Euthanasia document authors’ biases questioned

Multiple aspects of the recently released Health Canada guidance about Medical Assistance in Dying (MAiD) trouble Nicole Scheidl, executive director of Canadian Physicians for Life.

Scheidl told The Catholic Register that when she first observed the list of personnel who contributed to the Model Practice Standard for MAiD and the Advice to the Profession document, it had an undeniably pro-euthanasia bias.

“(Health Canada’s) position is being supportive of euthanasia, so they are bringing together people of like mind to draft the regulations and standards of practice to ensure that everything promotes euthanasia,” said Scheidl.

She detailed the background of some of these practitioners in an emailed statement to media partners.

“Two of the task group members, Willi Kirenko and Lillian Thorpe, both assess patients for euthanasia and perform it,” wrote Scheidl. “Laurel Plewes is a MAiD program director in B.C.. Jocelyn Downie gave Dying with Dignity Canada’s 2018 keynote. And chair Mona Gupta could not see why it was necessary to delay the expansion of euthanasia to those for whom a mental illness is the sole condition.”

Dying with Dignity Canada, which is fully on board with expanding MAiD, found no fault in the document. Spokesperson Sarah Dobec said the non-profit “was pleased to see the completion and release of the Model Practice Standard for Medical Assistance in Dying (MAiD), in response to a recommendation from the expert panel on MAiD and Mental Illness. The Standard, which also supports a recommendation of the Special Joint Committee, may be used by clinicians in developing or revising MAiD standards, by provincial/territorial ministries of health and regional health authorities in their policy development, and health professional associations developing clinical practice guidelines.”

While examining the regulations in the standards of the practice document, section 5.2.1 stood out and confirmed bias to Scheidl. It dictates that a physician or nurse practitioners who are unable or unwilling to directly participate in offering MAiD must “complete an effective (referral/transfer of care) for any person seeking to make a request, requesting or eligible to receive MAiD.”

Such an order, currently the standard in Ontario, “undermines the professional integrity of doctors who are opposed to ending their patient’s lives,” said Scheidl.

“Doctors who don’t think it is appropriate for the person, who don’t agree with euthanasia per se, who have moral integrity and say, ‘I don’t want to participate in this,’ they don’t have an option,” said Scheidl. “I know there are doctors who are leaving Ontario and doctors who are taking early retirement, and that is impacting patient care.”

Dobec disagreed with this interpretation and said “the choice to request an assisted death or to participate in facilitating an assisted death is an individual decision; no clinician is required to participate in a MAiD assessment or provision,” she said, citing Section 5.0 of the Standard — Responsibilities of (Physicians/Nurse Practitioners) Unable or Unwilling to Participate in MAiD.

Ultimately, Scheidl said the problem in Ontario will “spread like wildfire across the country if each province adopts the effective referral (rule).”

Despite many safeguards preventing a physician from advising MAiD eroding in recent years, a couple of protections remain intact. Scheidl spotlighted those in her letter.

She alluded to item 6.3 of the Model Practice Standard, which reads, “Upon forming reasonable grounds to believe that a person may be eligible for MAiD, a (physician/nurse practitioner) must determine whether MAiD is consistent with the person’s values and goals of care.” Paragraph 6.3.2 states, “if not consistent, do not advise the person for the potential of MAiD.”

This safeguard implores the physician/nurse practitioner to thoughtfully consider their patient’s cultural and religious convictions when formulating options for their care.

Schiedl also pinpointed segment 10.3.4.2, which concerns gathering collateral information, including from the treating team, family members and significant contacts of the patient. Point ‘A’ dictates “assessors and providers must attempt to obtain all collateral information necessary for the completion of a MAID assessment.” Point ‘B’ adds that the “provider and assessor must have received consent from the capable person prior to gathering collateral information.”

If the patient refuses consent for the provider or assessor to obtain this information, the person “cannot be found to be eligible.”

“Being familiar with a patient’s history, family and values can be life-saving,” wrote Scheidl. “At times, reminding the patient who they truly are by reviewing this background with them can shed light on the true goals of their care.”