"Dying-with-dignity laws can hit a slippery slope" by Charlie Fidelman

"Dying-with-dignity laws can hit a slippery slope" was published by Charlie Fidelman, Gazette Health Reporter, in the Montreal Gazette on September 17, 2013.

Tom Mortier got a shocking email last year that his mother, Godelieva De Troyer, who had been suffering with depression, had died a day earlier by lethal injection. This photo was taken on April 11, 2010, almost two years before her euthanasia.

MONTREAL — Belgian professor Tom Mortier got a shocking message at work last year informing him that his 64-year-old mother, who had been struggling with depression, received a lethal injection a day earlier.

Since his mother’s death, Mortier, who lectures on chemistry at the University College Leuven, has questioned and criticized Belgian law allowing euthanasia.

“These kind of legislations are taking the ethics out of the medical practice,” Mortier said in a telephone interview from his home Tuesday as Quebec launched parliamentary hearings on Bill 52, the controversial right-to-die legislation aimed at allowing doctors to help some terminally ill patients end their lives.

While several medical groups told parliament on Tuesday they support legislation to legalize euthanasia, Mortier warned Quebec that dying-with-dignity laws represent a slippery slope.

“It will only create new problems. They don’t see how it’s going to evolve,” Mortier said.

When Belgium adopted euthanasia in 2002, a year after Holland, the practice was aimed at patients with incurrable diseases and unbearable suffering.

“It was meant for very restrictive situations and rare circumstances, but the numbers have been rising,” Mortier said, and the practice has now gained wide acceptance.

Dr. Sarah Van Laer, who has euthanized 28 patients, has criticized the growing practice as “turbo-euthanasia.”

In June, the case of identical, deaf, 43-year-old Belgian twins Marc and Eddy Verbessem reverberated worldwide when the pair chose to die after discovering they had a genetic anomaly that would lead to their blindness. The case was striking because they were young and not terminally ill.

Mortier, who paid the issue little attention until confronted by his own mother’s death, said that nothing was written about euthanasia in her medical report.

Godelieva De Troyer died on April 19, 2012. She was suffering from chronic depression after a long-term relationship with her boyfriend ended. The death was carried out on the recommendation of a single psychiatrist.

“I spoke to the doctor who euthanized my mother and he said he was absolutely certain she didn’t want to live anymore,” Mortier said. “How could he be so sure?”

Mortier warned that Quebec’s proposed legislation would create a new class of physician — one who will have the power to determine the criteria for death. Paraphrasing the declaration from the World Medical Association, which opposes euthanasia, Mortier said: “Doctors should be taking care of people, not killing them.”

Quebec is not Belgium, said Dr. Yves Robert of the Quebec College of Physicians.

“This case would not have been allowed in Quebec under Bill 52,” Robert said of Mortier’s mother. “No stakeholders want this.”

The proposed law specifies three conditions: there must be an incurable disease, imminent death and unbearable suffering — which rules out depression, Robert said.

“Under these medical criteria, this woman would not have had access to medical help to die in Quebec,” he added.

Quebec did look to countries like Holland and Belgium to learn from their weaknesses; the problem in Europe is the scope of the law, Robert said, referring to cases where patients got life-ending drugs without their consent.

Quebec’s legislation excludes patients who are declared “inapt”, for example, those with dementia, and who cannot consent for themselves, Robert said, and the government will have to address that in the future because the bill does not cover all cases.

When Quebec first began debating the issue four years ago, more than 80 per cent of the province’s medical specialists surveyed said they had already seen euthanasia practised, and 48 per cent said that palliative sedation “can be likened to a form of euthanasia.”

But a law would provide tools — a framework and controls for end-of-life care, Robert said: “Without one, we’re exposed to clandestine activities with the complicity of everyone — and no way to intervene against that. That’s the benefit of such a law and why the College was in favour of this bill.”

However, opponents call attention to a 2011 study published in Current Oncology by University of Ottawa palliative care physician José Pereira, who says that safeguards protecting patients from abuse are an illusion.

A key highlight of Quebec’s proposed law, Robert said, is a vigilante-type government committee that would be responsible for verifying and overseeing all issues surrounding end-of-life care under Bill 52.

“Nothing is sure 100 per cent,” Robert said. “But I think there are enough safeguards to protect the public.”

Also, Quebec will have to invest in palliative support as part of the spectrum of end-of-life care, which in some cases will include the possibility of medical help to die.

“We said that to the MPs this morning, ‘Yes, there will be a need for investment,’ ” to improve services all across the province for a population that is aging, Robert said.

Claims that euthanasia will replace palliative care is “misinformation,” Robert said.

According to a survey this week conducted for the Quebec Medical Association, two-thirds of the province’s physicians say they agree that medical aid represents appropriate end-of-life care.

But not everyone agrees. Paul Saba, of the Coalition of Physicians for Social Justice, said that informed consent is not always respected in countries where euthanasia is legal.

Only 20 per cent of Quebec patients have access to palliative care in hospital. “Can they make a clear and informed consent when facing inadequate health care and risk suffering because they’re lacking homecare and medical services?”

Quebec is promoting euthanasia as a cheap alternative to palliative care, Saba said. The cost of dying is about $13 for an injection with a lethal cocktail of drugs, while the Canadian Hospice Palliative Care Association pegged the cost of a patient dying in a hospice at $439 a day and $800 to $1,000 a day in hospital.

On average, it costs $36,000 to die in a chronic care facility, the association said.

The hearings continue this week in Quebec City.

cfidelman@montrealgazette.com