[Canada] Canadian Politics Redux

[garbon]

And if any physician interpreted the requirements in such a silly way, they would certainly lose their licensure

What makes you think physicians aren't already approving such requests?

Here's an example for you from AP: https://apnews.com/article/covid-science-health-toronto-7c631558a457188d2bd2b5cfd360a867

61 year old Alan Nichols was suffering from depression.  He wasn't granted MAID because of his depression (that's coming in 2024), but for hearing loss.  His family says Nichols wasn't taking medication and wasn't using his cochlear implant which would treat his hearing loss, but he was approved for MAID anyways.

If this problem is so far reachinf, I'm a little surprised as to why the AP didn't mention examples from a time more recent than 4 years ago.

I thought this article is better at looking at the evolving challenges as it doesn't rely on emotional statements from a patient's family.

https://www.cbc.ca/news/politics/maid-canada-report-2022-1.7009704

[Barrister]

If this problem is so far reachinf, I'm a little surprised as to why the AP didn't mention examples from a time more recent than 4 years ago.

I thought this article is better at looking at the evolving challenges as it doesn't rely on emotional statements from a patient's family.

https://www.cbc.ca/news/politics/maid-canada-report-2022-1.7009704

Well probably because the story is so egregious, and I imagine the family has been lobbying hard.

I want to bring up something rom the article you mentioned.  Right at the end:

Downie said the upcoming expansion is "essential" because she thinks excluding people with mental disorders on the basis of their diagnosis is "discriminatory."

"To exclude in that way is stigmatizing, it's paternalistic," Downie said. "I don't think there's any justification for the exclusion."

Downie said she expects an "incredibly small number" of people with mental disorders will get access to MAID due to the request and assessment processes.

"Many will be found not to be eligible, many will be diverted by actually getting access to different kinds of services and supports," she said.

People suffering solely from a mental illness will be eligible for MAID as of March 17, 2024.

Downie is a Professor at Dalhousie University and an advocate for medically assisted suicide.

I love this classic double-talk.  MAID for the mentally ill is "essential" because it is discriminatory - but it will only be used by an "incredibly small number" of people.  I'm sorry - if it's such an incredibly small number of people then it probably isn't all that important an issue.

But then earlier in the story she pretty much contradicts herself.

Downie said she doesn't think the year-over-year MAID growth is unexpected or disturbing.

"When you have something that's illegal, and it becomes legal, you are going to have an increase in the numbers," she said. "And it's going to take a little while for the numbers to settle."

So it doesn't sound like she thinks the number will be all that small after all.

[garbon]

There were two 2019 patients cited in the ap article. Both were from 2019.

[Barrister]

There were two 2019 patients cited in the ap article. Both were from 2019.

Not sure what to tell you Garbo.

It's not like 2019 is ancient history (in particular for an article posted in 2022).  It's clear that Nichols family was outraged at what happened and have been pressuring for changes, which is probably why the AP got in touch with them.

There are other stories out there.  I just selected an AP article as being perhaps the most impartial you could find.

[garbon]

There were two 2019 patients cited in the ap article. Both were from 2019.

Not sure what to tell you Garbo.

It's not like 2019 is ancient history (in particular for an article posted in 2022).  It's clear that Nichols family was outraged at what happened and have been pressuring for changes, which is probably why the AP got in touch with them.

There are other stories out there.  I just selected an AP article as being perhaps the most impartial you could find.

My first thought on 2019 is that if this is such an issue as AP was positioning it (headline was of course: 'Disturbing': Experts troubled by Canada's euthanasia laws), surely they would have had stories from even that year (if not 2021) to highlight. It isn't that 2019 is at such a remove but it doesn't support the argument that there is a tremendous problem if you have to go a few years back.

I also would say that despite the general view I also hold that the AP is fairly impartial, the article you linked was not impartial. That started with its click bait headline and then a large chunk of the article being devoted to an emotional outpourings from the Nichols family.

That's why I thought the CBC article was more informative as it gave perspectives on both sides of the issue and avenues that still need to be further examined. In contrast the AP article very much felt like the gateway to conspiracy thinking - all this terrible bad stuff is happening and the people in charge are so callous that they won't do anything about it.

[crazy canuck]

I read the article, searching in vain to learn Process the doctors went through in order to determine that made was appropriate. Unfortunately, the article made no attempt to articulate what the reasoning of the was.

The article simply accepted at face value what the family said was the reason.

We will likely never know what the doctors were actually thinking, because as the article points out, the family was opposed to the man's decision.

They have a very self interested reason for telling their story and the article definitely slants to their position.

It would be more helpful if you could find a case from the college of physicians and surgeons from any of the provinces which discipline a doctor for not following the protocol in the legislation appropriately.

You appear to have taken this article, and the families explanation for what happened at face value, and so I can see why you have fears.


There is no way somebody would be euthanized for simple hearing loss. It's a shame that the article is taken seriously when it asserts that was the only reason.

You might also note that the article uses the word "killed". That may be a tip off that the person writing the article has an asked, grind, and a certain view.

[garbon]

I looked up the author earlier and assisted suicide is one of the many topics she has covered as a medical correspondent over the years.

This article below makes it clear though that she was creating a narrative based on family testimony on how Canada's approach is wrong.

https://leads.ap.org/best-of-the-week/canada-troubled-euthanasia-system#

Revealing look at Canada's troubled euthanasia system
MARIA CHENG AND MIKE HOUSEHOLDER

During the COVID-19 lockdowns, London-based AP medical writer Maria Cheng spent considerable time in her native Canada. While covering the pandemic from a global perspective, something caught her eye: individual tales of troubling euthanasia deaths in Canada that had spurred investigations and lawsuits.

Canadian media hadn't really connected all those stories. But Cheng, who had written previously about euthanasia in Europe, saw a pattern: controversial deaths unlike ones she had covered elsewhere.

She set to work on what was happening and why so many families seemed shocked by their loved ones' deaths. Extensive reporting, interviews and document searches revealed Canada had arguably some of the most lax euthanasia laws in the world, with fewer safeguards than many other countries with longer histories of medically assisted death.

Canada's treatment of the disabled was especially an outlier, with people allowed to seek death simply because they are disabled. The situation has fostered recriminations from all corners — disabled advocates, the United Nations and even the pope.

Cheng and Detroit-based video journalist Mike Householder told the stories of families' experience with euthanasia. Householder spent time in Ontario telling the story of a woman who was shocked that her father was accorded euthanasia within days of a fall. And Cheng obtained a copy of a form showing that one man who sought euthanasia listed just one condition for it: hearing loss. A family photo of Alan Nichols and an image of his form accompanied the story.

[Barrister]

It would be more helpful if you could find a case from the college of physicians and surgeons from any of the provinces which discipline a doctor for not following the protocol in the legislation appropriately.

You appear to have taken this article, and the families explanation for what happened at face value, and so I can see why you have fears.


There is no way somebody would be euthanized for simple hearing loss. It's a shame that the article is taken seriously when it asserts that was the only reason.

You might also note that the article uses the word "killed". That may be a tip off that the person writing the article has an asked, grind, and a certain view.

It's because the protocols are the problem!  Of course nobody is being disciplined for not following them.  Instead, doctors run the risk of being disciplined if they do not at a minimum refer someone to another doctor for MAID if requested.

Googling for more MAID stories, I found this very informative research paper.

https://www.cambridge.org/core/journals/palliative-and-supportive-care/article/realities-of-medical-assistance-in-dying-in-canada/3105E6A45E04DFA8602D54DF91A2F568

With respect to Nichols, the story mentions him as one example.  The RCMP gave the family a copy of his MAID request, which did in fact list "hearing loss" as the relevant diagnosis, so I'm not sure why you think that couldn't happen.

It also mentions Donna Duncan. She suffered from a concussion, had been waiting over a year for medical treatment, but received MAID within days of requesting it.

In fact the delays in receiving treatment (versus the speed of MAID) comes up several times.

A military veteran and former Paralympian who has been trying to get a wheelchair ramp installed at her home for the past 5 years testified that she was offered MAiD by her caseworker, and it has been confirmed that at least 4 other veterans were also offered the option of MAID when trying to access resources and care (Yun Reference Yun2022).

Access to medical and social care in Canada is often not timely, which can compound patient suffering and desperation. For example, the average wait time to be treated by a psychiatrist can exceed by up to 5 times the 90-day waiting period to access a lethal injection (Moir and Barua Reference Moir and Barua2021). This means that a person seeking death while awaiting treatment from a psychiatrist could die by MAiD long before they get access to appropriate treatment. The wait times for many other specialized health-care and social support services, including pain clinics, specialized long-term care homes, community-based housing, and disability benefits, also far exceed the 90-day assessment period (Lemmens and Krakowitz-Broker Reference Lemmens and Krakowitz-Broker2020). This highlights the need for comprehensive approaches to addressing suffering, rather than providing MAiD as the path of least resistance.

And of course let's remember that MAID is being extended to mental illness in a few months.  How is that going to turn out?

Therefore, patients with mental illness, a population known for a high prevalence of psychosocial suffering, will be wrongly informed, during periods of despair and hopelessness, that their conditions are "irremediable" and will not improve, despite this being impossible to predict. In response to concerns that irremediability of any individual's mental illness could never be predicted (a legal requirement to provide MAiD for mental illness in Canada), Dr. Justine Dembo, a MAiD activist and psychiatrist who sat on the 2022 federal panel on MAiD for mental illness, suggested she would simply advise the patient of the uncertainty that they could recover so they could make their own "informed decision" to receive MAiD, despite the fact that legal reporting forms require indicating that the medical condition is irremediable (Hanomansing Reference Hanomansing2023).

Oh and finally - someone who received MAID has been killed.  Let's not hide behind euphemisms here.

[Barrister]

I looked up the author earlier and assisted suicide is one of the many topics she has covered as a medical correspondent over the years.

This article below makes it clear though that she was creating a narrative based on family testimony on how Canada's approach is wrong.

"Creating a narrative" makes it sound like they're inventing these stories.  They're not.

[garbon]

I looked up the author earlier and assisted suicide is one of the many topics she has covered as a medical correspondent over the years.

This article below makes it clear though that she was creating a narrative based on family testimony on how Canada's approach is wrong.

"Creating a narrative" makes it sound like they're inventing these stories.  They're not.

Well that's not what I intended. I meant the same as I said this morning, this is an example where the AP article is not at all objective but rather coming with a clear slant. One that says you judge the policy based on how the survivors feel about it.

[Barrister]

More horror stories.  This is from evidence given at a parliamentary committee last year.

A man had a small stroke affecting his balance and swallowing. The patient was depressed and isolated due to a COVID-19 outbreak on his ward. The stroke neurologist anticipated the man would be able to eat normally and regain most of his balance. He declined all therapy, and psychiatry diagnosed him with an adjustment disorder, but they felt he would improve. However, he requested MAID. Neither of his MAID assessors had any experience in stroke rehabilitation and recovery.
    In this acute phase while struggling with his mood and isolation with no therapy to gauge his final level of function, he received MAID. He had no terminal illness, but due to the fact that he was adapting to a slightly thickened diet and so was temporarily slightly undernourished, they considered him "track one" eligible, and he received MAID the following week. No safeguards were technically broken, and yet he died when acutely down, isolated and had not experienced living with maximal recovery from his stroke.
     Mr. Ernest McNeill was a 71-year-old widower admitted to hospital for falls. During his admission, he contracted C. difficile, an infectious diarrheal illness. He was openly humiliated by staff for the smell of his room. He developed a new shortness of breath that was not comprehensively assessed. Without the patient requesting it, a hospital team member raised and recommended MAID to him.
    The team said he had COPD, and it held a terminal prognosis. The MAID procedure was booked by the hospital team before he even had a second assessment, and within 48 hours of his first assessment he was dead. Post-mortem tests confirmed no significant COPD, and his family doctor also said he didn't have end-stage COPD, but no one had contacted her for collateral history.

https://www.parl.ca/DocumentViewer/en/44-1/AMAD/meeting-10/evidence

And just for the record I'm not saying MAID should never be available, but that it should not apply to mental illness, that you are liable to die within reasonable proximity, and in general just a lot more safeguards should be put in place.

Because otherwise it just looks like we're trying to kill off as many disabled people as we can.

[crazy canuck]

BB,

I'm not sure what to say to a person who takes that article as a description of what actually occurred rather than a very slanted view from one particular perspective.

All I can really say is that you must be able to recognize that hearing loss alone does not meet the criteria. That viper has now explained to you at least three times.

If you can identify a case that has occurred in Canada, where the protocols have clearly not been met I would be happy to hear about it. I would consider that a very serious matter, and one that should definitely be dealt with by the relevant provinces College of physicians and surgeons.

[crazy canuck]

More horror stories.  This is from evidence given at a parliamentary committee last year.

A man had a small stroke affecting his balance and swallowing. The patient was depressed and isolated due to a COVID-19 outbreak on his ward. The stroke neurologist anticipated the man would be able to eat normally and regain most of his balance. He declined all therapy, and psychiatry diagnosed him with an adjustment disorder, but they felt he would improve. However, he requested MAID. Neither of his MAID assessors had any experience in stroke rehabilitation and recovery.
    In this acute phase while struggling with his mood and isolation with no therapy to gauge his final level of function, he received MAID. He had no terminal illness, but due to the fact that he was adapting to a slightly thickened diet and so was temporarily slightly undernourished, they considered him "track one" eligible, and he received MAID the following week. No safeguards were technically broken, and yet he died when acutely down, isolated and had not experienced living with maximal recovery from his stroke.
     Mr. Ernest McNeill was a 71-year-old widower admitted to hospital for falls. During his admission, he contracted C. difficile, an infectious diarrheal illness. He was openly humiliated by staff for the smell of his room. He developed a new shortness of breath that was not comprehensively assessed. Without the patient requesting it, a hospital team member raised and recommended MAID to him.
    The team said he had COPD, and it held a terminal prognosis. The MAID procedure was booked by the hospital team before he even had a second assessment, and within 48 hours of his first assessment he was dead. Post-mortem tests confirmed no significant COPD, and his family doctor also said he didn't have end-stage COPD, but no one had contacted her for collateral history.

https://www.parl.ca/DocumentViewer/en/44-1/AMAD/meeting-10/evidence

And just for the record I'm not saying MAID should never be available, but that it should not apply to mental illness, that you are liable to die within reasonable proximity, and in general just a lot more safeguards should be put in place.

Because otherwise it just looks like we're trying to kill off as many disabled people as we can.

I'd like to know whether the doctors she is accusing of negligence were also called to give their side of the story?

For those who may not know testifying before a Senate committee gives the witness absolute privilege, which means they can say defamatory things without having to ensure that they are true.   The testimony is this doctors characterization of what the proper diagnosis ought to have been after the fact. If the witnesses who actually made, the diagnosis were called as witnesses, you might have a very different view of whether this witnesses testimony should be accepted over the testimony of those who actually made the decisions. Again, this is a case of somebody else, characterizing the decision making process of others, and not hearing directly from those who made the decisions.

I find this kind of argument very problematic. If you have something that shows that a decision-maker did everything they accused of then I'd be very interested in seeing that.

[Grey Fox]

Earlier BB & Jacob agreed that 1 in 15 was a bit high. In the report I linked yesterday, it talks about how only 68% of MAID demands were administered. Of that unaccepted 32%, 1/3 were from people that simply died before the demand was treated/administered.

Somehow, it doesn't seem so bad to me then.

[Barrister]

BB,

I'm not sure what to say to a person who takes that article as a description of what actually occurred rather than a very slanted view from one particular perspective.

All I can really say is that you must be able to recognize that hearing loss alone does not meet the criteria. That viper has now explained to you at least three times.

If you can identify a case that has occurred in Canada, where the protocols have clearly not been met I would be happy to hear about it. I would consider that a very serious matter, and one that should definitely be dealt with by the relevant provinces College of physicians and surgeons.

Nichols is slightly different because, having happened in 2019, the criteria were different.

But absolutely hearing loss would be enough to qualify!

Let's review the criteria again:

-have a serious illness, disease or disability
-be in an advanced state of decline that cannot be reversed
-experience unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable

Total hearing loss is a serious disability (albeit one that can be managed).
It can not be reversed.
So if someone says they are experiencing unbearable mental suffering as a result of that hearing loss, they would seem to qualify.