CCBI News: Safeguards and Non-Compliance

November 18, 2024

Dear Friends of CCBI,

Safeguards and Non-Compliance

In a recent article in Atlantis, Alan Raikin reports on non-compliance with the regulations in Canadian criminal law by those who assess suitability for MAID and who provide it. There are strict federal and provincial criteria for those involved, and a breach could result in a prison sentence. Practitioners must properly assess whether people are eligible and ensure that the safeguards are in operation. Safeguards, of course, are deemed inadequate and almost useless by those who object to euthanasia and assisted-suicide procedures on principle, but also by some professionals who are in favour of MAID but not in cases of assessing patients with mental health issues. The existing safeguards are deemed necessary steps by the Supreme Court and Parliament to ensure that MAID practices are not abused. Providers must report each request and each death, both for statistical purposes and for evaluation.

In Ontario, these duties are reviewed by the Office of the Chief Coroner. The head, Dr Dirk Huyer, noted: “Every case is reported. Everybody has scrutiny on all of these cases. From an oversight point of view, trying to understand when it happens and how it happens, we’re probably the most robust in Canada.” This should be reassuring, but it is not correct. In an October 2018 memo to all Ontario health care practitioners, Huyer announced that his office would implement a new system “to respond to concerns that arise about potential compliance issues.” The reason given was that “some case reviews have demonstrated compliance concerns with both the Criminal Code and regulatory body policy expectations, some of which have recurred over time.”

In the new system, each compliance issue was to be assigned levels of severity, Level 1 being the least severe and 5 the most severe. The Coroner’s Office deals with the issues, ranging from a discussion with any physician involved in non-compliance with the law, to reporting the issue to the police, with a possible jail-sentence in the offing. Dr Huyer told an audience of MAID providers that a number of practitioners do not respond properly to correctives and had a pattern of non-compliance. His office, however, has never reported any physician to the police, even when one physician brought the wrong drugs for a procedure, left the scene for wo hours to find the appropriate drugs, while, in his own words, “… the person and family suffered tremendously.” The physician was reported to the regulatory body (CPSO), which barred her from administering MAID, but allowed her to continue to practise palliative care.

In 2023, his office raised concerns about non-compliance for a quarter of all euthanasia providers in Ontario. (emphasis added).At the May, 2024 annual conference of the Canadian Association of MAID Assessors and Providers, Dr Huyer gave a presentation listing 178 compliance problems, as Raikin notes, “— an average of one every other day,” for a total of 428 non-compliance issues since the Coroner’s Office began using the ‘level’ system. Of that number, only four cases were reported to a regulatory body, and not a single case was reported to the police, although Dr Huyer is clear that some MAID providers have a ‘pattern’ of violations and need further education. This seems a remarkably compliant response to patterns of non-compliance, especially when some examples are considered.

Raikin writes:

• For euthanasia deaths where the patients were not terminally ill, 15 percent required a response about a compliance issue.
• Again for euthanasia deaths where the patients were not terminally ill, in some cases practitioners reported that they were not experts in the illness that caused the person’s suffering, and no outside expert was consulted — violating a safeguard mandated in Canada’s criminal law.

In fact, Canada’s MAID law states:

… the following procedural safeguards apply to persons whose natural death is not reasonably foreseeable (*indicates safeguards specific to those requests):

• request for MAID must be made in writing: a written request must be signed by one independent witness (a paid professional personal or health care worker can be an independent witness)
• two independent doctors or nurse practitioners must provide an assessment and confirm that all of the eligibility requirements are met
  • *if neither of the two practitioners who assesses eligibility has expertise in the medical condition that is causing the person’s suffering, they must consult with a practitioner who has such expertise (emphasis added)

The law is clear, and one would think non-compliance with such an important and necessary step would result in a penalty of some sort, otherwise why bother having such a safeguard at all? This points yet again to the fact that the concept of safeguards in euthanasia procedures can be toothless, and other jurisdictions should pay attention to this lax approach in Ontario, with its fast-growing number of requests. Raikin’s sources provided a video of Dr. Huyer, the head of the Office of the Chief Coroner, describing such cases as “a learning opportunity, let’s put it like that.”

Well, it can be put another way. A law which many think immoral in its purposes is, in Ontario, being flouted by MAID providers who, in turn, are receiving nothing more than a tap on the wrist from the Coroner’s Office to which they report. The Chief Coroner has openly stated that the 428 non-compliance issues ( and who knows how many more, in Ontario and elsewhere?) are ‘learning opportunities.’ Nothing to be done, little to be pursued, regardless of the ‘safeguard.’ Yet, given the example above regarding the need for expertise,how can assessors make an honest assessment of the requestor’s condition, far less comply with the supposed safeguards, without such guidance? Professional codes of ethics need to be revisited in many quarters.

While it is challenging in Canada to make headway over an issue that is already legal and technically regulated, it is important for Canadians to know what is happening in this country. It is ultra-important for countries considering legalization of procedures, such as England and Wales, where the second reading of the Leadbetter Bill on assisted dying will take place on November 29^th and which promises ‘strict’ safeguards, to be aware of the extent to which legally mandated ‘safeguards’ have been trivialized in Canada.

Help with Grief and Bereavement

The Canadian Hospice Palliative Care Association is sponsoring a webinar by the Saint Elizabeth Foundation, tomorrow, Tuesday November 19^th , National Grief and Bereavement Day in Canada. Register on their site, where there are also resources for help at difficult times: National Grief and Bereavement Day – CHPCA

Resources

A Pattern of Noncompliance — The New Atlantis
Canada’s medical assistance in dying (MAID) law
National Grief and Bereavement Day – CHPCA

Pope Francis’ intentions for November

For anyone who has lost a child
We pray that all parents who mourn the loss of a son or daughter find support in their community and receive peace and consolation from the Holy Spirit.

Moira and Bambi