https://archive.is/jj1XK

Some key bits here.

TORONTO (AP) — A homeless man refusing long-term care, a woman with severe obesity, an injured worker given meager government assistance, and grieving new widows. All of them requested to be killed under Canada’s euthanasia system, and each sparked private debate among doctors and nurses struggling with the ethics of one of the world’s most permissive laws on the practice, according to an Associated Press investigation.

As Canada pushes to expand euthanasia and more countries move to legalize it, health care workers here are grappling with requests from people whose pain might be alleviated by money, adequate housing or social connections. And internal data obtained exclusively by AP from Canada’s most populous province suggest a significant number of people euthanized when they are in unmanageable pain but not about to die live in Ontario’s poorest and most deprived areas.

Some of the requests from the forums were approved and acted upon. Others were denied. But the discourse about patients who are poor, disabled or lonely shows a fraught process where medical professionals test the limits of what conditions warrant euthanasia. The controversial cases in the forums have never been disclosed through Canada’s oversight system, even in an anonymized manner.

When Canada legalized assisted dying in 2016, officials said they wanted to reduce suffering and support individual autonomy and freedom of choice — and polls have consistently shown public approval. Prime Minister Justin Trudeau promised then that safeguards would prevent vulnerable people from being euthanized “because you’re not getting the support and care you actually need.”

But experts tasked with delivering euthanasia to people who aren’t dying have called it “morally distressing” and say the legal provisions are too vague to be protective, obliging doctors and nurses to at times end the lives of people they believe might otherwise be saved.

“I don’t want (euthanasia) to become the solution to every kind of suffering out there,” a physician wrote to colleagues on one of the private forums.

The nonprofit organization Inclusion Canada regularly hears from people with disabilities who are offered euthanasia, including one disabled woman whose physiotherapist suggested it when she sought help for a bruised hip, said executive vice president Krista Carr.

“Our response to the intolerable suffering of people with disabilities is: ‘Your life is not worth living,’” she said. “We’ll just offer them the lethal injection, and we’ll offer it readily.”

When euthanasia was legalized, doctors and nurse practitioners set up email discussion groups as confidential forums to discuss potentially troubling cases, with limited patient details for privacy. They’re now run by the Canadian Association of MAiD Assessors and Providers.

Association President Dr. Konia Trouton told AP via email that providing euthanasia for vulnerability or financial reasons alone is “completely forbidden.” Trouton said doctors and nurse practitioners consult with one another on the forums “to gain insights and learn from the experiences of others.”

The participant who shared some of the email discussions with AP provided dozens of messages raising questions about the medical and ethical complexities of euthanasia requests from people nationwide who weren’t terminally ill.

A middle-aged worker whose ankle and back injuries made him unable to resume his previous job told his doctor that the government’s measly support was “leaving (him) with no choice but to pursue MAiD.” His doctor told forum participants the patient met legal criteria, with severe pain, strained social relationships and inability to work. Others agreed and assured the doctor the man was clearly in pain. But the doctor was hesitant because the man cited reduced government payments as a key factor.

Cases of homelessness appear regularly and spark some of the most heated debate. One doctor wrote that although his patient had a serious lung disease, his suffering was “mostly because he is homeless, in debt and cannot tolerate the idea of (long-term care) of any kind.” A respondent questioned whether the fear of living in the nursing home was truly intolerable. Another said the prospect of “looking at the wall or ceiling waiting to be fed … to have diapers changed” was sufficiently painful.

The man was eventually euthanized.

One provider said any suggestion they should provide patients with better housing options before offering euthanasia “seems simply unrealistic and hence, cruel,” amid a national housing crisis.

“The question about who gets euthanasia is a societal question,” said Kasper Raus, a researcher at Ghent University’s Bioethics Institute in Belgium. “This is a procedure that ends people’s lives, so we need to be closely monitoring any changes in who is getting it.

“If not, the entire practice could change and veer away from the reasons that we legalized euthanasia.”

Health Canada, the government agency responsible for national health policy, publishes yearly reports of euthanasia trends but hasn’t released any review of cases that triggered ethical concerns.

Marie-Pier Burelle, a spokeswoman for Health Canada, said in an email that “lack of access to social supports or to health services is not and would never be part of eligibility criteria” for euthanasia. Burelle cited “stringent safeguards to affirm and protect the inherent and equal value of every person’s life.”

In private, though, Canadian officials have examined worrisome cases.

A document from the Ministry of the Solicitor General in Ontario sent to all euthanasia providers in the province in May noted two cases of “lessons learned” in nonterminal cases. The document was shared with AP by a doctor on condition of anonymity because it wasn’t authorized for release.

In one, a 74-year-old patient who’d suffered high blood pressure, a stroke and blindness, among other difficulties, was increasingly dependent on their spouse and “expressed their interest in MAiD to their family physician, due to their vision impairment and loss of hope for improvement of their vision and quality of life.”

The report cited three instances where legally mandated safeguards were not met. Among them: No assessor or expert versed in the nonterminal condition was involved, and efforts to discuss alternatives to death were “limited.”

The report also said the procedure was scheduled “based on the spouse’s preference of timing.” Officials questioned whether “the patient’s death was genuinely voluntary and free of coercion.” Independent legal experts said those breaches could constitute violations of criminal law.

When a health worker inquired whether anyone had euthanized patients for blindness, one provider reported four such cases. In one, they said, an elderly man who saw “only shadows” was his wife’s caregiver when he requested euthanasia; he wanted her to die with him. The couple had several appointments with an assessor before the wife “finally agreed” to be killed, the provider said. She died unexpectedly just days before the scheduled euthanasia.

Nah, seems legit, what could ever go wrong here.

Just a reminder that nova scotia wants to discipline doctors who refuse to refer people to other doctors willing to give maid.

https://ctkdartmouth.com/conscience-protection-for-nova-scotia-doctors/

Should a doctor refuse to provide a referral and a patient lodges a complaint against that doctor, he/she could be subject to disciplinary action including a mark on their record, a fine, and possible loss of their medical license.