Euthanasia in Quebec?

Quebec legislators are reportedly within days of passing a law that would permit euthanasia for competent adult patients with incurable disease which causes constant and unbearable physical or mental suffering. The euthanasia-related portion of Bill 52 (an English-language copy of which can be download here) seem modeled on euthanasia laws in Europe, in that it requires a diagnosis of incurability rather than of terminality, and explicitly ties access to euthanasia to suffering. A person is eligible to receive a physician's aid in dying only if he or she "suffer[s] from an advanced state of irreversible decline in capability; and suffer[s] from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable." The term "aid in dying" is not actually defined in the bill, presumably in order to leave methodology in the hands of physicians.

Euthanasia is illegal according to Canadian national law, and it's not clear that the Quebec provincial law's alternative reference to "aid in dying" will skirt that national prohibition. Parti Quebecois officials are reportedly thinking of simply asking Crown officials not to prosecute euthanasia within Quebec after the law passes.

The bill covers a great deal of ground in addition to the euthanasia innovation. It creates a provincial commission to gather information on end-of-life care, establishes a regime for the creation and registration of advance directives, and addresses the provision of hospice and palliative care.

The bill has attracted a fair bit of high-profile opposition from groups of physicians, from the Catholic Church, and from some bioethicists. Here's a piece on the slippery-slope argument ("Soon we'll be killing children and the demented, just like in Belgium") being advanced by prominent conservative Canadian bioethicist Margaret Somerville.

Ventilating the Dead, More Updates

The following message was posted on the Facebook website, Keep Jahi McMath on Life Support, less than an hour ago (boldface added):

Thank you for all your prayers, thoughts and good wishes for Jahi, her family and others helping them. Jahi is Gods own child, she is being properly taken care of and loved by many. She is stable and she is much better in the new facility. Keep the love and prayers going. When there's any eventful information on her continuous healing, you will be updated. Please continue to be respectful of Jahi, her family and each other, have a blessed weekend and let us keep praying for Jahi. Matthew 18:20, "For where two or more are gathered together in My name, there I am in the midst of them". Thank you and God Bless.

McMath was declared brain dead by the state of California on December 11, and her parents have been keeping her body on ventilation and artificial nutrition/hydration at an undisclosed location ever since. It is very unlikely that she is "much better," or that she is undergoing "continuous healing." The power of the loving eye to see evidence for hope is strong indeed.

Meanwhile, Salon is reporting that the family of Marlise Munoz, the brain-dead Texas pregnant woman who was kept on ventilation against her family's and her own previously-expressed wishes, may be faced with $300,000 of medical bills. Alternatively, the taxpayers of Tarrant County may end up footing the bill for their county hospital's actions. The hospital spent the money because of its view (rejected last week by a Texas judge) that a Texas law prohibiting the removal of "life-support" from any pregnant "patient" applied to the dead pregnant woman.

My previous coverage of the McMath case is here and here. Previous posts on Munoz are here (initial news), here (update), here (family's intention to sue), here (court proceedings), and here (removal from ventilation). A contrast of the Munoz case to a similar case in Canada is here.

Ventilating The Dead: Canadian Case, McMath Update

Dylan Benson of British Columbia, Canada, is keeping the pregnant body of his brain-dead wife Robyn ventilated in order that their son might develop inside her and be born. Robyn was 22 weeks pregnant when she was struck dead by a brain hemorhage. Benson is using donated funds to pay for Robyn's ventilation; when his son is delivered by C-section, he will then bury his wife.

This case is strikingly parallel, of course, to last month's Marlise Munoz case in Texas, but there are also some striking differences. In the Benson case, the husband and the hospital agree on the aim of saving the developing fetus, and the husband believes his late wife would have wanted the child saved. In the Munoz case, both husband and parents wanted ventilation removed, and husband believed that his wife, an EMT, would not have wanted to be kept hooked up to machinery. Benson was 22 weeks pregnant when she died; Munoz only 14. Munoz's fetus went without oxygen for the same period of time that Munoz herself did; the lack of oxygen that killed her brain left her developing fetus devastated. But Benson was still breathing, though unresponsive, when her husband found her and rushed her to the hospital; it is possible that her fetus was unaffected by her brain hemorrhage.

Meanwhile, last week, a video was posted on the Keep Jahi McMath On Life Support Facebook page, purporting to show the feet of Jahi McMath, the brain-dead 13-year-old whose parents are keeping her on ventilation and artificial nutrition and hydration, responding to cold stimulus. The video has since been pulled, but remains widely available on the web. A female voice on the video says, "I don't understand how a brain-dead person could do this." But spinally-mediated movement by brain-dead persons has been documented for a long time.

Canada and the Crime of HIV Exposure

The Supreme Court of Canada has just issued two rulings, one on an appeal from Quebec and the other on an appeal from Manitoba, which together clarify and restructure the circumstances under which criminal sanctions can be applied to an HIV+ person who has sex without disclosing that HIV status to his or her sexual partner.

Since 1998, Canadian law has held that those who fail to disclose their HIV status can be charged with sexual assault or aggravated sexual assault if their sexual relations pose "a significant risk of bodily harm" to their partners. Lower court holdings over the years have held that there was no significant risk of bodily harm where the accused used a condom, or where the accused had a low viral load due to medication. The new Supreme Court holdings agree that there is no significant risk, and no legal duty to disclose HIV status, where the accused's viral load is low due to medication, and a condom is used. But the Supreme Court upheld the convictions of defendants who did not use condoms, even if their viral loads were low.

The decisions have drawn immediate criticism from opposite sides. Advocates for persons with HIV/AIDS accuse the court of reinforcing irrational and unscientific fears of HIV transmission, of stigmatizing those who are infected, and of creating a world in which even responsible condom use offers no surefire protection from prosecution for those who do not disclose their HIV status. The threat of criminal prosecution for an act of consensual sex, they argue, doesn't protect people from HIV transmission. Conservative critics of the opinions lament the Court's having given legal permission for people not to disclose their HIV+ status to their sexual partners in some circumstances.

The Court also said that the "significant risk" necessary to underwrite criminal prosecution would vary with the sex-act in question, and could also change with medical progress.

Canadian AIDS Researchers Oppose HIV-Exposure Prosecutions

The current CMAJ includes this letter from three researchers at the British Columbia Centre for Excellence in HIV/AIDS, arguing for an end to Canada's criminal prosecution of people who allegedly expose sexual partners to HIV. The letter points out that the actual risks of transmission to sexual partners are quite low for well-controlled HIV; that prosecutions have never been shown to reduce rates of infection: and that they may in fact discourage or interfere with HIV testing and treatment. In this interview, one of the co-authors also notes that while Canadian rates of prosecution for HIV exposure have been on the rise, there is no similar policy of prosecuting those who expose partners to other potentially serious viruses like HPV.

Globe and Mail on End-of-life Care

I'm grateful to Thaddeus Pope for drawing my attention to the Globe and Mail's amazing current series on end-of-life care.

There are two current important cases on end-of-life care pending in Canada. I blogged earlier about Gloria Taylor's case rising from British Columbia, which is challenging, for the first time since the Rodriguez case in 1993, the constitutionality of Canada's law against assisted suicide. The second case is that of Hassan Rasouli, a patient in a permanent vegetative state in Toronto. Rasouli's medical team wants to discontinue aggressive care and begin palliative care, but the patient's family disagrees. Lower courts held for the family, but the doctors have now appealed to the Supreme Court.

Challenge to Canada's Assisted Suicide Law

The Royal Society report I blogged on earlier today may end up having an impact on an important case which has just begun in British Columbia. It's a new challenge to the constitutionality of Canada's law criminalizing assisted suicide. The case aims to overturn the 1993 Rodriguez case, in which a 5-4 split Supreme Court upheld the criminal law by affirming that it did not interfere with the rights to liberty and security of the person affirmed by the Canadian Charter. The Royal Society report includes extensive discussion of contemporary Canadian attitudes toward euthanasia and assisted suicide--attitudes which have changed substantially since 1993. Such changes in national climate--plus a number of intervening cases interpreting "security of the person"--may leave Rodriguez vulnerable to reversal.

Royal Society of Canada: Assisted Death

Have a look at this report from the Royal Society of Canada on end-of-life care. It's headline-grabbing recommendation is that both assisted suicide and voluntary euthanasia should be legally available; but the full report, with its overview of current Canadian public opinion and law on end-of-life options, is well worth reading.