Published in The Times Colonist on January 19, 2017.
Re: “Dying words,” Jan. 14.
Noreen Campbell chose to end her life by means of physician-assisted suicide, as was her right under Canada’s new law.
Since that law was passed, more than 744 people have also chosen to end their life this way.
But apparently Campbell’s dying wish was that even more people would avail themselves of this new right.
She wanted her story about ending her life to “open the door for others” and “draw attention to the gaps she saw in the process,” because, as a member of the assisted-suicide advocacy group Dying with Dignity, she felt the law doesn’t go far enough.
The ease with which she embraces killing as a good solution to suffering is simply appalling.
Her opinions about why people should go the same route as she did contributes nothing new to this discussion — it’s all about fearmongering and undermining people’s expectations about what palliative care can achieve.
According to her, taking a lethal injection is preferable to the alternatives, and promoting this idea is an insidious form of coercion that will only result in more needless premature deaths, and an increasingly callous approach to people who might be suffering near the end of life.
Published November 8, 2016, on the National Post
by Douglas Farrow and Dr. Will Johnston
In 1639 three nuns got off the boat from France and began to build Hotel Dieu in Montreal, the first hospital in Canada. Over time, some 275 hospitals were built across our country by self-sacrificing Catholics who faithfully served the sick and dying out of love and compassion, without regard to their patients’ faith or lack of faith. Succeeding generations of Canadians have been grateful for the spiritual and physical care they have received at such places.
St. Paul’s Hospital in Vancouver is one of those Catholic hospitals. In keeping with its faith-based principles, it respects the Catholic sense of human dignity — meaning, among other things, that it does not perform abortions or participate in assisted suicide or euthanasia.
Ellen Wiebe, a physician who is also an abortion and euthanasia activist, together with a lawyer, Richard Owens, recently criticized St. Paul’s because it would not euthanize one of its dying patients, Ian Shearer. Instead, Mr. Shearer was transferred to another institution, reportedly in terrible pain, where his request to die was granted.
They blame St. Paul’s for his suffering, without divulging that the pain resulted from his medication being reduced so he would be lucid enough to consent to his death. That (not to speak of botched transportation arrangements) accounts for his agony. Had he simply stayed at St. Paul’s, received uninterrupted palliative care and declined treatment for his sepsis and kidney failure, as is normal in his situation, he may have died undisturbed and relatively pain-free right there.
Wiebe is on record as saying that the euthanasia debate is not really about pain relief, which is generally very effective, but about autonomy, understood as the right to end one’s life when one sees fit. She nevertheless attacks St. Paul’s for its putative lack of compassion and for its religious-based refusal to participate in euthanasia, something she and Owens insist every recipient of public funding must be prepared to do.
It is frankly absurd to attack St. Paul’s as lacking in compassion. But does the fact that it receives public funding mean that it should perform any and every procedure of which the law presently approves, even those that St. Paul’s considers gravely immoral?
Of course not. Some hospitals do not deliver babies or install new heart valves, for example; they leave that to institutions with the requisite expertise and equipment. Others, even others that are not religiously founded and governed, do not perform abortions or euthanasia – not because they are incapable of it, but rather because those who work there do not want to do it, usually for moral reasons. In neither case is there any reason to deny access to public funds.
All public money, after all, starts out as private money, collected in taxes from diverse people and businesses and distributed to places where it can be spent to good effect. These places do not need to be all alike, any more than the people themselves need to be all alike. Diversity, within reasonable limits, is a good thing.
Wiebe and Owens, however, have decided that the diversity represented by Catholic hospitals, and by other institutions that object to euthanasia, is a bad thing. They accuse St. Paul’s of abusing its power by imposing “its metaphysical beliefs on those in its care.” But we should ask who is really imposing on whom.
Wiebe and Owens say they respect religion, yet religions such as Judaism and Catholicism, which regard life as a gift from God over which a person is steward, not master, they do not respect at all. They are quite happy to apply coercive measures to those who hold such views, demanding that they either violate their consciences or withdraw from medicine altogether. Not to put too fine a point on it, they propose to use the public purse to back their own beliefs about human autonomy and the human fate, while denying to others the same privilege.
One may, with Wiebe and Owens, suppose that, if one is dead, one is at peace. That, however, is a very narrow – and, from a Catholic point of view, quite false – understanding of peace. It is hard to imagine why it should determine public policy, or why we should sacrifice Canada’s venerable Catholic hospitals on that altar. Particularly when the fundamental freedom of conscience and religion would have to be sacrificed along with those hospitals.
Douglas Farrow is Professor of Christian Thought and holder of the Kennedy Smith Chair in Catholic Studies at McGill University, Montreal
Dr. Will Johnston is a family physician in Vancouver, B.C.
Published on Canadian Healthcare Network
Written by Tristan Bronca on June 1, 2016
Discussed: The ‘wedge’ cases, the language of the debate, the moral culpability of the doctor, and the question of pure autonomy
Dr. Will Johnston
The Euthanasia Prevention Coalition was officially founded in 1998 in response to rising public support for physician assisted dying. It’s made up of about 2,000 donors—both members and organizations—who began to come together in about 1993 during the Sue Rodriguez case. One of those members is Dr. Will Johnston.
Now the chair of the B.C. chapter of the coalition, the family physician took a strong stance against euthanasia about 22 years ago, when he began writing about it and speaking to high school students and church groups. He also testified opposite euthanasia advocates in the Carter case, which led to the legalization of medically assisted death in Canada. Dr. Johnston spoke with the Medical Post about his concerns with the legislation recently passed through the house of commons, the laws around the world, and why he feels Canada is about to make a dangerous mistake.
Q: Explain the impetus for a coalition of bodies who are opposed to physician-assisted dying.
The bodies that are involved in the euthanasia prevention coalition might not agree on any other issue but they share in common a sense of the huge societal mistake that is being made in euthanasia and assisted suicide. We realize that there is some strength in numbers. Obviously not enough strength to stop the freight train that ended with the Supreme Court being unanimous in its decision—which I think is a troubling sign of the shallowness of the Supreme Court’s reasoning—but nonetheless more power than we would have as individual activists.
Q: Which elements of the proposed federal legislation do you personally find most troubling?
The legislation doesn’t yet allow the euthanasia of children, psychiatric patients, or mentally incapable patients long after they consent, but the preamble to the legislation promises to explore those areas further, which is deeply troubling.
The activists who won in the Supreme Court won in part because they assured Canadians that they weren’t talking about those three groups. They were only talking about competent adults at the end of their lives who were able to give consent at the time they were killed.
Q: So you see the expansion of the legislation to include these other groups as problematic?
Absolutely. It seems clear that this no longer has anything to do with dying. This legislation has left open the door for assistance for people who want to commit suicide but don’t want to do it themselves, while it was originally marketed as helping terminally ill people in terrible pain to die sooner than they would have otherwise died. The latter was used as the cloak to wrap the agenda inside.
When the real agenda is to allow anyone who is dissatisfied with their life to be killed with the endorsement and assistance of the national medical system, it makes sense to hide those intentions behind the story of a person about to die who was having difficulty controlling physical symptoms.
Q: My understanding is that the reason why this legislation may be extended to psychiatric patients and to mature minors is because the legal experts didn’t feel that exempting those two groups would stand up to a charter challenge. It would be discriminatory to bar them from access to the service that is now being talked about as a universal human right.
You’re absolutely right and, in fact, I was making that point exactly as you have just made it back in the days when we were in court with Gloria Taylor and the Carters. You could never contain it to just these terminally ill patients but in court that’s all they claimed they were asking for: Terminally ill, capable adults who were suffering intolerably at the end of their lives and who consented and were capable of consent to be killed. That was the story on which the Carter case was won. . . .
These judicial activists were happy to pass the Carter case through on the narrow grounds knowing that it would be expanded later. They were happy to make an incremental change that they knew could not withstand a further charter challenge because of section 15 equality rights and so forth.
Q: So, legally, there’s a slippery slope?
I don’t talk about slippery slopes because that doesn’t mean very much anymore. I just point out that the hardest palliative care cases at the end of life were used as a wedge to open the door and the same clever legal maneuvering that managed to twist the words of the charter to allow intentionally killing out of a right to death will easily stop criminal prosecution in other situations, which might make Canadians uncomfortable.
Q: Can you give examples of some of these other situations?
We only have to look to Belgium and the Netherlands: Older people who are euthanized because they say they are tired of living; the bereaved who die in group suicides because they don’t want to live without their spouse (which happened recently in Belgium); providing euthanasia for sex-change operation recipients who are unhappy with the results. There’s almost no life situation which will not prove to be intolerable to some applicant for assisted suicide or euthanasia.
Q: But the “intolerable suffering” criterion isn’t going to be the only requirement under the new legislation.
The criteria under the new legislation only has to be challenged in court to be expanded. For instance, the idea that your death is foreseeable. What does that mean? As young as you may be your death is foreseeable. The legislation seems to be written to apply to those who are at the end of their lives by any reasonable person’s expectations. But then reasonable people would have thought that the Charter Right to life, liberty and security as a person was to defend you against the state, not to give you a lever to coerce your own destruction out of the state.
Q: You refer to so-called wedge cases that cracked open the legislation, people like Gloria Taylor and Sue Rodriguez. There are others enduring similar suffering. Is it the position of your organization that these patients don’t have a right to…
First of all, it’s important to dispel the common misperception that a “right” is being created. There is no legal right to have the government kill you. What the government has created is a system whereby your killer can be exempted from criminal prosecution if certain steps are followed.
Q: Aren’t there situations where the criteria are met beyond questioning?
No. We’ve been warning that people who fill all of those criteria are actually in suicidal depression because they see no hope for the future and they see no meaning in going on existing. We find it instructive that of the 600 people who die of ALS every year, pretty well all of them die peaceful deaths with good palliative care and we think that should be what is offered and available to everyone.
Q: Is there a way to close loopholes in order to deliver a service that is consistent with what the patient wants?
We simply don’t think it’s a good thing at all that intentional killing be introduced as an integral act of the healthcare system. It’s inevitably going to result in wrongful deaths. Criminal trials can drag on for years with witnesses challenging the facts of the case and even then there were wrongful convictions and wrongful executions. How are any two doctors who are willing to sign off on an assisted suicide—given the fact that we can’t really know what’s going on inside the suicidal person’s mind—going to prevent wrongful death? On the face of it, it seems obvious that wrongful deaths will occur.
Q: What do you make of the polls that show the public is supportive of assisted-suicide legislation? Isn’t the government required to follow suit?
The public can be overwhelmingly wrong about something and then it’s seen as a tragedy when the government follows suit. For instance, there was overwhelming sentiment against Chinese immigration in the 1920s and the government followed suit and published shameful Chinese exclusion laws. The fact of the matter is that under the scrutiny of the parliamentary process, with all of the time available to a normal process, this kind of legislation has been rejected many times over the past couple of decades. Parliament is there to provide the careful inquiry that is not provided by snap polls of an under informed public.
Q: How is the public under-informed?
When people are asked about end-of-life issues, such as withdrawing ventilators and so forth, they often confuse that with assisted suicide. In reality, it is just the withdrawal of futile care. We need thoughtful representatives who have a chance to explore issues in much greater detail than members of the general public. I doubt that anyone would have any respect for a system where the general public voted on what interest rates should be set by the Bank of Canada.
Q: But this issue revolves around questions of personal autonomy: what one like to have happen to oneself . . .
The debate has been successfully framed as a pure autonomy question.
(But) to call it a pure autonomy question suggests that setting up a system where people can be intentionally killed affects no one but the people who declare that they want to be killed; that it doesn’t affect anyone around them, that there are no conscience issues involved, that no one could ever be wrongfully killed, that no one could ever have heirs or beneficiaries who want them to die influencing the decision. If the system allows, for instance, you saying years ahead of time that you would like to die if you ever become demented, that means if you ever get to the point where you can’t communicate your wishes but you’ve changed your mind, you would be killed against your wishes. It would be the most destructive thing that your autonomy could ever undergo; that is the removal of you as an existing being. So the idea that this is pure autonomy and that everybody’s idea of autonomy has triumphed here is an illusion, I would suggest.
You seem to be using words like “killing” and “euthanasia” deliberately but in recent years that there’s been a shift towards words like “dignity.” I’m just wondering to what degree your choice of words here is intentional and what the desired effect is?
It’s interesting you would say that. The debate has been cleverly reframed using euphemisms like “physician assisted dying” and so forth. Unfortunately reality cannot be imagined away by changing the terminology. When you inject that poison into the person’s vein, you are killing the person. If we lose sight of the fact that the doctor is killing the patient and if we allow ourselves to believe that this isn’t really killing then unfortunately we are committing a kind of intellectual suicide as well as an ethical suicide.
Take a doctor who has zero compunction about providing this service. Say they feel they have a moral responsibility to abide by these patients’ wishes and these patients meet the criteria set under the law. Do you feel the physician has a responsibility to opt out despite their beliefs?
It’s been seen in other jurisdictions that there is a real psychological toll on doctors who have killed patients. They may feel ideologically in support of the concept of physicianassisted suicide or euthanasia but there’s a deep moral intuition that it is wrong to do this, especially when we have never before in history had a better alternative in the form of good palliative. Good palliative sedation can remove all of the patient’s suffering and yet is not irrevocable.
But people have said that measures for palliative care have fallen miserably short and some view physician-assisted death as a solution for those looking for a way out. How do you dispel that mode of thinking?
It would help if we had the same clever manipulators of public opinion. If only they could provide similar support for a law that mandated the availability of palliative care. Where is that law? Palliative care is a state of mind, it’s not a building; it’s a body of knowledge that is easily passed along to enthusiastic care providers. They want the tools, they need the tools, why don’t we just get on with doing it? Instead we hear this fretting about whether suicide and euthanasia will be available in every hamlet in the country.
Hypothetically, if things were to get exactly to where you believe palliative care should be, do you believe there would be the same demand for physician-assisted dying?
According to the people who practice palliative care there’s an overwhelming trend towards dropping requests for hastened death when symptoms are dealt with properly. Some of those symptoms can be hopelessness. For instance, dignity therapy, pioneered by the Winnipeg psychiatrist who chaired the external review panel that the Harper government set up, gives people a chance to find meaning in their life by story telling at the end of their lives. There’s so much psychological as well as physical care that we could be delivering that currently isn’t happening.
When physician-assisted death becomes legal how does the mandate of your organization change?
We’ve entered into full harm-reduction mode. Canadians may think they’ve won a new right but in reality important protections have been removed. We see that when society has made bad changes or wrong turns in the past it’s taken decades to reverse. So we take the long view that the general public can be deeply mistaken and it’s our job to keep pointing out what we think to be the truth and hopefully, eventually, public opinion will change. It’s interesting that there’s starting to be a bit of push back in Belgium and the Netherlands even from people who were activists for euthanasia a few decades ago. One example would be Dr. Theo Boer who used to be an advocate of euthanasia in the Netherlands. He thinks the whole thing is going too far…
One final question: what role has religion played in the coalition?
I was wondering when you would get to that! That’s how the other side makes their biggest points with the public. In Washington State they managed to get assisted-suicide passed on a referendum (it never went through the legislature) and basically they were appealing to raw, anti-religious bigotry. The message was essentially ‘do you want some priest telling you what to do at the end of your life?’ People really didn’t want to be bossed around by somebody else’s religion. I think that the problems with assisted suicide and euthanasia really stand on their own. Yet, arguments that have been presented in a completely secular and straightforward way are smeared by suggesting that their source is an obscure religious agenda. People have to assume that everybody has come to their
conclusions for altruistic reasons. A lot of people have seen a relative suffer a badly managed set of symptoms at the end of life and that provides a lot of horsepower for the right-to-die movement. I don’t doubt these people’s altruism I just think that there’s a better way.
Dr. Will Johnston’s testimony to the Justice Committee can be found at 1:11:18. Answers to the questions of the need for a legal provision for conscience rights can be found at 1:26:00, and the answer regarding advanced directives at 1:36:00.
Published on The Huffington Post on April 22, 2016
Dr. Will Johnston, Family Physician in Vancouver, BC
It is not surprising that many Canadians are concerned about the dangers of the new assisted suicide and euthanasia bill, C-14.
What is really not credible is how the word-benders who used the Charter “right to life” to legalize the intentional suicide or killing of some patients are now protesting that they have been cheated of total victory. While they were in court, they said that all they wanted was for competent consenting adults who were suffering terribly at the end of life to be able to have a doctor kill them, with no criminal consequences for anyone.
Now they are hopping mad that non-adults and those who are mentally incompetent, those unable to consent, those whose suffering is purely psychological, and those with years to live just might be excluded. They don’t have to worry. The same semantic ju-jitsu which delivered the Carter decision to them will have no problem convincing the courts to invite whoever else to the death party.
“Even Kay Carter would not have qualified under C-14” , says the BCCLA organization, which wants assisted suicide and euthanasia to be widely available. This is hard to believe. An awful lot of people will qualify under C-14.
Are you eligible for your provincial medicare?
Are you an adult?
Do you have a grievous medical condition (like Kay Carter’s spinal stenosis)?
Is it irremediable (if you decline surgery for spinal stenosis it automatically becomes irremediable)?
Are you in an advanced state (not defined) of irreversible decline (spinal stenosis won’t go away without surgery)?
Is your situation intolerable (your call)?
Is your death reasonably foreseeable ( like it is for 89 year olds like Kay Carter)?
Do you want to die?
We just approved Kay Carter for assisted suicide. How hard was that?
Now let’s say you have some money and some real estate and your heirs are waiting for you to die. Your doctor does some tests and thinks you have something – let’s call it malignant sarcophagosis. You are duly impressed and share your story with your beneficiaries. Under C-14, your beneficiaries can tell you how you don’t have to suffer and how OK it would be with them if you let a doctor, nurse practitioner, or anyone aiding them kill you . Blatantly urging someone to commit suicide remains illegal, but how do we enforce that against a quiet word, a wink and a nod?
One of your heirs can even sign the request for you, if you have difficulty writing.
Then two independent doctors will agree that malignant sarcophagosis will work for you just like spinal stenosis would have for Kay Carter. It is not surprising that they will agree, because one of those independent doctors is the one who will kill you with an intravenous injection or provide you with suicide pills. The other doctor will reliably concur, not least because there is no limit to the doctor shopping to locate a compliant one.
But what if your sarcophagosis is of milder sort, the semi-malignant kind? No problem, because your “natural death” just has to be “reasonably foreseeable”, and no need to specify “the specific length of time.”
But what if the physicians goofed, and you don’t have malignant sarcophagosis, or the mental competence to consent, or an uncoerced wish to die? No worries, because a blanket protection called “reasonable but mistaken belief” about “any fact” protects them even if you are dead as a result.
Oh, by the way, absolutely anyone is allowed to “assist” you to administer your suicide dose, with no oversight yet mentioned in this law. If you had changed your mind and struggled, who would know?
Meanwhile, aboriginal leaders, including Liberal MP Robert-Falcon Ouellette , are justified in wondering where the intensity required to prevent suicide among youth is going to come from.
If one ounce of the effort that has been put into assisted suicide and euthanasia had gone toward suicide prevention, or of course palliative care, it would be easier to take the howls of outrage from the extremists for whom C-14 will never go far enough.
So what should be done? Ideally, throw out the law, and strengthen the wording of the current law against assisting suicide (because the Supreme Court played games with the old wording about needing to protect only the “vulnerable”). Make palliative care access, not suicide access, mandatory in law.
But failing that, at bare minimum ensure independent third party review before all proposed deaths. Don’t let any two wannabe Kevorkians wave these things through. Defend the rights of all Canadians by guaranteeing that no doctor or institution will be coerced to participate, and say so loud and clear in the law.
We must not leave such a pillar of our freedom to an uncertain fate inside Ministry of Health regulations, which, “for lack of time,” have not yet been revealed.
Will Johnston is a Vancouver family physician and Chair of the Euthanasia Prevention Coalition of BC
Follow Dr. Will Johnston on Twitter: www.twitter.com/willjohnston19
Published in the National Post on April 14, 2016
Six questions about physician-assisted death, from a conscientious objector
Canadian policy makers have recently proposed to require all doctors to provide an effective referral for physician-assisted death (PAD) upon the patient’s request. Forcing doctors to knowingly send their patient to another doctor willing to cause the patient’s death will seriously compromise the moral integrity of conscientiously objecting doctors and risks undermining the quality of patient… (more…)
I was disturbed by Mark Hume’s article, “A B.C. family’s secret: How they helped their parents die,” which treats as a given that a father and mother, who died via secret assisted suicides, wanted to die. We don’t know that. What we do know is that the adult children left behind, who state that they fear prosecution, have presented a somewhat loving account of the story. I say somewhat loving because they admittedly allowed their mother to die alone, upstairs, while they gathered together in the kitchen below.
In my life, I have not experienced children who “helped their parents to die.” I have, however, had contact with women abused by their spouses, who outright deny that the abuse occurs. The victim protects the perpetrator. I have an older friend who wired $5000 to a stranger who had phoned impersonating her grandson. Yes, she acted voluntarily to send the money, but she had been manipulated to do so. When she later realized what had happened, she was so embarrassed, it took her three weeks to tell me. The money was long gone. But it was only money and not her life.
The Government of Canada website describes elder abuse as a widespread and hidden problem. The abuse is often perpetrated by family members such as the adult children described in Humes’ article. We can’t stop the abuse now. Relaxing our laws on assisted suicide will only increase it. I can only hope that our country does not take this course.
[Editor, this is a link to the Government of Canada website: http://www.seniors.gc.ca/c.4nt.2nt@.jsp?lang=eng&geo=110&cid=154#e You may also be interested in this study describing the high prevalence of elder abuse in the United States: http://www.metlife.com/mmi/research/broken-trust-elder-abuse.html#findings ]