CMDS Toronto 2017 Conscience Protection and Euthanasia Notes

These are notes I took from the afternoon today.  Larry the CMDS Executive Director and Alberto the lawyer for the fight for conscience spoke at length. I only captured a bit of the jist of the matter.  There was so much to hear and so manny slides. But I share this here.  Please forgive the typos and missed bits.  I trust there’s enough left of the very fine presentations to appreciate all that is transpiring in this matter right now.

Coalition for HealthCARE and Conscience
June 2016-May 2017

Presentation by Larry Worthen, Executive Director

Help Protect Conscience Rights Across Canada

Coalition
-founded Jan 2016
Enterprises Consultants and Ensight Consultation
Consultants on retainer
coalition - ‘taking a patients right violates at least one of the following:
Hippocratic Oath
Religions convictions
etc

members
Evangelical fellowship of canada
Catholic society
Salvation army
Canadian Physics for Life
Archdiocese of Vancouver
Achdiocese of Toronto
etc

Bill C-14 passed June 2015 legalized euthanasia
-huge shift in medical care in Canada
-must acknowledge the stress doctors are under
-profession had shifted and was supporting something completely foreign
-intense disappointment and concern
-Margaret Cottle presentation and poetry - got into the hearts
-grieving the change
-if we are to survive these changes the Lord will pull us together
-professional reputation is important to physicians and hard to be vulnerable with each other
-physicians expressed the isolation and feeling the seismic shift , that some colleagues and some patients were no longer in line with them that they were no longer in line with this (euthanasia).

since June 2016
Federal government lobbying
‘nothing in this section would require an individual to provide or assist in the provision of MAID’
conservative private members Bill unsuccessful
ecumenical press conference - Christians, Jews, Muslims all religious people represented saying they don’t like this.
-Christians have been the greatest barrier to success - a lot of Christians are so beaten down by this culture and we give up…..don’t believe this is the Lord’s will for Canada but we’re all brain washed with this whole secularist agenda - we’re programmed into slavery
=Senate Consience amendment defeated
-Christians of all denominations in power positions voted against us….they have their own conscience problems - they feel bowing down to power is better than to follow faith..
-15-20 meetings in Toronto with Ontario officials
discussed palliative care as well as individual and facilities protection
the abortion issue is under the euthanasia issue
conscience rights, the CPSO, College, requires doctors to provide a referral for medical assistance in dying -
we were faced with perception that we would not accept LGBT community
The Cardinal advised them that Catholics and Christians were among the first to respond to Aids in Canada
No other foreign jurisdiction requires MAID referrals
Ontarion hyman Rights and Charter of Rights and Freedoms protect people from discrimination based on religion conscience or creed
CPSO experts insist conscientiously objections phsyciins leave family medicine, palliative care and move to cosmetic surgery or pathology - this attitude is embedded within the structure
Udo Schulen - ‘doctors must put patient interests before their own integrity”  If this means doctors leave the practice of medicine so be it.
Explicit support from Conservatives and to a lesser extent NDP
50 meetings between physicians, MPPs Cabinet ministers and senior beurocrats.  Cabinet was impressed that doctors would leave work and come to lobby, that there were young and female and coloured doctors involved.
Legislation 84 Dec. 7 16 - opportunity to include amendment
Ontario announced a ‘care coordination service’….patients can access but physicians must provide referral


Call for Conscience Campaign
-educate Ontarians
made 3 min video
presentation resources - sample pulpit announcement
information for churches to get voters to write MPP
Christians haven’t been good in general in these battles
the others are activitists and their people are activists and they will support and write for a particular candidate, they tow the party line, they all work together, they’re better organized.
the Christians - are splintered and don’t talk to each other , catholics don’t talk to catholics in next parish, we’re only learning to be collaborative and activist using the techniques that have been winning against us, we are so individualistic
we were first using the same people used in election campaigns, working with doctors, faith communities, data base of 25000 supporters
our problem was we had few doctors
we allow our petty differences stand in the way of working together as Christians doing what the Lord wants to do through us.

present data base is 28,000
estimated 25, 000 letters went to mrs
130 member churches contacted at least twice by evangelical fellowship of canada
meetings held at synagogues
All chaotic bisihops in On participated
$40,000 raised from web site for legal expenses
Some liberal media were supportive, unheard of in Canada

Conservative proposed amendments
Government didn’t support amendments
Physicians are still required to provide referrals

Care Coordination Service
-patient can access directly
MOHLTC says physicians must call to the name of a doctor who will do assessment and make connection between doctor and patient and provide relevant information to the other physicians
-College sees you as criminal if you do not participate -
Dr. Cottle - CMPA at Palliative Care a year ago - lawyer said patients had charter right to have - lawyer said ‘we’d defend you but don’t expect it to end well’
hence need for court case as a group

Lessons Learned
-we made progress lobbying
-Christians care about conscience and will write letters to their MPP”s
-our attitude can lead us to limit what God can do
-Doctors most effective media approach is
—-describe the emotional impact of being forced to be involved in killing a patient
—-Secularism has replaced pluralism among the governing elites.

Anyone who wants to be a doctor , lawyer or teacher who is a Christian might as well forget it.

We’re bilingual and we operate in secular world and Christian world but there are these people who believe only in the Secular Religion.

It’s evil and immoral.

It’s a spiritual battle.

The ‘silent majority’ must be silent no longer
must come ‘out of the closet’ in the public square and professional
Requires adopting the mindset of the beatitudes
‘Blessed are you when people revile you and persecute you and utter all kinds of evil against you falsely on my account. Rejoice and be glad, for your reward is great in heaven, for in the same way they persecuted the prophets who were before you MT 5:11-12

This is an inconvenient truth in the scriptures.

We must stop being anonymous Christians

We as Christian are afraid to get out of bed to face the day but do because we must to receive the blessings the Lord has promised.

Alberto, the lawyer,  presentation
Update on the Case
2 challenges - physician obligations
assisted suicides


named the leading Rabbi’s, Ethicists and Researchers, world famous persons who showed that in other jurisdictions there was no requirement for doctors to make referrals and that euthanasia operated without difficulty.
conscientious objection - historical approach given - maintaining the physicians moral objectivity is essential to the profession
countering the narrative that Christians are anti abortion , anti euthanasia, anti LGBT , ant Homeless and all these people will be abandoned but this is not the case
no other regime in the world requires conscientious objectors to refer people
a group of pro abortion people came forward insisting that if doctors aren’t forced to refer then vulnerable people will be without abortion or euthanasia yet despite this bias and this propaganda the evidence doesn’t support this.
nurse expert gave opinion confirming that providing referrals for something that is morally repugnant causes equivalent of ptsd - ‘moral distress’
health care system in Ontario can and should be able to accommodate moral objection
our material is 21 volumes of evidence
most of arguments done in writing
lots of paper
6-12 months for decision
we can win but if we don’t win we will go to the supreme court and that could be another 5 years

I enjoyed meeting and talking later with Dr. Jim Lane a BC Physician who has involved himself in this whole area of physicians of  conscience
.

Facing the Challenges of Aging and Dying, An International, Interdisciplinary Conference, Queen's University, Kingston, Ontario, Canada

Catherine Dhavernas (French Literature, Theory, Queen’s University) and Janet Dunbrack (Board Chair, Hospice Care, Ottawa) organized a conference on Aging and Dying.   I attended this conference noting that increasing numbers of my patients are considered aging. Indeed I’m considered Aging.
It’s been many years since I studied with Elizabeth Kubla Ross and increasingly I have patients dealing with dying parents. Personally I am feeling my age as loss.  Once extremely fit and athletic a series of injuries in the last few years have taken far too long to recover from. The aches and pains remain and on top of that some fat old man seems to have invaded my body.  Where once I’d love to run today I walk and actually prefer to ride. I’ve had the loss of some smell after a particularly severe sinusitis and added to that is thinning hair and some mild hearing loss.  It has given new meaning for me personally to the classic Canadianism, “eh?"
My older brother, the rock of the family, the one who lead the way through childhood, the one who protected me in cubs and scouts, had a near death experience with a pulmonary embolism and subsequent discovery of pancreatic cancer.  Queen’s University oncology department doctors have been the best.  He’s responding to chemotherapy now.  We only just buried the ashes of my father and mother who died separately these last few years.  It was my brother who dealt with the bureaucracy of the funeral parlour and graveyard who tried to insist that only my mothers ashes, not a mix of my mother  and father’s ashes were ‘reserved’ a space in their prestigious graveyard.  It was my brother’s wisdom and patience that solved the problem waiting till the right time to stroke the outstretched palm, knowing that this was all it was ever about.  Baksheesh,  The trade in the dead.  My suggestion, typical through life, that I’d add some more corpses to their precious graveyard had been tempered by my brothers understanding and acceptance.  He’s been a voice of reason always.
As a psychiatrist who has helped stop literally hundreds from killing themselves I’ve been depressed with the Supreme Court’s new ‘physician assisted suicide’ stance.  I took an oath to ‘do no harm’ and the weasel words of their decision seem less logic and more convenience.  The UN Agenda 21 has invaded courts and bureaucrats like cancer offering death in the name of life wherever it goes.  I was excited by this conference because it promised to address this topic.  One of the leading lawyers involved in Quebec’s euthanasia program was to be a speaker as was the University of Toronto's leading medical authority on palliative care.
Nearly 25 years ago I’d been condemned for recommending ‘palliative care’ for a patient only to find that the doctor and nurse who were claiming to be more caring and more concerned than me and clinically wiser, were doing pharmaceutical company experiments on the elderly and demented for kickbacks without consent.  As so many were making such big money I was lucky at the time to keep my license, finding no friends in the very places where people were on high government pay to protect the lives and dignity of patients.  The practice stopped, I was ‘set free’,  I was hated by those who had lost a prime source of income and considered stupid for not accepting the lucrative olive branch offered to me to turn away.  I was thereafter designated a ‘non team player’ and suspect as ‘disloyal’.  Palliative care meanwhile was what was appropriate for my patient and supported by her family.  So in the end Palliative Care won out.  It’s today a cornerstone of end of life care and thinking. Yet I know this wasn’t always the case from my personal horrendous experience.  
 
The conference was held at the beautiful Isabel Bader Conference Centre at Queen’s University.  A truly lovely location with wonderful views of Lake Ontario and state of the art facilities.  Not surprisingly the symphony performs there which explains to some extent the elegance and sense of refinement that permeated the facility.


The originators of the conference , Catherine Dhavernas (French Literature, Queens) and Janet Dunbrock (Board Chair, Hospice Care, Ottawa)
opened the morning sessions.

 “Aging and dying are a reality central to the human condition”.  The greater significance of this now is that ‘with growing aging population…raising the awareness (with) sense of priority and care they deserve…and belief in multidisciplinary exchange with an awareness of barriers."
She saw that the arts and humanities could work with the health professionals ,noting that her own interest and awareness had resulted from her volunteering to assist in the palliative care unit.
She introduced the topic of “Narrative Medicine”, and described how ‘literary studies help develop awareness."
She quoted Rita Charon, Narrative Medicine, Honouring the Stories of Illnesss, 2005

Rita Charon, Narrative Medicine, Honoring the Stories of Illness 2006

-“We clinicians act as ventriloquists to give voice to that which the patient emits.  I put it that way because the patient cannot always tel, in logical or organized language that which must be told. We let the other talk through us, finding the words in which to say that which cannot be said.”

“No story is possible, if by story one means: to tell a story of events which makes sense>”

Sarah Kofman, Smothered Words

She showed pictures by  Rembrandt and Goya (“Anatomy Lesson” Rembrandt1632 and ‘Witches Sabatth” Goya 1821-23 to illustrated the change from painting as a pursuit of knowledge and the dead as an object of knowledge to a different perspectives, a dead man as object of knowledge to superstition replacing knowledge.
 “Does medicine have to overlook the unknown? was the question raised.
Drawing from works of Marguera Yourcenar the Abyss, the movement from ‘self to other’ was discussed with the origins of the essence of ‘palliative care’ underlined. “the patient in the throes of death….acknowledges the unknown and unknowable….nonverbal only viable way to care for patient - invisible inarticulable care."
“our society, aging, denies unknown….promotes youth in denial."
It was a deeply moving presentation that raised all manner of considerations for me a physician.
They stated ‘Our hope is to open discussion across various disciplines to recognise aging and death."
The conference certainly did this for me.

I was moved by the pictures of the events of dying, the changes in perception over time and culture.  Each presenter was excellent.  I had come to hear mostly the University of Toronto physician discussing palliative care in light of the new physician assisted suicide changes in law.  There was a snag in the technology but I was delighted by how the planners rose above these post modern difficulties with almost medieval persistence.  The presentation was all I could have hoped for. I had also been most interested to learn from the lawyer who spoke on the Quebec legal experience of euthanasia. What was so satisfactory to learn was that  ‘Palliative Care’ was enshrined in the laws In Quebec.  Euthanasia was not something to be offered to the poor while the rich got Palliative Care.  The law demanded that the highest forms of Palliative Care be provided.
Now that said, I as a pragmatist and scientist was most impressed by the presentations by the ‘flaky’ arts faculty. Rather than ‘soft’ their presentations were hard and to the point.  I was truly challenged by the presentation on Caravaggio discussing the actual sense of timing and time as it changed. We have used ideas in science of brain death and such but here was a truly enriching consideration of the history of this idea of time and timing as related to art history.  Who would have thought!

(Instant of Never-Ending Death : Divergent Trajectories in Caravaggist Art

Itay Sapir

Art History

Universitye due Queebec a Montreal

Issues around death

-public versus private

-right to death

-technology)

I loved the whole idea of Ars Morendi and was thankful to learn of this. The discussion of the art of different periods and the ideas of what was important in the day and age most interesting.

(Ars moriendi - The Art of Dying in the Middle Ages

Thekla-Christine Hansen, M.A.

Art Historian , Mail: thekla.handsen@gmx.de

Christian-Albrecht-Universitat Kiel

Plan

preconditions - living conditions, medicine

 -ideas of afterlife in medieval times

Ars Moriendi- the art of dying well)

I loved the art and presentation and discussion of present day views of aging. Indeed, when the  somewhat fat old white guy torso was put on the screen I wondered for a paranoid instant who’d been taking pictures in my bathroom.  Yet, seeing this, I felt less ‘shame’ in my definitely changed look from the days when I too was young.  It struck home viscerally how much we are a youth culture and how ‘other’ I felt until hearing and seeing this.  I intellectually know this and yet the art and this presentation touched me in that experiential place where I went aha.  This was a great presentation. 

(The Art of Aging in the Photography of John Coplans, Suzy Lake and Cindy Sherman

-Meghan Bissonnette

Lecturer, Art History, Valdosta State University

Contemporary artist who —represent aging

1. aging as beautiful - 
2. coming of age - art and science - show - heartfelt/dignified/beautiful
3. rarely do we represent stigma - aging as sentimentalized
4. artist who take more critical stance
5. beyond stereotypical )

The presentation by a native woman brought home the importance of culture in any discussion of aging and death. AT UBC I’ve had the privilege of knowing and working with Dr. Soma Genesin, cross cultural psychiatrist who insights are always so profound.  This presentation raised the awareness of the cultural and aculturation aspects of aboriginal societies where a person’s belief systems could easily range from traditional to fully westernized so that ‘assumptions’ had to seriously be guarded against.  I was interested in the presenters tribal Mohawk nation ideas so different tribally from the Haida and Kwakiutl of BC and the Cree and Blackfoot plains tribes of mid west. Having worked extensively in the aboriginal cross cultural context with the benefit of First Nations Elder Anglican Minister Vivian Seegers medicine wheel insights I appreciated the difficulty the presenters had in general reducing so much material into an overview presentation.  The challenge would be akin to saying,  in 1 hour tell us about “European Culture”. The take home point was strongly made for the need to address this especially with the native elderly.

Finally , I loved Downar quoting Woody Allen,  “I don’t mind dying, I just don’t want to be there."

The conference was a day and a half. Unfortunately I had planned my flights originally flying out of Kingston but had changed to leaving Toronto so was unable to attend the morning conference.  I did enjoy the lunch and breakfast time which in ages gone by we called ‘mixers’.  There was a reception to and a celebration of the new courses and master program in Aging that had begun at Queen’s.  I do hope they continue this conference and would recommend it to all those who work with an aging population or have an special interest in aging and dying.  I’m very thankful to have attended

Harm Reduction Strategies and Palliative Care

Harm reduction Strategies are all the rage in government health circles. That's where tax payer money is going. The adherents of this religion are in the ascendent and have been for a long time.  It is important to understand that this all has followed on the success of abstinence strategies and spiritual programs that proved addiction was a treatable and curable disease.   It's further not seen purely as an 'individual' treatment as with 'alcoholics anonymous' which was aimed solely at the individual alcoholic.  Harm Reduction Strategies are principally a 'public health program', not a traditional 'therapy' per se.  In traditional medicine 'harm reduction strategies' have been called 'palliative care'.  There is nothing new or sexy in the model despite the 'spin doctors' sales propaganda.
I first studied "Harm reduction' as a Community Medicine resident 25 years ago in my Public Health program.  My Family Practice and Psychiatry training were principally aimed at curative or ameliorative strategies and principally concerned the individual.  We learned and practiced 'harm reduction' and 'palliative care' but only as a 'last resort.' They were never proposed as the 'principal' treatment or 'alternative treatment' or 'primary treatment'.  They were an approach to care when it was thought in most cases 'death was inevitable' and all we could do was to make the person 'comfortable'.
Harm reduction strategies are exceptionally good public health.  Unfortunately they are often 'spun' as the best thing for a patient.  However, it's important to note that patients with addiction are by nature fairly psychotic.  By the standards of the community they are clearly out of touch with reality.  They drink and drug themselves to death and cause major societal concerns and the courts even let them off crimes because their reasoning was impaired.  Indeed the modern MRI shows that reasoning deficits last after a person stops the subtance of abuse approximately 3 months.  Experienced addiction personnel note that the greatest vulnerability for relapse, ie recurrence of the psychotic behaviour, last for at least a year or more.  During this time a person's capacity to judge the 'safety' for themselves of a substance of abuse is subjectively at great variance to the objective reality of friends, family and society at large.
Given this I have actually wondered if addicts shouldn't be assigned lawyers to help them make decisions about their health care in face of the increased pressure on impaired individuals to accept 'harm reduction' which is clearly more beneficial for the community.
Harm Reduction is a Public Health measure that 'colludes' with the patients insaniety about their ability to practice doing heroin 'safely' or drinking 'safely' or smoking 'crack' safely.  The very term 'harm reduction' doesn't suggest 'safely'.  Palliative care was a much more honest term and is used for all other areas of medicine.  So why not in addiction.
In medicine we have a term called 'treatment of choice'. This refers to the treatment that has the highest likelihood of success.  Harm reduction strategies by comparison have the least likelihood of success for the individual however from a public health perspective they may have the greatest appeal.
If there are two programs available, one which is 'curative' and 'abstinence' based for addiction therapy, and one which is 'harm reduction' the former therapy is more costly whereas the latter is 'cheap' by comparison.  In the treatment of appendicitis, surgery is the treatment of choice for the individual however surgeons, surgical theatres, OR nurses, aseptic fields and anesthestists are all terribly expensive.  If one doesn't have surgery a harm reduction approach to appendicitis is to just give antibiotics. This is surely better than nothing and some people indeed get better with this approach alone.
The key here is that 'harm reduction strategies' are cheap.  The principal fear of an insurance monopoly is that the economists and investors would eventually see that the greatest profit lay not in 'curative' therapy but in 'harm reduction' therapy.  Ultimately 'no therapy' becomes harm reduction.  Beurocrats have long known that their greatest rewards come when the emperor has no clothes. In this case, it's the patient.
Never forget that from a public health perspective 'euthanasia' is a 'harm reduction' strategy because it reduces 'harm' to the community.
It's further to be remembered that only the doctors, nurses, health care providers, and not the 'administrators' or 'economists', have codes of ethics that mandate caregivers to put the well being of the individual at least on par with the concerns of the sometimes 'for profit' insurance concerns.
I was trained in harm reduction and palliative care over a quarter of a century ago. I've practiced it ever since. I was further trained in curative and restorative and rehabilitation models and always opt to offer these first.  Some 'harm reduction' and 'palliative care' models actually buy time for an individual waiting to get the 'treatments of choice'.  However increasingly I see 'harm reduction' presented as a 'superior model'  or an 'equal' but 'alternative' model and certainly those 'promoting it' are considered sexier and get paid far more than those in the front lines providing scientifically proven therapeutic care.
This was always a point of contention with the government when it was noted that alcohol and drug counsellors with greater training and equal experience were paid far less than the people selling alcohol in the Canadian government controlled outlets.  Given that our government benefits from the taxes on sales I"m not surprised they want to keep people drinking to the very last sip.  That was the experience we had with the government around smoking until decades after all the 'harm reduction' strategies were used up and the government had moved it's tax base elsewhere did definitive legislation come in that helped individuals and public together.
I just read of the latest harm reduction strategy. It's called "MAP" a rather cute acronymym. It's basically a 'drink your way into sobriety' program like the new 'shoot heroin safely program.'
I express my cynicism because my colleagues who promote them and get such accolades never mention how 'cheap' these services are and also don't care to mention that they are getting the money for these programs from 'therapy' and 'health care' programs that were not specifically allocated for 'public health' or 'law enforcement'.  Indeed, Drug Court is a highly effective 'harm reduction' strategy I fully support but it's funding doesn't detract from family medicine.
The fact is that all the 'tools' in the 'tool box' are what are needed however the 'celebration' of 'harm reduction' and the spin doctoring around it sends a very questionable message to children, and the community at large.  Something about 'palliative' care' never did this.  Mind you I've been highly suspicious of government and beurocratic language since the same folk in the 60's gave us the 'Peace Missile'.  What concerns me is that we will one day have to pay more taxes to clean up after the priorization of harm reduction programs just as we all paid more taxes to clean up the excessive missiles which now are the reason for the excessive costs of security. Government bearocracies have a long documented love for short term success projects that have long term negative consequences.  Their favourite is spend our way out of debt, a political harm reduction program that is causing Greece and others like it a little concern to put it nicely.
There's something to be said for competition in health care insurance.  Harm reduction is necessary and certain harm reduction programs like drug court, and methadone maintenance,  are highly beneficial.
The WHO supports harm reduction but only as a stepping stone to abstinence.  I don't see that being the agenda of many of the programs that are promoted as really 'sexy'.  They seem unfortunately to be putting today's problem off till tomorrow.  That sounds to me like 'let's make the  children and grand children"  pay for the government's spending schemes.  Harm reduction is simply palliative care. Is there a plan as the WHO would demand that these approaches ultimately lead to abstinence or is this just a way to have the government get more of the highly lucrative turf of alcohol marketting and street drug dealing. Great public health but please don't say 'it's for the patient's own good' without ensuring that poor girl or boy has a lawyer representing him.