When and how to die

As an expert to the Quebec commission on euthanasia, I wrote a memoir and testified during the public consultations. In response to the CMAJ editorial by Flegel and Fletcher,1 I would like to share facts that are not known by most physicians and patients.

There were 427 presentations to the commission: 99% favoured palliative care; 60% opposed euthanasia (34% favoured); and 2% supported assisted suicide. The resulting recommendation of euthanasia by the commission showed that arguments presented were ignored. As explained in The Gazette,2 the commission’s report3 is a “pro-euthanasia manifesto” that reflects an a priori ideological desire to impose “medical aid in dying,” while neglecting worrisome facts.

The commission ignored reports from the Remmelink Commission in the Netherlands that exposed abuse in the euthanasia process in 1990, 1995 and 2003.4 The commission did not seem concerned that major depression is a valid condition for euthanasia (since 1993), and that 20% of instances of euthanasia are regularly not reported, in violation of the law. In Belgium, the Control Commission is impotent to oversee and effectively assess the validity of euthanasia requests; not a single case has been reported to the Justice Department for review.5

Euthanasia lobbyists advocate access for patients with dementia and all minors in Belgium. In the Netherlands, the pro-euthanasia lobby advocates the procedure for all those over 70 and “tired of living.” A report from the Netherlands shows about a 73% increase in the number of instances of euthanasia since 2003, and a 50% increase in the number of deaths by terminal sedation.6 These facts invite further thought before instituting safeguards that have not worked elsewhere.

An in-depth reflection on how to die remains necessary. The notion of dignity needs to be grounded in philosophy, not opinion polls. I suggest that physicians and health care professionals may not want to become agents of homicide (at the State’s behest), even if it is labelled “therapeutic.” Let’s be clear: homicide is never therapeutic.