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Canada Needs More Meaningful Consultation on Physician-Assisted Death

09/14/2015 12:12 EDT | Updated 09/14/2016 05:12 EDT
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Closeup shot of an elderly man holding his wife's hand while she is ill in the hospital

Last month, Ottawa's expert panel on PAD -- physician-assisted death -- launched its website so that we could provide our views, not on if it should be legal (the Supreme Court decided that in February), but how it should happen.

Unfortunately, two of the three experts on the panel were witnesses for the government in a case they lost 9-0. So lots of Canadians were leery of the panel's impartiality and waited for the website to clear up that suspicion.

Said Dr. Max Chochinov, the panel's chair who was one of the two government witnesses. "I would encourage [Canadians] to go to the online tool and really to decide for themselves."

So I did that, and you know what? It is painfully biased.

It first asks you to complete the online "issues book."

The name "issues book" is odd since it's not a book at all, nor a discussion of the issues. In fact, there is no book, and unless the panel is planning to engage in a two-way online discussion with hundreds of thousands of Canadians, there never will be. All "consultations" with individual Canadians (there is a different process for medical authorities and other interested parties) must take place via the emotionless medium of the internet to discuss an issue that's deeply, inherently emotional.

The reality is, it's just a survey, just like all those other online polls where you state your preferences from "strongly disagree" to "strongly agree."

It's a blatantly one-sided survey as well. Here are just four questions that betray the panel's baked-in bias.

One question asks: "Who will be eligible for a physician's assistance in dying?"

It warns: "Eligibility criteria will be needed to ensure that people are protected from harm as a result of abuse or error."

But nowhere in the entire 20 to 30-minute survey does it ever mention ensuring that Canadians who are suffering horribly will be eligible for a physician's assistance in dying. The Supreme Court's judgment stated the terrible dilemma in stark terms: "...she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel."

So it's odd that the panel forgot to mention the most important guarantee of eligibility of all.

Next question: "To what extent do you agree or disagree that you...should be able to receive a physician's assistance to die if..." and then they offer two examples:

"Regardless of how much time you may have, you are concerned about being a burden to others, either emotionally or financially."

"You received this diagnosis at the age of 16 and have a full and complete understanding of your condition and wish to die."

But the fact is, the Supreme Court rules that neither of these situations qualifies as eligible for assisted dying. So what are they doing in this survey at all?

They're manufacturing fear where none need exist.

Next question: "Do you agree or disagree that physicians who refuse to provide assisted dying should be required to provide referrals to other physicians who are willing to provide access?"

Presenting this as a black and white choice certainly stakes out two options. But like so much on this site, it removes the possibility of nuance or a third solution. For example, it leaves out entirely the position of the Canadian Medical Association, which are considering that doctors who aren't willing to provide physician-assisted death should refer their patient to an independent agency.

Makes sense.

Final question: "How important do you think it is for the following safeguards to be required by law before a patient may receive assisted dying? The first safeguard is "a consultation with a mental health professional." The second is "requests are evaluated by a group of diverse professionals (e.g. doctors, lawyers, social workers)?"

What it doesn't mention is the professional group favoured by Dr. Chochinov and that right-to-die advocates fear will be the real decision-maker -- judges.

As he told the CBC in April: "A court needs to determine if I can get a variance on placing a fence. Why shouldn't the court determine if somebody meets criteria so they can receive assisted dying."

But what do we know about taking anything to court?

It takes a very long time.

And time -- especially the days, weeks or even months for someone who is dying in incredible pain -- is exactly what the patient doesn't want. Nor deserves.

When his panel's site was launched, Dr. Chochinov said: "If the tool were biased, Canadians would see through that immediately."

Right.

Bob Ramsay is married to Dr. Jean Marmoreo, who is on the physicians' advisory committee of Dying With Dignity.

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