right to palliative care.

“We know that MAiD is law. It’s now a right bestowed on all Canadians. I’m not sure the same can be said about the availability of palliative care as a viable option of care for all Canadians,” Pallium Canada CEO Jeff Moat told The Register. “Fundamentally, Canadians now have a legal right to die, but they also have a right to live.”

Pallium Canada provides palliative care training to a broad range of health care professionals and has been working with the CCCB to produce education kits aimed at helping parishes ensure Catholics understand what palliative care is and how they can access it. The kits will be available in 2021.

“These (government) promises (to boost palliative care) go way, way, way back,” said Kenny. “We then legalized and decriminalized (voluntary euthanasia) first, before we delivered on the promise of hospice palliative care.”

The country’s largest provider of home care is seeing small, gradual increases in funding and access to palliative care at home, said St. Elizabeth Health Care chief clinical executive and senior vice president Nancy Lefebre.

Ottawa’s Action Plan on Palliative Care is making some progress in making health care professionals and patients more aware of the scope and benefits of palliative care, she said.

“They’re overall trying to increase awareness and understanding. I think there’s a lot of work being done in that area,” she said.

In 2017 Parliament passed the Framework on Palliative Care in Canada Act, then spent 2018 negotiating with the provinces and territories who have responsibility for delivering health care. Funding agreements signed with provinces and territories in 2019 covered some aspects of palliative care.

In the 2017 budget the federal government committed to spend $6 billion over five years building up palliative care capacity across Canada. Health Minister Patty Hadju must report progress on the Framework on Palliative Care to Parliament in 2023.
“Some activities have already begun, while others are at the concept stage and will be developed further and rolled out over the coming years,” Health Canada spokesperson Natalie Mohamed told The Catholic Register in an email.

Kenny sees very little happening to expand access to palliative care, despite the 2017 budget commitment and the 2019 Action Plan.

“I still get all the medical correspondence. I’ve never seen anything since this announcement, and I’m involved in the area,” she said.

Whatever procedural safeguards result from the recent two-week, online consultation on MAiD regulation, palliative care is still in the shadows, according to Kenny.

“Medically-assisted death has become normalized so rapidly,” she said.

With files from The Catholic Register.