time to decriminalise assisted dying in canada

Here's this weekend's OpEd on Assisted Dying in the Kingston Whig-Standard.

This last week doctors organized under the Canadian Medical Association met for their policy convention in Calgary. A whole bunch of sensible policy recommendations came out of this meeting, including the suggestion that our kids should no longer be able to purchase energy drinks.

But commentators writing for national news organizations concluded, in typical handwringing style, that the CMA failed us terribly by not issuing a recommendation on the issue of the decriminalization of assisted dying.

I don’t think that was much of a failing. In fact, I don’t quite understand why it should matter more what doctors think than what you or I think about our own death. Why should they have a bigger say or stake in the manner of our own dying? I guess it could matter if they were to be forced to participate in assisted dying if it were to be decriminalized. The thing is, that would not be the case, anyway, so why get overly excited about our doctors’ views on the matter?

Where are we in the assisted dying stakes, anyway? Quebec has decided that assisted dying is no more than part of continuing medical care, and so, by its lights, it is its decision alone how it regulates this matter since health care is one of those powers entrusted to the provinces through the Constitution. The provincial government is intent on making assisted dying a possibility.

Quebecers overwhelmingly support this. There is even cross-party support in the province for the proposed legislation. The National Assembly is currently debating it. You can be sure that the federal government – currently controlled by conservative Christians – will try to have this provincial law set aside by the courts, and to be fair, there is a serious constitutional issue at stake here! The constitutional issue isn’t – as you might expect – about assisted dying, but about the question of whether our provinces should be able to set aside the parts of the federal Criminal Code that prohibit assisted dying by redefining it as a provincial health matter. If they were able to do so, what parts of the Criminal Code might be next?

Independent of the goings-on in Quebec, the Supreme Court of British Columbia declared in a 2012 ruling those parts of the Criminal Code that criminalize assisted dying unconstitutional. The federal government has appealed this decision and we should hear within the next few months how that went. However the Court of Appeals decides, the losing party will undoubtedly try to get this matter heard by the Supreme Court of Canada.

It is always tricky to predict how court judgements, especially Supreme Court of Canada judgements, will pan out. The latter, protests from legal eagles notwithstanding, has plenty of leeway to determine the course of assisted dying in this country.

I’m optimistic that decriminalization in some form or shape will eventually occur. The reason for this is essentially that our Charter of Rights and Freedoms places a very high value on respect for the autonomous choices we make for ourselves. That explains why suicide is legal in Canada. That also explains why we have the legal right to stop life-extending medical care at any time. Short of having us declared incompetent, doctors cannot treat us against our wishes.

Given this context, it doesn’t seem to be a great stretch for a court to determine that we also have the right to assistance in dying. Respect for our individual freedom will win out. It has on the abortion fronts, it has on the marriage equality front, and it will win on the assisted dying issue, too. As a species we seem bent on placing individual rights and freedoms, as far as self-regarding actions are concerned, above conservative values that have others determine what’s best for us.

The countervailing arguments against decriminalization are pretty thin - and that is putting it mildly. In the old days the same anti-euthanasia campaigners who busily contribute to public debate today were pretty clear that assisted dying would violate their religious rules, and so none of us should have access to it, regardless of our own worldviews. They have since realized that this kind of arguments doesn’t exactly help their cause among the wider Canadian public. Accordingly, they switched their campaigning to concerns about possible abuses of never-clearly defined “vulnerable” people.

Given that pro-choice campaigners are concerned about individual free choice and also our quality of life, the strategic shift in the anti-choice rhetoric to testable claims about worrying slippery slopes is actually to be welcomed. It is a fair enough question to ask whether disabled people, the poor and others you could reasonably describe as more vulnerable than some other classes of patients would be put at risk if we decriminalized assisted dying. No doubt the courts will look at this issue in great depth and detail.

The reason for my optimism on this front is that we know from jurisdictions that have decriminalized that there is no evidence that vulnerable people are disproportionately represented among those who receive assistance in dying. From some jurisdictions we even have firm data demonstrating that abuse has actually decreased since decriminalization. Even if there were a limited number of clear, uncontroversial cases of abuse in societies that have decriminalized, we would still need to establish that that abuse was a result of decriminalization.

The anti-choice campaigners have a habit of carefully fudging the issues here. Their claim that decriminalization has led to reductions in the quality and availability of palliative care also turns out to be without any basis in fact. None of the actual evidence we have fits the anti-choice campaigners’ scaremongering tactics, hence their ever-more-hysterical-sounding claims on that front.

With the exception of Quebec, I think it is fair to say that this country has been let down disgracefully by its elected representatives. Opinion poll after opinion poll - and this includes polling undertaken by anti-choice campaigners, too - concludes that an overwhelming majority of Canadians support the decriminalization of assisted dying. That, combined with the lack of evidence of a slippery slope to unwanted killings as a result of decriminalization in societies that have legalized assisted dying in some form or shape, makes a pretty powerful case for the decriminalization agenda.

Not so in the eyes of our elected representatives. They have caved in to the religious right’s lobbying and scaremongering on this issue, instead of showing the leadership we can rightfully expect of them. For what it’s worth, this failing cuts across party lines. Even the so-called Liberal Party of Canada, whose very name suggests that it should proudly support decriminalization, is to be found on the wrong side of history on this issue. The good news for us is that the courts will not be susceptible to pressure from religious and other campaigners.

Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen's University. He has chaired a panel of international experts drafting a landmark report on end-of-life issues on behalf of the Royal Society of Canada. He tweets @schuklenk

Open Letter to Canadian Health MInister

Dear Ms Leona Aglukkaq:

I am currently on a research assignment in Britain, hence I missed the uproar in Canada about the appointment of a Pfizer VP to the governing council of the CIHR. This open letter is in response to this growing scandal.

I am appalled that anyone should have considered appointing a representative of the pharmaceutical industry to such a position of influence, let alone a representative of Pfizer.

As to the former: Continuing conflicts of interest between the role the Pfizer VP would have to play in order to avoid breaching the fiduciary relationship the company and its employees have to its shareholders, and the public interest are inevitable. His role is to represent the interests of Pfizer and its shareholders, while the CIHR agenda surely is in the Canadian public's interest. There is no reason at all to assume that Pfizer's interests and those of the Canadian public necessarily are identical.

As to the second: Pfizer as a pharmaceutical company is probably the most egregious of the companies involved in terms of continuing breaches of ethics regulations. The company routinely and repeatedly pays out large sums to extricate itself from breaches of ethical guidelines, and frequently the law. I am flabbergasted that, of all companies available, a Pfizer representative should have ever been considered. Are you or your advisers unaware of any of this?

I urge you to intervene before it is too late. The CIHR is at great risk of losing credibility as a biomedical research funder by appointments such as these.

Sincerely,
udo schuklenk

Hospitals are dangerous places

According to conservative estimates between 2-4% of hospital patients fall victim to doctors’ mistakes. In Germany every year between 340,000 and 680,000 patients are affected by such errors. At least 17,000 patients die in that country each year because of doctors’ errors. Compare that to the about 5,000 people who die in Germany in traffic accidents per year. No doubt, sub-optimal health care is a dangerous business. Equally, though, mistakes are all too human. They are obviously of greater consequence in some professions than in others.

W Five’s investigative team broadcasted last Saturday allegations about professional failings of a surgeon at Scarborough General Hospital. Some of these allegations seem to have been well-founded, because the surgeon in question is these days restricted in terms of the work he is able to perform at the hospital. The program makers went further. They demanded that patients should be able to access individual surgeons’ records of success and failure rates. After seeing the program and listening to truly heart-wrenching stories, anyone’s gut feeling would likely be that such disclosure is not unreasonable. After all, wouldn’t we all want to improve our odds if we had to undergo surgery? Surely, none of us would volunteer knowingly to be operated on by the worst-performing surgeon of any hospital department, or would we?

The ethical argument underpinning this demand is essentially that for any patient to give truly autonomous informed consent to any medical procedure she needs to know anything that is reasonably material to informed decision-making. One could argue that information about a given doctors’ failure rates is very much materially relevant to informed decision-making. Admittedly, a reasonable person likely would want to know. And yet, I remain skeptical about this solution. It seems, once we were to receive such information we would be sliding down a slippery slope that strips our health care professionals of much of the same rights to a kind of professional type of privacy that we take for granted for ourselves. Why not ask our doctors to also disclose any health problems they might have that might pose a risk to us during surgery? Do they suffer from infectious illnesses (we might not trust the efficacy of universal precautions)? Should we not test them prior to surgery and display that information on posters throughout the hospital and on the internet? Should we enforce psychological testing prior to surgery to ensure that no spousal dramas affect the on- the-job performance? Why not also have public report cards on the maintenance of the hospital equipment, cleanliness and so on and so forth? There does not seem to be a clear line that can be drawn in the sand on this issue, once we start going down the track proposed by W Five’s investigative journalists.

When we board a train, do we expect displays indicating how often the train driver erred during his career? Do we check when we board a transatlantic flight how old the plane is, or whether the pilot and captain have a history of heart problems?
Most of us don’t bother undertaking such detective work, and we don’t expect such information to be reasonably available to us. Nothing less, however is being proposed for doctors. When you think about planes and pilots (indeed, bus drivers!) many more lives are at stake, yet our inquisitive minds are at peace in the knowledge that regulatory agencies will ensure that the bus driver is well trained, and that the equipment she uses is in top condition. Government and statutory bodies like the Ontario College of Surgeons and Physicians look after the quality of our doctors and have checks and balances in place that ensure that individual professionals failing us are found out and properly dealt with. So it should be. This much the professions and our professionals owe us as society.
The real issue then should arguably not be to keep publicly track of individual performances, but to ensure that hospitals act fast when individual professionals’ performances are suboptimal. Scarborough General Hospital clearly failed on this count, if the information on the W Five program is to be trusted. It is also worth asking how we can ensure that the College of Surgeons and Physicians moves faster than it has in the case highlighted on W Five. It is a perennial problem of such bodies the world all over that many citizens and indeed, many professionals think that they are more concerned to cover up for colleagues under scrutiny then to keep the interests of individual patients, clients and society at large at heart. This constitutes a serious threat to the professions and the trust society has invested in them. It is government’s responsibility to ensure that institutions like the Ontario College of Surgeons and Physicians deliver on that front, and do so in a transparent manner.

The current demands for the public availability of individual doctors’ performance data are missing the point. Patients should not ever find themselves in a situation where such data would make a difference, because the offending professionals should be out of their jobs way before that information would be on display. That is the real regulatory issue.

South African government insanity on HIV/AIDS seems to continue

'Mbeki must be investigated'
26/09/2007 17:40 - (SA)

Cape Town - The Treatment Action Campaign (TAC) has called for a judicial investigation into the presidency and the health minister, as well as Christine Qunta.

In a press statement released on Wednesday, the TAC said there was prima facie evidence that illegal and unethical experiments were conducted on people living with HIV/Aids with a toxic and unregistered substance named Virodene.

The experimentation was for commercial benefit.

The statement claimed that the substance Virodene P058 was a derivative of the toxic, potentially lethal industrial solvent N dimethylformamide (DMF), which was never registered with a medicines regulatory authority of any state in the world.

There was evidence that the Office of the Presidency, President Mbeki and Minister of Health Manto Tshabalala-Msimang were involved in these trials after the Medicines Control Council and the University of Pretoria ruled them unethical and in contravention of the law, the TAC said.

President corrupt?

This led the organisation to call for the appointment of a judicial commission of inquiry to determine to what extent the president, health minister, government official had been involved and how much experimentation on people was being conducted.

The TAC also alleged that Christine Qunta, a practising attorney, was an investor and director in a company that profiteers from selling untested and unregistered cures and treatments for Aids.

Qunta was allegedly appointed by the health minister to a presidential task team on traditional medicines.

The TAC alleges that Qunta and her legal firm had earned tens of thousands of rands in fees profiteering from the unethical, unscrupulous and unlawful activities of Matthias Rath, the vitamin salesman.

The organisation believed that "at best it appears someone in the presidency acted unethically in 2000 and 2001. At worst, there is direct involvement of the president himself in corrupt, illegal actions with potentially deadly consequences for patients with HIV."

Racism alive and kicking - why every ethnic group is capable of being racist

This is Evon Reid, a political science studies graduate from the University of Toronto. Evon shot to unexpected (probably international) fame because a government employee responsible for managing a recruitment process (and his job application) referred to him as a 'ghetto dude'. The Toronto Star newspaper reports the story today. Here's a brief excerpt:

'Evon Reid couldn't believe his eyes yesterday morning when he opened an email from the Ontario government's cabinet office where he'd applied for a position. "This is the ghetto dude that I spoke to before," said the email to the University of Toronto honours student from the very person handling his job application.
... Ghetto dude? It means I'm black. It's very insulting," Reid told the Star yesterday. "It's still pretty shocking to me." As he sees it, the email explains why he hasn't gotten a followup interview for a job as a media analyst. He applied July 3 but missed a July 10 call from Aileen Siu in the cabinet office. Although he called her back and sent followup emails, there was no response. Until yesterday's email. "Based on my resumé I deserved to be called, but I was not worthy of being called back once they heard my mother's voice and my voice," said Reid, 22. "She has a Jamaican accent and it's about the way I talk. There's a nuance." ...

The email was never intended for Reid, according to Siu, who learned she had sent it to him only when the Star telephoned yesterday. An acting team leader in cabinet office hiring, she said she was "multi-tasking" Thursday when she hit the wrong button and copied Reid on an email she was sending to a job-search colleague. "It wasn't directed at Evon at all. That was internal ... It didn't have anything to do with any of the applicants," said Siu, 26, and a recent U of T political science graduate. She insisted the email didn't refer to anyone "outside my circle of friends."
Siu acknowledged the term is negative but said, "I don't even know what nationality he is, right?" She added she's of Asian descent and doesn't want anyone to think she makes racially based judgments.'

There we have it... a truly neat example of somebody one would think would have reached the bottom of the pit that she's dug herself into, but then she musters all her strengths and continues digging even deeper. First Ms Siu is pointing out to us that he wasn't meant to see the message and that it was directed at someone else in her office. Obviously, one should be concerned about the culture in her work environment, because seemingly such language and conduct must be considered acceptable there. Perhaps talking in suitably derogatory socially charged terminology about job applicants is one of the hallmarks in this government office.

Secondly she proposes that she couldn't make racially based judgments because she is of Asian descent. I have heard all of that before, in South Africa. Many 'black' folks, while talking in the most racially charged terminology about 'white' folks, insisted that they couldn't possibly be racists by virtue of their ethnicity. In fact, seeing the history of that country, one shouldn't be too surprised about such conduct. Also, lest someone charges me with being biased, in that country, I also heard 'whites' making racist comments about 'blacks', folks of East Asian descent would make nasty comments about both of the just mentioned groups, and so did folks that go under the label of 'coloured' in South Africa. My main point is that ethnicity (minority or otherwise) does not in its own right prevent racist conduct. Just think of continuing conflicts between African American and South Korean migrants in the USA... - So, Ms Siu's remarks are not only ill-considered, they also make one wonder about the quality of a political science degree at the University of Toronto. Surely one would expect graduates of such a programmes to be aware of such issues.

As a post scriptum: A few of the comments I received since I posted this comment, naturally anonymised.

'Thank you for sharing your solid view on the shocking attitude that exists
within Queen's Park. Since I am not a highly educated person I tend to keep
fairly basic in my thinking, as it serves me well. It struck me that Aileen
Siu would not have made that comment, unless she sincerely believed that it
was the type of grammar her 'job search colleague' enjoyed.'

'I just read your BLOG I totally agree with you. As a black Canadian male I see it all the time with my friends and society in general. Stereotyping other racist and nationalities it sickens me that someone young would have thoughts like this, if it was someone older you can at least use age or a generational gap as part of their ignorance.'