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Dear Friends,

On September 11, 2019, Quebec Superior Court judge Christine Baudouin ruled that the prohibition of “medical assistance in dying” of people who are not at the “end of life” (in the Quebec law) or whose death is not “reasonably foreseeable” ( Canadian law) is unconstitutional. Elated by its victory, the death lobby is now pressing the Prime Minister to weaken the law even further by removing the requirement that a person be capable of consenting to the euthanasia at the time of their death.

The scenario envisaged in the news reports is that of someone, having requested euthanasia, losing the capacity to consent as their condition deteriorates. But euthanasia activists are also pressing for lethal injection for people incapable of decision-making because of cognitive disorders who expressed a desire for it by advance directive.

Concurrently, a Quebec government committee released its report on November 29, 2019, recommending euthanasia by advance directive in both these situations. Federal Justice Minister David Lametti also announced on December 11 his intention of considering this possibility.

At least two people in British Columbia who have early dementia but reportedly retained their decision-making capacity have been euthanized by such physicians, who claim that “This is not an expansion of our law … This is a maturing of the understanding of what we are doing…”. They were not disciplined by the BC College of Physicians. Activist physicians are effectively rewriting the law, removing in practice the safeguards so carefully crafted by our lawmakers to protect vulnerable citizens from the new exemption from the prohibition of homicide in certain cases.

We will address in another article the very low likelihood of the average MAiD provider being able to evaluate capacity to choose death in a cognitively impaired patient. A more fundamental question is: What would things look like in Canada if euthanasia for dementia became an acceptable practice?

Proponents say that people should have the right to choose whether they want to continue living in such a condition. But do they have true alternatives? One of the people euthanized in BC had expressed a fear of being placed in a home. What about supporting families so they can reorganize their lives, their jobs and their homes to support and care for a family member with dementia? What about promoting creative residential alternatives to the dreaded impersonal long-term care institution: for example the Carpe Diem approach pioneered in Trois-Rivières; the Alzheimer village in Langley BC; and the secure neighborhood being developed in St-Jean QC. The ideas exist but the reality is not yet available for most Canadians. What about working in that direction?

As physicians we are called to honor and care for all our patients in their integral personhood. In the geriatric clinic where I see patients with dementia and their families, I am constantly inspired by their ability to rise above the cognitive loss and increasing dependency, and find new sources of joy, inversing and deepening relationships as the carer becomes the cared-for. Indeed, in 35 years I have never received a request for euthanasia, neither before it became legal, nor in the four years since the law came into effect in Quebec. Which reminds us that the vast majority of people want to live, not to die.

At a medical conference I attended recently, a physician in the audience asked about the ethics of withholding oral food and water from a patient under her care in a nursing home (“putting her NPO”), thus causing death from dehydration and starvation. The patient has advanced dementia and could eat and walk, but then fractured her hip, was refused surgery and returned to the nursing home non-ambulatory. She could now eat but not walk, so was judged by her doctor to have “no quality of life”.  The physician appeared quite distressed at the presence of this patient and others in similar circumstances in her nursing home and felt that she had to do something to accelerate their demise. Had the patient written an advance request, as the proposal goes, she could have been swiftly removed from the nursing home population.

At the other end of the spectrum we have the gentleman in B.C. whose widow says his ” ‘need to read’ was integral to who he was”, and who began contemplating MAiD when he could no longer read a map.

These stories illustrate the danger of reducing personhood to the qualities or capabilities a person has, rather than honoring the richness and uniqueness of each person regardless of what they can or cannot do.

As Jean-Marc Barreau observes in his book Soins palliatifs : accompagner pour vivre ! (Palliative care: accompaniment for life!), every human person has two dimensions: work / action, which he calls facere, and love / relationships, which he refers to as agere. When a person is in good physical and psychological health they are in a certain equilibrium, although we tend to put more time and energy into facere than into agere. When illness arises the proportion is inversed, and the role of the health care team in palliative care (and dementia care) is to accompany the person as work diminishes to allow progressively more time for love, until a point is reached where there is only love. Care. Given and received.

To allow euthanasia for dementia would reduce the stress in some people’s lives and would certainly be a relief to the public purse. But it would impoverish our society on a human level, by removing those members who call us to unconditional love. But as the Canadian Association for Community Living (CACL) and the Council of Canadians with Disabilities (CCD) remind us, government and society have a duty to avoid negative perceptions of the quality of life of the elderly, ill, and persons with disabilities, indeed to ensure that life with a disability is never painted as a life worse than death.

Do we want to be a society that perpetuates the stigma and facilitates the way out for Canadians with dementia? Or one that creates the conditions for them to live happily until the natural end?

 Make euthanasia unimaginable.

We take this opportunity to wish you all a merry Christmas, happy
Hannukah, joy in all your celebrations this holiday season, and a happy and
peaceful new year 2019.

Sincerely,

Catherine Ferrier
President

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