Woman with arthritis approved for euthanasia in Canada
A 77-year-old woman with osteoarthritis should be allowed to have euthanasia in Canada, a judge has ruled.
The patient, known only as AB, was diagnosed with the condition when she was 43 and has suffered increased pain over the decades.
After starting to take opioid painkillers fentanyl and morphine in 2015, she told her doctor in Ontario that the pain was unbearable and she wanted to die.
However, although Canada legalized assisted dying last year for people enduring unbearable suffering, two doctors refused to administer lethal drugs since they feared being charged with murder because her illness is not terminal.
But on Monday, a judge declared AB’s doctor could legally assist her in dying – and chided the doctors for ‘apprehensive misunderstanding’ of the law.
The patient, known as AB, was diagnosed with the condition when she was 43 and suffered increased pain over the decades. Now a judge has clarified that her suffering qualifies for assisted dying under Canadian law
CONFUSION OVER CANADA’S ASSISTED DYING LAWS
The Canadian law, passed by the Supreme Court in 2016, has been the source of confusion for two main reasons: for being vague, and for including an added phrase that even lawyers admit is difficult to understand.
1) VAGUE
Doctors are absolved of murder charges if their patient is enduring unbearable suffering that cannot be remedied.
This has been found to be constitutional. However, some doctors have been cautious to carry out the operation for fear of being accused of misinterpretation and, therefore, murder or culpable homicide.
2) EXTRA PHRASE: ‘REASONABLY FORESEEABLE DEATH’
The Canadian government added an extra phrase without passing it through the Supreme Court. It stated that the patient’s death needs to have ‘become reasonably foreseeable’.
This phrase was the crux of the AB case.
Justice Perell concluded that the word ‘become’ seems to suggest a patient’s condition needs to have changed.
I.e.: the patient qualifies for medically assisted dying if their condition changes in some way, making their natural death foreseeable.
Andrew Faith, the lawyer who represented AB, acknowledged that ‘no one knows what it means’.
‘We are all on the trajectory towards death from the moment we’re born,’ he said. ‘But this is about how death has “become” reasonably foreseeable.’
Superior Court Justice Paul Perell told the courtroom in Toronto that a patient’s death does not have to be imminent, and their condition does not have to be terminal.
Rather, he said, the patient qualifies for medically assisted dying if their death ‘has become reasonably foreseeable’, and that their remaining years would be marred by suffering.
The patient, he said, is an ‘almost 80-year-old woman in an advanced stated of incurable, irreversible, worsening illness with excruciating pain and no quality of life’.
He explained: ‘The legislation is intended to apply to a person who is ‘on a trajectory toward death because he or she a) has a serious and incurable illness, disease or disability; b) is in an advanced state of irreversible decline in capability; and c) is enduring physical or psychological suffering that is intolerable and that cannot be relieved under conditions that they consider acceptable,’ The Toronto Star reported.
According to the Star, the woman penned a searing account of her pain in an affidavit read out in court.
‘I will remain here in this room forever, in pain, until someone allows me to die,’ she explained.
‘I have lived a good life and a long life… I simply want to quietly move out of life, end my intolerable suffering and go home to God.’
Her agony became the focus of a court case as two doctors changed their minds on how to interpret the law.
One doctor agreed on April 4 this year that she qualified for medical assistance in dying. The verdict was referred to another doctor to confirm.
However, once the second doctor came to an agreement, the first doctor backed out, saying ‘he [was] concerned about the risk of prosecution should he be legally incorrect in his conclusion.’
Now Justice Perell has assured both doctors they need not fear prosecution.
The symptoms of osteoarthritis are characterized by the degeneration of the cartilage which lines the bones and acts as a shock-absorber.
The condition predominantly affects the hips, knees, spine and hands. Osteoarthritis commonly leads to problems with pain and/or stiffness in the affected areas.
Traditionally, osteoarthritis is treated with painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
In recent years, there has been significant interest in natural treatments for osteoarthritis – including exercise, stretching and diet.
One of the most commonly used diets is one which eliminates foods of the nightshade family, such as tomato, potato, capsicums and aubergine.
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These foods contain a substance called solanine which some scientists believe may be involved in the processes which cause osteoarthritis.
However, AB told the court that even heavy-duty painkillers had little effect on her chronic case.
The ruling on Monday was a clarification of the law for the doctors who told the court they still felt ‘uncomfortable’ administering the lethal drugs.
It comes just over a year after Canada legalized assisted dying.
Death is by injection of intravenous drugs in the hospital. A multidisciplinary quality committee provides oversight, reports metrics annually to the medical advisory committee, and stewards data for use in quality assessment and research.
In May this year, the University Health Network in Toronto released the first annual report on medical assistance in dying.
In Toronto alone, there were 74 inquiries for the procedure, 74 per cent of which were for patients whose primary diagnosis was cancer.
Twenty-nine proceeded to assessment; 25 were approved, and 19 received medical assistance in dying.
But according to Andrew Faith, the lawyer that represented AB, some doctors are still nervous about going ahead, especially in ‘gray area’ cases.
WHAT IS OSTEOARTHRITIS?
The symptoms of osteoarthritis are characterized by the degeneration of the cartilage which lines the bones and acts as a shock-absorber.
The condition predominantly affects the hips, knees, spine and hands. Osteoarthritis commonly leads to problems with pain and/or stiffness in the affected areas.
Traditionally, osteoarthritis is treated with painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
In recent years, there has been significant interest in natural treatments for osteoarthritis – including exercise, stretching and diet.
One of the most commonly used diets is one which eliminates foods of the nightshade family, such as tomato, potato, capsicums and aubergine.
These foods contain a substance called solanine which some scientists believe may be involved in the processes which cause osteoarthritis.
However, AB told the court that even heavy-duty painkillers had little effect on her chronic case.
In essence, the AB case was to clarify what is meant by a patient having a ‘reasonably foreseeable death’.
The Canadian government added this phrase to the law without passing it through the Supreme Court.
The doctors argued that they were not sure whether AB
Justice Perell concluded that the word ‘become’ seems to suggest a patient’s condition needs to have changed. In other words, the patient qualifies for medically assisted dying if their condition changes in some way, making their natural death foreseeable.
Andrew Faith, the lawyer who represented AB, acknowledged that ‘no one knows what it means’.
‘We are all on the trajectory towards death from the moment we’re born,’ he said. ‘But this is about how death has “become” reasonably foreseeable.’
Faith said he believes the phrase is likely unconstitutional, and a high profile case – Lamb vs Canada – is under way to decide whether or not it should be scrapped.
For now, Faith said, he hopes the case will allow his client to be treated as she wishes, and set a precedent for other patients and doctors in similar legal conundrums.