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Depression in the terminal stage is common and receives little care, and patients who suffer from it are four to five times more likely to request euthanasia.

This is one of the salient facts discussed in an impressive seminar recently presented by Dr. François Primeau, psychiatrist and Chief of Geriatric Psychiatry at the CSSS Alphonse-Desjardins, during an Association of Quebec Psychiatrists conference (AMPQ). We invite you to listen to this teleconference, which we make available with permission from Dr. Primeau and the AMPQ.

As a psychiatrist, Dr. Primeau highlights that depression affects 20 to 50 % of terminally ill patients and that only 3% among them are treated for this disorder. He also cites a study reporting 44% of patients in palliative care request termination of life, but half of them change their mind within two weeks. These figures are particularly troubling, he says, when we consider in the Netherlands that accepted euthanasia requests lead to death in less than two weeks. Aside from the problem of untreated depression, Dr. Primeau reminds us of the well-established fact that only 30 % of terminally ill patients currently have access to palliative care, which is critical to their physical and mental comfort.

These numbers are of particular concern especially since the last provincial budget included cuts of $ 400 million in health services, while the Quebec Association of Health Facilities and Social Services had argued the need for an injection of $1.2 billion just to maintain current services in the context of an aging population.

“Could euthanasia become a demographic control over an economy burdened in the future?” He asked, arguing that in 2010, the Economic Planning Commission of Australia recommended euthanasia as a viable way to control health care costs, which are also growing due to demographic changes.

Here are some other facts and issues presented by the speaker:

• Canadian law demands universal access to health care. If euthanasia is legalized as a form of “care”, it will be very difficult to set limits, since these may be considered discriminatory. For example, in the Netherlands, major depression has been accepted since 1994 as a criterion for eligibility to receive euthanasia upon request. Bill 52 is already paving the way for this scenario by considering “psychological” suffering as an eligibility criterion.
• The supposed “consensus” in Quebec on the legalization of euthanasia is misleading: 59% of the submissions to the Advisory Committee opposed euthanasia and 35% were in favour. As for the polls, they show a lot of confusion on the subject. Only 33 % of respondents to an Ipsos Reid poll conducted in September 2013 understood that the term “medical aid in dying” signified the injection of a lethal substance to a patient, 29% believed that it was a form of palliative care and 22% thought it was the discontinuation of aggressive therapy . A survey of specialists in August 2010 reported 75% of doctors were in favour, but the answers also show that 48% of respondents confused palliative sedation and euthanasia.
• Globally, euthanasia remains a marginal practice: it is legal in only three countries representing 0.45% of the world population, i.e. the Netherlands, Belgium and Luxembourg, and in two US states (Oregon and Washington). The World Medical Association, which consists of 9 million doctors in 106 countries, ruled against euthanasia in 2013.
• According to Dr. Primeau abuse is not a hypothesis but a reality. In the Netherlands, statistics show an increase of 117 % of euthanasia cases between 2006 and 2012, bringing the numbers from just over 1900 to about 4000. In 2013, 45 patients with psychiatric disorders were euthanized. Major depression has been a criterion for eligibility since 1994. Euthanasia of children is permitted. And 23% of acts of euthanasia are not reported. The UN spoke out against the high number of euthanasia cases in the Netherlands, concerned about the “omnipotence “of doctors who unilaterally establish the prognosis, decide whether the patient is eligible for euthanasia and carry it out.

The conference was followed by a question period and an interesting discussion with other physicians.