Senator Enverga speaks out against the physician-assisted dying bill in the Senate Chambers
Last night, Senator Enverga spoke out against the government’s bill to allow for physician-assisted dying.
Although intrinsically and profoundly against any form of killing, legally or illegally, Senator Enverga acknowledges the reality of the Supreme Court of Canada’s ruling on assisted dying. However, ensuring the maximum protection and safeguards, is the Senate’s sworn duty in order to fix the government’s flawed proposal. The three main concerns Senator Enverga mentioned were the lack of sufficient palliative care available to Canadians, which should be offered before allowing a person to ask for assistance in dying; the lack of explicit protection to deny those with a underlying mental condition to access this assistance; and the lack of procedural safeguards prior to a person’s life being taken by a health care practitioner. Using his personal experience when his late mother-in-law fully recovered after being urged by doctors to end her life support, he argued that: “… a doctor does not really know if or when a patient is going to die from an ailment.”
Bill to Amend—Second Reading—Debate Adjourned
Hon. George Baker moved second reading of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)
Hon. Tobias C. Enverga, Jr.: Honourable senators, I rise today to speak to second reading of Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts.
I want to thank the sponsor, Senator Baker, and others who have shared their views and concerns about this historic legislative proposal. I also want to take this opportunity to thank our colleagues who served on the special joint committee for the long hours they spent under great time constraint, and our colleagues on the Standing Committee on Legal and Constitutional Affairs for their study on the subject matter of the bill.
Honourable senators, I will declare my opposition to physician- assisted dying from the beginning. I am of the belief that a life ends with natural death and should not be shortened by another person, be it a medical doctor under legally sanctioned conditions, an executioner who acts in accordance with the law or a person who commits a murder. No life should be taken by another person.
That said, with the realization that many do not agree with me, I have to accept the Supreme Court of Canada’s decision in Carter v. Canada and do my sworn duty as a member of this house to ensure that we pass legislation that will eliminate the risk of harming the most vulnerable in our society.
Honourable senators, a person suffering intolerable pain due to a serious illness is among these most vulnerable. Among this group, we find those who are even more vulnerable, those who are minors and who suffer mental and developmental disabilities and disorders. It is our duty to protect them all from a number of risks including others who may, for whatever reason, influence the patient’s decision, or patients making an ill-informed decision based on lacking palliative care options to alleviate pain and to spend their final days in a dignified environment.
Honourable senators, let me tell you all a personal story to illustrate why I believe every patient deserves the utmost care, personal compassion and the best palliative care instead of the choice of death.
My mother-in-law, a frail old woman, was living with us when she got seriously ill because of a massive allergic reaction to a medication prescribed to her. She had what is called system breakdown. She was in ICU for a couple of months and attached to all kinds of machines to monitor her or to keep her alive. They included blood transfusion, dialysis machines, an artificial respirator and many more.
The first few weeks she was unconscious, but finally regained consciousness. She was visibly in pain and uncomfortable at best. The hospital staff even put a DNR, or do not resuscitate, on her files, which my wife immediately protested, after which the DNR designation was promptly removed. Because of this, we hired people to watch her 24 hours a day in the hospital to help the nurses and so, at the same time, she would have someone to communicate with while she was bedridden and connected to all the machines.
On a regular basis during this time, my wife and I were visited by doctors and ethicists who all informed us that there was no hope, that she would not recover and that she had no quality of life.
In other words, the doctors implied and the ethicists clearly suggested to pull the plug and to let her die to relieve her of her suffering. What was so cruel about some of these conversations was that my mother-in-law was within hearing distance. The feeling we were left with was that the ethicists and the doctors were trying to persuade her to make a request to end her predicament. In spite of all these difficulties, my mother-in-law had never indicated that she wanted to die to end her suffering. We know why she chose to stay alive. It was not only because of her faith, but because people who visited her gave her comfort and a little conversation. A little touch from her grandchildren and friends took some of the pain and discomfort away.
With love, prayers and constant care, she was able to survive and recover. For the next two years, she was able to live and enjoy life to the fullest. She even travelled to the Philippines and back before she died from an unrelated ailment.
My point, honourable senators, friends and colleagues, is that a doctor does not really know if or when a patient is going to die from an ailment. Medical science has made advancements in the last 20 years and still continues to make advancements. What was not possible then may be possible now. There are advancements in pain-management with new medicines, even with sedation.
My belief is if we show our patients compassion and love, and offer the right treatment option or palliative care, chances are we will not see anyone asking for death.
Honourable senators, there is much to be said about this bill and all the committee work that has been done, but due to time limits, I am forced to bring forward only a few of the main concerns that I have and that many members of the public have voiced over the past year.
My first concern, colleagues, is the lack of palliative and end-of- life care available to Canadians, especially those who live in more remote areas, of which we have many in our great country. I want to quote one of our honourable members of the Special Joint Committee on Physician-Assisted Dying, a senator, in an exchange with His Eminence Thomas Cardinal Collins, Archbishop of Toronto, during his testimony before the committee on February 3. The senator said:
. . . you’re preaching to the choir here, because all of us would believe there ought to be more readily accessible, better palliative care available to more Canadians, but again that’s not our issue.
I strongly beg to differ. That is exactly what is before us. We senators are asked to allow for the state in Canada to take the lives of people, not being a threat, for the first time since we ended the practice of capital punishment in 1962. How can a person who suffers make a competent decision when such a person is not offered proper palliative care? Before we start allowing for competent adults to make the choice to end their lives, we have to provide them with an option. A choice without an option is not a choice, and it seems as if we are giving up on palliative and end- of-life care by passing this legislation.
This is the most terrible and horrific situation we have been put in during our nearly 150 years of existence as the upper house.
My second concern, honourable senators, is the lack of safeguards in this legislation. The Supreme Court was quite clear in its ruling. The court used the term “competent adults” to describe who should be allowed access to physician-assisted dying. I was terribly concerned about the joint committee’s report once it was tabled here, because it opened the door for mature minors and those who suffer from an underlying mental condition. The bill before us now does not specify that persons with an underlying mental condition do not qualify for assisted dying. It is alluded to in the bill’s preamble under the guise of development of non-legislative measures, but it is far from clear.
Departmental officials and the responsible ministers have repeatedly stated that where mental illness is the sole underlying medical condition, assisted dying will not be provided, but the bill does not state this. Two main arguments are used: first, that the eligibility criteria together make it highly unlikely that such a person would qualify; and second, that future expansion of access to assisted dying will undergo further study.
Honourable senators, this is not sufficient as a safeguard. Let me give you an example of an underlying mental condition that I think will allow for access. One potentially deadly mental illness is “eating disorder.” This is an umbrella term that includes but is not limited to anorexia nervosa, bulimia nervosa and binge eating disorder, and it is suffered by an estimated 600,000 to 990,000 Canadians at any given time. The first two disorders kill an estimated 1,000 to 1,500 Canadians every year, with a mortality rate of 10 per cent to 15 per cent for those suffering from anorexia and 5 per cent for those with bulimia.
Honourable senators, although one can argue that it is a remediable condition, it is not necessarily so. The key here is that the condition, as stated in the proposed section 241.2(2)(c):
. . . causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable . . . .
Since this legislation is patient-centred, as the title of the special joint committee’s report so poetically put it, the acceptability of the treatment is in the eye of the beholder, so to speak. One can argue that once a person applies for assistance in dying, the resolve for and acceptability of treatment is diminished.
Honourable senators, I am a member of the Senate’s Aboriginal Peoples Committee, where the often harsh reality of a large vulnerable part of our population is studied. Colleagues probably recall the state of emergency declared on April 9 this year on the northern Ontario Attawapiskat First Nation reserve after an epidemic of suicide attempts — 100 in seven months. A month earlier, Pimicikamak Cree Nation in Manitoba also declared a state of emergency in response to a string of youth suicides. Again, we are assured that those who wish to commit suicide are not eligible to assisted death under this legislation, but it is not explicitly stated. Not being a medical doctor, or a mental health specialist, I would consider that a condition that makes a person want to and try to take his or her own life would potentially qualify for assisted death under this bill because repeated attempts would eventually lead to a person’s reasonably foreseeable death.
The third concern I will speak to is the bill’s lack of procedural safeguards. While considering this legislation, our first duty should be to ensure that not one single life is taken without proper procedures having been followed, or that someone is wrongfully assisted to die. If we look at the way similar legislation operates in Belgium and the Netherlands, we should take note of the issues that have emerged there after these countries allowed doctors to play a part in ending their patients’ lives.
Honourable senators, in the Netherlands, with a population of about 17 million, nearly 5,000 people died with their physician’s assistance in 2013. Their system has a reporting mechanism in place, where five regional review committees assess each case after the fact to assess the legality of the procedure that took place. In an article in the British Medical Journal from 2011, of 3,136 cases reported, nine were found not to have met the criteria, with a further 500 cases awaiting a decision. The percentage is low, but when we deal with ending a person’s life, no percentage is acceptable.
In Belgium, a country on the dubious forefront of assisted death, the statistics are more alarming. The Belgian law requires physicians who perform euthanasia to report each case to the Federal Control and Evaluation Committee for review. The disturbing fact, found in a study published in 2010, shows that in the Flanders region of Belgium in 2007, only 52.8 percent of euthanasia cases were reported. That, honourable senators, translates into every second case not being reported.
How is it possible to ensure compliance with guidelines when one has such a severe lack of reporting? The study on Belgium references a similar study in the Netherlands for the same year, which shows that just over 80 per cent of cases were reported there. These numbers are staggering and this is a potential path that Canada, with our sanction, is heading down unless we do our constitutional duty and ensure that this historic legislation is profoundly scrutinized and duly amended to ensure that not one life will be mistakenly or irregularly taken.
Honourable senators, I have tried to highlight three major flaws in the bill before us today, but there are still other issues that I cannot delve into which others will surely speak about, like conscience protection to protect practitioners from the horrific and traumatic experience it must be to kill a patient rather than healing them, and others. I have done this to try to show how the reality of the language —
The Hon. the Speaker pro tempore: Senator Enverga, do you request five more minutes?
Senator Enverga: Yes, more time, please.
The Hon. the Speaker pro tempore: Is it agreed, honourable senators?
Hon. Senators: Agreed.
Senator Enverga: I have done this to try to show how the reality of the language in this legislation does not match what we are being told by the responsible ministers and officials in the Departments of Justice and Health.
As I stated in the beginning, I am against any kind of state- sanctioned killing of a person who does not pose an immediate threat. My fear is far more profound than what may come across in our limited time.
What I want all honourable members of this chamber to do is to realize the actual legislative flaws of the bill, that stated safeguards are not present in the current version, and that we as senators have a unique opportunity to make the necessary amendments to ensure maximum protection of our vulnerable, while still respecting and honouring the Supreme Court of Canada’s ruling on Carter v. Canada.
Honourable senators, let us retain the honour of this chamber by not being an accessory to any murder that may be caused by a very weak law. Thank you very much.
Some Hon. Senators: Hear, hear!