Mental illness should never be a death sentence

National Newswatch

Margaret Eaton

Anyone living with mental illness knows it can absolutely be grievous and even unbearable. However, what sets mental illness apart from all other types of suffering is that there always remains the hope of recovery. That’s why the Senate’s amendment to C-7, the assisted dying bill, is so concerning.

People with a mental health problem or illness need assistance to live and thrive, not hasten death. . . [Full text]

Portuguese assisted suicide/euthanasia law and freedom of conscience

Sean Murphy*

The Portuguese parliament passed Decree No. 109/XIV on 29 January, 2021, legalizing euthanasia and assisted suicide. It has been referred by the President of Portugal for a review by Portugal’s Constitutional Court.

The law permits physicians and nurses to assist in suicide or provide euthanasia for eligible patients.  Eligible patients are adult nationals or legal residents of Portugal who experience intolerable suffering as a result of an extremely severe and permanent injury or incurable terminal illness.  Eligible patients must also demonstrate a serious, voluntary, informed, continuing and reiterated decision to seek euthanasia/assisted suicide.  Physicians who are satisfied that a patient is eligible must obtain the approval of  the Committee for the Verification and Evaluation of Clinical Procedures for Advancing Death (CVA) before providing the procedure.

The law includes a protection of conscience provision.  Any health professional may decline to “practise or assist in the act of antecipação da morte de um doente“, which, literally translated, means the act of “anticipating the death of a patient.”  However, from the context it appears that this is more correctly translated as “advancing the death of a patient.”  To assist in “advancing the death of a patient” is broad enough to encompass diagnosis, evaluation and facilitation by referral or other means.

An objection can be based upon clinical, ethical or other grounds.  An objecting professional must advise a patient of the objection and reasons for it within 24 hours, presumably within 24 hours of a request from the patient.  Objectors must also give written notice to the person in charge of the health establishment where they work and to their professional orders.  Such an objection is permanently and universally valid and “does not need to be justified” (e não carece de fundamentação).  This appears to mean that objectors are not required to demonstrate that their clinical, ethical or other reasons for refusing to participate are correct.

The law is not clear about the freedom of health care facilities to refuse to be involved with euthanasia and assisted suicide or to prohibit the procedures on their premises. Article 12.1 states that it is up to the patient to determine the location for the procedure (“A escolha do local para a prática da morte medicamente assistida cabe ao doente.”). However, nothing in the law requires a facility to comply with a patient’s choice. The rest of Article 12 simply describes places where the services can be provided.

Lack of clarity on this point is likely to cause problems, especially if Portuguese euthanasia/assisted suicide advocates are as aggressive as those in Canada. See, for example:

Portugal’s euthanasia law goes for constitutional review

AP News

LISBON, Portugal (AP) — Portugal’s president on Thursday asked the country’s Constitutional Court to evaluate a recent law passed by parliament that allows euthanasia and physician-assisted suicide for terminally ill and gravely injured people.

Portuguese President Marcelo Rebelo de Sousa said in a statement the legislation appears “excessively imprecise,” potentially creating a situation of “legal uncertainty.” . . . [Full Text]

MAID for mental illness opens dangerous doors

Hamilton Spectator

K. Sonu Gaind, Sephora Tang

Last week the Canadian Senate voted to recommend a “sunset clause” on the exclusion of mental illness as a sole eligibility criterion for medical assistance in dying (MAID).

If ratified by the House of Commons, within 18 months people suffering solely from a mental illness will be able to request MAID. Some argue that prohibiting access to MAID for mental illness is unconstitutional and discriminatory. Unfortunately that claim is based on a superficial notion that anything being treated differently reflects undue discrimination. In reality, significant differences exist between illnesses that are mental in nature and those that are physical, such that removal of this prohibition would be more than merely discriminatory, it will be fatal for those who most need protection and care within a protective legal framework. . . [Full text]

Palliative care experts warn of ‘deeply flawed’ assisted dying Bill

‘There’s no proper oversight or scrutiny… this legislation could lead to a slippery slope’

The Irish Times

Sorcha Pollak, Jennifer O’Connell

Planned legislation before the Oireachtas which seeks to legalise assisted dying in Ireland is “deeply flawed” and leaves the population open to “significant risk”, consultants in palliative medicine have warned.

Last October, the Dáil voted to pass the Dying with Dignity Bill to committee stage by 81 to 71 votes after the three Government parties allowed a free vote on the legislation.

However, experts working in end-of-life care have expressed concern about the wording of the Bill, tabled by People Before Profit TD Gino Kenny . . .[Full text]