Dear readers: I expected some negative fallout from this post and of course I’m getting it. I’d like to make one thing clear: when it comes to rehab, addicts and alcoholics are free to talk about their own recovery. What I object to is the tattling nature of what the Toronto Star has done by speaking to others in Ford’s rehab facility. Every patient needs privacy, not just the mayor, and this sort of reporting puts everyone at risk.
Kevin Donovan, an investigative journalist with the Toronto Star, has angered many of us who monitor healthcare in Canada. At issue is the privacy of Rob Ford’s stay at GreeneStone, a drug and alcohol rehabilitation facility based in the Muskokas. Here’s how Donovan’s article begins:
Mayor Rob Ford pushed and scuffled with fellow rehab residents and was so verbally abusive that he was kicked out of his group therapy program, according to people who have knowledge of his two month stay at GreeneStone. These accounts of what one person referred to as “destructive behaviour” stands in stark contrast to Ford’s recent public statements that he…takes his recovery seriously. “Ford broke things, got into fights with other residents…[he] stopped people from sharing their stories, which is key to a successful rehab experience,” said another source. “Other residents felt intimidated. They felt he was a bully. He was always saying he did not belong there.”
Donovan goes on to describe his sources:
For this story, the Star has obtained accounts of Ford’s time in rehab from three people with knowledge of his time there, including a fellow patient, and from others, including a staffer, who provided accounts through an intermediary. Due to concerns over publicly breaching the confidentiality of the treatment facility, the sources asked that their names not be published.
Mayor Ford has been an ongoing target of a Toronto media unhappy with his conservative politics. However, as the entire English-speaking world now knows, Torontonians have other reasons for concern: his downward spiral into drug and alcohol abuse is well-documented thanks to his carelessness, the ubiquity of smartphones and a media willing to pay for scandalous videos. That Ford has been his own worst enemy is not in dispute. Neither is the fact that the Toronto Star, as evidenced above, has pushed past acceptable boundaries and violated his and his family’s privacy.
When it comes to health records, violations like it can be deadly. In my family’s case, my stroke-afflicted mother was put at risk by the words of the surgeon who had amputated her leg. In her discharge summary — the document that summarizes a patient’s stay in hospital — I, like Ford, was described as abusive. This was in reference to words I exchanged with the surgeon when I discovered he’d falsified a report. Of course that context was not described in the summary, so when subsequent doctors read about our disagreement, my mother was turned away from their offices with vague excuses. Our difficulties became particularly acute when a dedicated eldercare clinic, which provides transport for the disabled, precipitously dropped my mother as a patient. When our rattled social worker tried to investigate, she was stonewalled. Abuse, it turns out, is in the eye of the beholder.
To read more about my family’s experience, clickhere.
Rob Ford may very well have behaved badly at GreeneStone. The missing piece of the puzzle, however, is the context. Having volunteered at a rehab, I know patients are often volatile and staff are trained to deal with them accordingly. It’s quite likely that Ford wasn’t alone in behaving badly, if indeed he behaved badly at all. Taking the word of other patients is a risky affair and Donovan’s doing so is a sign of his naivete when it comes to the world of addiction and recovery.
Moreover, he implies that one GreeneStone owner, Shawn Leon, has a questionable background. Although Leon says he does not have a history of addiction, many rehab workers are recovering alcoholics and drug addicts, some of whom do have criminal pasts. However, when we consider that the majority of prison inmates in Canada are there for crimes committed because of drugs or alcohol, these troubled pasts make sense. Some of the most dedicated counsellors I’ve met through my volunteer work have spent time in jail. Take away the substances and what you’re left with, most of the time, are damaged but eminently decent human beings who have learned hard lessons. Donovan’s colouration of facts is misleading and nothing he reports counts as news for those of us familiar with addiction.
So I wrote to GreeneStone to ask them who spoke to the media. Here is our correspondence:
I’m wondering if the person who shared private information about
Mayor Rob Ford is going to remain on your payroll? The Toronto Star’s coverage, by
Kevin Donovan, is very troubling. I’d like to know if anything will be done
about the people who broke his anonymity.
Thank you for your email. GreeneStone takes patient care and
confidentiality very seriously. As an organization we take great strides to
protect patient confidentiality and have never spoken to the media about any
of our patients.
I believe the staff at GreeneStone when they say they take confidentiality seriously. They wouldn’t be in business if they didn’t. So who snitched? And why do Donovan and the Toronto Star believe that other patients are more reliable than Ford? Isn’t it possible that the patient Donovan spoke to simply dislikes Ford and is seizing the opportunity to do something about it? And what about the future? This breach of privacy makes the possibility of any subsequent rehabs, which the mayor may need, exceedingly difficult: what institution will go up against the Toronto Star and their willingness to pay and plant informants? How many high risk patients, who fear exposure, will leave and not get the help they need?
Donovan’s errors in judgement are a genuine tragedy for the Fords and their children. When it comes to rehab, it’s a time honoured tradition that the famous are granted space and time to deal with their addictions. Denying them their privacy — which the Toronto Star has done here — sets dangerous precedents for us all.
The Media, Snowden and Ford: I am a freelance writer based in Montreal. This article is about Edward Snowden and Toronto’s mayor, Rob Ford. I’m concerned about our mainstream media’s attacks on the mayor and his family: are reporters reporting news or trying to make it?
Close the blinds. I’d like to talk to you about privacy.
If you’ve ever had yours violated, you’ll know the feeling. The warm flush of exposure, like aPanopticon prisoner’s, settles in and you internalize the presence of a stern or threatening power. It happened to me when I was mischaracterized by a surgeon who had operated on my mother. Two paragraphs in her hospital record impacted my life and hers in ways I could not have predicted: angry that I had discovered a false report, the surgeon warned other doctors about me, making the search for medical after-care difficult.
That man’s words were more effective than any cattle-prod could have been. I became fearful, stopped complaining and, for a time, remained silent when further problems occurred. This is how privacy violations work.
So my concern over the narrative being woven about Rob Ford – a position that has exposed me to considerable abuse – is based more broadly upon my concerns about privacy. Ubiquitous smartphones are changing the way we communicate. Their video capabilities, I would argue, are changing the way we behave. Is this a good thing? I’m not so sure.
The rags to riches narrative is deeply embedded in our North American psyche: with hard work and a bit of luck, upward mobility can be achieved in a generation or two. It makes sense then that the Cinderella fairytale, in all its variations, is sold to us repeatedly by an entertainment industry that knows us well.
In real life, however, this narrative works differently. When boosted by technology, it can morph into an exaggerated version of itself, a version that requires a hero and a villain, a combination that endangers us all. Teenage sexting incidents, and the suicides they have caused, are harbingers of the dangers ahead: like 17th century stockades, public shaming is becoming the punishment of choice for those who consider themselves civilized.
Why is this important? There are many among us who would make great politicians, but having our lives closely scrutinized, by adrenaline junkies who are also reporters, keeps us from it. The melee around Ford is just one instance of reporters seeking to create their own Cinderella moment, a moment when they can best their fellow reporters (their stepsisters), out a bad politician (their evil stepmother), and marry a prince (garner princely attention and make their careers). That the focus of their story may be an individual’s personal turmoil makes no difference.
Even former journalists have become targets. Jane Purves, the Nova Scotia MP who beat a youthful addiction to heroin, went public on the eve of being outed by a media that conveniently ignored her past while she was one of their own, a reporter and managing editor of the Halifax Chronicle Herald. Similarly, Anne Robinson, of The Weakest Link fame, turned out an autobiography, Memoirs of an Unfit Mother, after having a long career as a broadcast journalist in the U.K. Once she appeared on American television, she too was pushed to the brink of exposure and pre-empted it by writing frankly (and quickly) about her alcoholism. One reason she wrote the book, she says, was to limit any further harm to her daughter.
There’s an obvious double standard here. Those in the media get a free pass when it comes to addiction, but the addictions of public officials, particularly those whose behaviour or politics are provocative, are considered fair game. Robyn Doolittle, the young reporter who wrote Crazy Town, The Rob Ford Story, is dining out on the media attention she’s getting, building her career not only on Ford’s misbehaviour, but also on the lack of privacy she’s now bestowed on his loved ones. Her inclusion of an unverified tape of Ford’s wife, which in most circumstances would raise ethical alarms, is being quietly accepted as verified, a fact that would have been inconvenient had Ford been a liberal and a well-behaved one to boot.
The media’s other omissions are curious too. Edward Snowden’s revelations about the NSA, which are unfolding at the same time, are disturbing because the agency’s spy power is far greater than most security experts thought. Governments of countries friendly to the U.S. were outraged by its violations and Snowden’s prediction, that young people being born today will not experience privacy, now seems plausible. So while Netflix suggestions and Facebook posts seem innocuous to us now, Zeynep Tufekci, a social media expert, believes surveillance techniques of the future, which will affect us all, will penetrate deeper and be harder to detect:
Internet technology lets us peel away layers of divisions and distractions and interact with one another, human to human. At the same time, the powerful are looking at those very interactions, and using them to figure out how to make us more compliant. That’s why surveillance, in the service of seduction, may turn out to be more powerful and scary than the nightmares of Nineteen Eighty-Four.
How does this apply to us here and now? Although Canadian politicians are still relatively accessible, the situation is different in the U.S. Barack Obama, like most presidents, has two narratives vying for control: he is a hero to some and a villain to others. At the moment he is mostly popular, however, because he is a brilliant orator and has gifted writers preparing his speeches. These are speeches that sound great, say little and obfuscate some troubling realities.
The obfuscation is both subtle and effective and creates a considerable distance between the hero and villain narratives. While Snowden’s disclosures hint at a vast network of surveillance, Obama himself seems to be standing a football-field’s length away from the epicenter of the crisis. That’s because his personal story — the story of the first black president — is a Cinderella tale with the heft and power to win almost any public relations fight. By following the media outpouring on the NSA, one senses, even now, that Obama will not be held accountable by history. And that’s because along with his “heroic” background, his PR people and image controllers are doing their jobs and doing them well.
This is not a system we want.
By contrast Rob Ford seems a difficult and combustible creature. His antics and appetites have provided late night comics with a lot of material and rightly so. But here’s what I think: Jon Stewart and Stephen Colbert, who have had Robyn Doolittle on their shows, can laugh at the mayor all they want: I’d rather have a politician with a vast network of flaws instead of a vast network of surveilling spybots. I’d rather have a politician who over-imbibes, gets caught and admits he was in a drunken stupor, than a slippery politician who evades responsibility with a consistent patter of empty rhetoric. I’d rather have a real human being, however awkward and embarrassing, instead of a haloed demagogue who holds court for appearances only.
We have a good thing going in Canada: we have a relatively transparent system that doesn’t allow our leaders to hide much to begin with. That’s why it’s easy to make fun of them. We are also tolerant of differences: we have had charismatic politicians like the pirrouetting Trudeau, who could be quirky and angry, delightful and sullen. When his marriage broke up in a very public way, even his enemies mourned along with him. When his wife, many years later, talked openly about her mental illness, we listened and forgave her. Now her son Justin may be our next prime minister. The Trudeaus are not a perfect family — they are certainly not the Obamas — but we Canadians are hardy enough to withstand those imperfections.
Our nation’s media needs to remember that and to stop delighting in the frailties of others, especially when those others are wives and children. Celebrating a book like Crazy Town tells me our politics are inching towards the cynical sort that produces wacky critics like Stewart and Colbert, the kind that also produces first families like the impossibly airbrushed Obamas.
Moreover, if we agree with the violation of the Ford family’s privacy, how can we claim both sides of the argument and defend our own? The sheer volume of the attacks on the mayor, however much he may deserve them, are becoming troublesome because they are shading into attacks on the democratic system that elected him and the system that protects our rights too. The principle of respecting others’ privacy is what’s at stake here, not whether we like or dislike the politician being tested by it.
In the interest of curbing the political relativism, I would suggest calling a moratorium on all attacks of the personal sort, but something tells me our nation’s media, and the reporters and editors who run it, would be loathe to comply, especially with subjects as worthy as Snowden and Ford. It’s clear they relish being our unofficial policemen, so I doubt that the more balanced kind of reporting seen in France, where personal lives remain personal, will become a reality here.
It’s too bad because our nation’s leadership, under our media’s jaundiced gaze, is becoming that much poorer for it.
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From Raphael Cohen-Almagor: “The Belgian population should be aware of the high level of paternalism among their physicians. One study shows that 60% of the surveyed physicians think that they should be able to decide to end the life of a patient who suffers unbearably and is incapable of making decisions.”
The Canadian media is being unkind to those of us who oppose euthanasia. I suspect a liberal bias is at the root of it. This means I have found myself, a committed leftist, feeling some empathy with Canada’s conservatives. They and many people who believe in God, are, like me, opposed to euthanasia.
This problem reminds me of another problem I saw in Toronto in the 1980s. It was a phenomenon called “not in my backyard” or NIMBY for short. In a Toronto context, this referred to downtown liberals who espoused liberal-sounding beliefs, but behaved quite differently when the people who benefitted from those beliefs wanted to move into their neighbourhoods. These are people I call buffetliberals. They are like Champagne Charlies but with a lot less charm.
I know from whence I speak. I am part of a global network of activists. We are concerned about how our parents are being treated in the Canadian, Belgian and U.K. healthcare systems. We have watched with dismay, disbelief and horror as they have been mercilessly shortchanged. We have seen bad nursing, bad doctoring and certainly bad administering. Our stories are legion in Canada, but you’d never know it from following our nation’s media.
Canada’s Healthcare System
The myth that the Canadian healthcare system is great is persistent: the NIMBY issue is the undesirable news that no, actually, in some places it’s in tatters. I know bloggers who have given up because of the venom fellow Canadians have directed at them for uttering words to this effect. This is what happens to those of us who dare to challenge the accepted wisdom. I really wish the Canadian media would get on board and listen to us and validate our stories. As it is, our absence means we are treated with far less respect than we deserve.
When it comes to euthanasia, proponents make two common refrains: one, that statistics from euthanasia-friendly countries do not support evidence of abuse; two, that reports of abuse – in Belgium and elsewhere – are anecdotal and sensationalist.
The following is mostly a list of facts culled from a series of Belgian studies directed at doctors and nurses. Raphael Cohen-Almagor is the author of “First do no harm: pressing concerns regarding euthanasia in Belgium,” and the text below is a summary of his most salient findings. He’s a euthanasia expert based at the University of Hull in the U.K.
The Situation in Belgium
Belgium has just passed a law allowing euthanasia for terminally ill children and patients with dementia. Udo Schüklenk, the Ontario Research Chair in Bioethics, thinks this is a good thing:
If anything this should be a sign the system is working and is well-enough trusted by Belgians for them to change their eligibility criteria. If 75% of Belgians would like assisted suicide available for certain kinds of terminally ill children that surely isn’t a sign of a slippery slope.
Despite Schüklenk’s confidence, statistics complied by Cohen-Almagor tell a very different story.
It is illegal in Belgium for nurses to perform euthanasia; however, a study conducted in 2010, eight years after euthanasia was legalized, showed that 12% of nurses in Flanders, the northern and Dutch-speaking part of Belgium, did so and 86% did so without the presence of a physician. This was in cases where euthanasia was specifically requested.
In cases where euthanasia was not specifically requested, 45% of nurses administered the drugs, and in 82% of those cases, they did so without the presence of a physician. Apparently these nurses were ordered to perform the procedure.
The law about who can perform euthanasia is not being followed and some physicians are shifting the responsibility from themselves onto hospital staff. The implication is that this allows them to bypass regulations requiring them to consult another physician and to report the death to the Federal Control and Evaluation Committee, a committee that even now only sees an estimated 50% of euthanasia cases reported. Non-reporting is important because as the incidents with nursing staff show, it can be indicative of non-compliance.
Defining Euthanasia in Belgium
Even more troubling are the results of a 2009 survey. Seven years after euthanasia was legalized, there was still no consensus about the definition of euthanasia among Belgian clinicians. The survey described hypothetical cases and physicians were asked to define them according to their own practices.
In one scenario, a terminally ill patient explicitly asked for and was given a lethal injection. 20% of physicians failed to define this as euthanasia and 30% did not realize the procedure had to be reported to the Federal Control and Evaluation Committee. Only 21% correctly identified it as euthanasia and stated the procedure had to be reported. The remaining physicians labeled this very clear case of euthanasia as an “intensification of pain and symptom treatment” or as “palliative sedation,” procedures that do not require reporting.
There is a good explanation for this. Despite a law that allows physicians to euthanize patients, many in Belgium have not been trained in palliative care and are wary of coming under scrutiny for not following procedures properly. Handling euthanasia correctly means talking to a patient about other options and calling in a consultant physician as well as a psychologist or palliative psychiatrist. It’s up to the patient’s physician to make sure the patient is fully supported in all aspects of decision-making.
This is a time when physicians must be willing to co-ordinate with colleagues and have “intimate conversations” with their patients. However, many report they find these tasks “burdensome” and “unnecessary.”
Other Secondary Effects
This, combined with what Cohen-Almagor states are dangerous levels of paternalism, may also explain why euthanasia is grossly under-reported. For example, as the opening study shows, 60% of Belgian physicians believe they have the right to terminate the life of a patient who is incapable of making decisions, a figure significantly higher than physicians in six similar countries.
In instances where disagreements between a physician and a consulting physician did occur, the following reasons were cited: 26% of cases showed that the consultant did not think the patient had unbearable suffering; 31% did not think the patient had a medically hopeless condition; 10% thought the euthanasia was not well-considered; 26% thought palliative options needed to be exhausted first. Flemish physicians who are uncomfortable with euthanasia feel there should be a “palliative filter” in place to stop a rush to the procedure, an option that currently does not exist.
Lastly, Cohen-Almagor points to the fact that in 2007, .49% of deaths in Belgium were euthanasia deaths, and yet these euthanized patients accounted for 23.5%, or almost one quarter of all lung donations. It’s a number he says we should be watching—in Belgium the default position is that all patients donate their organs. He suspects the rush to harvest them, via euthanasia, is a distinct possibility.
Cohen-Almagor’s statistics were culled from peer-reviewed articles and his report, in its entirety, makes for chilling reading. It’s clear that the regulations around consent are not being respected in Belgium. With Canada’s shortage of medical expertise, it’s just as likely our physicians will cut corners too, if only because they are so overworked.
I hope the buffet liberals who support euthanasia are taking note: ideologies aren’t always about picking and choosing ideas, not unless, of course, you’re actually following an ideology of narcissism. If you support euthanasia, it logically follows that you support the return of the death penalty too. If we’re willing to foist premature deaths onto unwitting seniors, it’s the least we can do for our criminals.
This post is terribly difficult to write. But the conversation needs to happen.
One of the most significant threats to people with disabilities in North America is the belief that our lives are just not worth living. It’s a belief that permeates the media, sneaks into casual conversation with a flippant “I’d rather die than be in a wheelchair” and moves stealthily into our culture tucked neatly beneath the cloak of mercy. It’s a belief that declares bodies “broken”, bodies deviant, and people confined.
It is a belief that relies heavily on assumptions about the quality of a life like mine, and a belief that is rarely questioned. My wheelchair is routinely treated in popular culture as worse than death by people who have not lived in it or considered that just like any other life, mine has moments of great struggle and moments of great joy. That isn’t the nature of life in a wheelchair. That is the nature of life.
This being said, I was devastated to open up the newspaper and read the story of 32-year-old Tim Bowers, who sustained a severe spinal cord injury a few weeks ago that would have left him a quadriplegic. Just one day after the accident, Mr. Bowers was allowed to remove life support and die after learning of his diagnosis.
One day. Where was the counseling? Where was the opportunity to talk to another person with a severe disability? Where was the chance to explore his options, and learn about his “new normal?” I understand that traumatic injuries are devastating, but it is natural to feel despondent just one day after the accident.
I believe with my whole heart that had a non-disabled person been feeling suicidal, the health care system would quickly suggest counseling, quickly take anti-suicide measures. But Mr. Bowers was allowed to determine the value of his new life on the spot. Nobody questioned the hasty assumptions, the hegemonic model of a disabled life as a terrible one. That should scare you.
I am not minimizing the life-altering quality of sudden disability, but it is disturbing how quickly the newly disabled are presented with a bleak picture, made to feel like a burden, and never given a chance to consider that life in a wheelchair does not have to mean the end of a valuable life.
The problem in society is that it carelessly allows people to believe that it is the end, no questions asked. The “no one would blame you if you want to die” attitude says “Yeah, I don’t see the value of your life either” and people with disabilities can extinguish their lives unchallenged. We believe what we are taught, and we are taught to expect empty lives when we become disabled. I do not feel angry at Bowers for his choice, but I do feel angry at the world he lived in for making him feel like that choice was only natural.
It makes me weep that the world he lived in, the same one that I call home, engrained in him so deeply that a life in a wheelchair wasn’t worth it that he would rather die than face it. Tim Bowers was a young husband, a soon to be father. The world told him that he wouldn’t ever hold that baby, and made him feel that a wheelchair would make him less of a father.
I wish I could have told him that holding a baby does not make you a father. I wish I could have told them that I too may never be able to hold a baby on my own, but I still dream of my future child, knowing that it is love, not motor skills that make a parent.
I wish he had been given time to realize that the world still needed him. Where are the cries of “it gets better” for people with disabilities, the reminders that support is out there? Where are the reassurances that it’s okay to ask for help?
Aside from a few whispers from the disability rights community, they are not here, and society quietly, unequivocally agrees that no, our lives cannot possibly be fulfilling, and remains unwilling to answer the above questions, perhaps due to the shame that we haven’t bothered to come up with any good answers.
Perhaps if we invested the time in creative support systems that we invest in negative media portrayals of people with disabilities, Tim Bowers would have made a different choice. Perhaps if we found time to go above basic standards for access, Tim Bowers would have woken up knowing that the world he lived in would find a place for him.
Perhaps if people like Tim, and myself, were more frequently measured by their human potential instead of their financial “cost”, he would have thought to himself, I will be okay, because the world will embrace me. Instead, I sit here and grieve for him, and the attitudes that made him too fearful to carry on when his circumstances changed.
I hope that one day there will be no more stories like this, because we will know how much we are loved and valued no matter what our physical abilities may be. That we will not have to be afraid of how others will see us once we become disabled. That we will go forward knowing that we are entitled to a valuable existence. And no one will be hastily allowed to die because no one gave him or her a chance to learn how to live again.
I’ve written an analysis of the Canadian Broadcasting Corporation’s campaign for the legalization of euthanasia in Canada. This is a longread, but I cover information the CBC refused to cover, especially an instance of suicide contagion that occurred in Quebec in 1999, an instance so serious that the province’s coroner stepped in, asking media outlets to stop reporting on the suicide that triggered it.
Thanks to naive and incompetent journalists at our nation’s broadcaster, we are being sold a dumbed-down view of assisted suicide. It is in fact very difficult to manage safely, as liberal Belgian, Dutch, and English experts will tell you.
If emergency room wait times of 12 hours are the norm in some Canadian hospitals, how can provincial systems can handle a procedure as risky as assisted suicide? In countries and regions where AS is legal, cautionary tales abound, but the CBC is not reporting them. Who is really running the nation’s largest broadcaster and why aren’t they concerned about our safety?
Quebec’s ‘Medical Aid in Dying’ bill has passed its second reading in the province’s national assembly. It will likely pass a third, leaving Quebec at odds with federal laws that prohibit assisted suicide. The CBC has been running 20-minute segments about assisted suicide on Monday night episodes of The National. Producer Duncan McCue said that instead of debating the issue, his series would tell the “stories of terminally ill Canadians who are facing tough questions.”
However, experts do appear on the program. McCue interviews John Major, a retired supreme court judge, Dr. Udo Schüklenk, Ontario Research Chair for Bioethics, and Joel Bakan, a UBC professor of constitutional law. Perhaps it’s just clever editing, but all these experts give the impression Canada is on the brink of accepting assisted suicide into law. Major suggests the supreme court could make the change by simply repealing one clause in the criminal code, Schüklenk suggests that baby-boomers, with their history of activism, will inevitably demand that change, and Bakan, an Oxford-educated scholar, says the experience of European countries, which have legalized assisted suicide, will help Canada adopt safer policies.
The sense of fait de compli in the series is palpable. It seems the only thing stopping the decriminalization of assisted suicide in Canada is a weakness of will on the part of politicians. The delay clearly puzzles McCue, who incorrectly states that “poll after poll” shows that roughly 80% of Canadians are in favour of changing the law. (Pollsters south of the border employed a similar tactic: by announcing Hillary’s win in advance, they were hoping to influence voters. The strategy? If Hillary is going to win anyway, why bother voting for Trump?)
Contrary to popular belief: Not all Europeans support euthanasia
Much has been made of the “success” of euthanasia and assisted suicide programs in the Netherlands, Belgium and Oregon. These programs are upheld as models of good policy in the delicate matter of voluntary death. However, as opponents of assisted suicide know, talking about the problems with these programs is a bit like describing history from a loser’s point-of-view: the bad news is simply not making it into the mainstream media, or at least not in significant ways.
Sarah Van Laer is a Belgian doctor who has euthanized 28 patients and has gone on the record about it:
“It’s too much for me. Lately I’m averaging one second opinion a week. Once a month, I am asked to perform the euthanasia itself… Recently I was called urgently for a patient who had been promised that euthanasia would take place that evening. But the doctor would not do it. When I came in I said I had [only] come to see how things were. The family did not understand that — ‘a promise is a promise’, they said…There are too few doctors ready to perform euthanasia…Meanwhile politicians are pressing for an extension of the legislation to minors. I wonder who will be willing to perform these…”
As one of a minority of doctors who perform the procedure, Van Laer feels she often does so under less than ideal circumstances. Appealing to her colleagues who won’t do it, she says:
“Please do not get us there at the last minute. If I’m also supposed to perform a euthanasia, I want to be involved early. I am not a product on the supermarket shelf which you buy whenever you need it. I’m a person with my own needs and feelings.”
Promises of infallible checks and balances are what make the idea of decriminalizing assisted suicide palatable. However, rules are clearly not being followed to the letter in Belgium, a fact widely known among those of us who follow this issue. If laypersons like myself are aware of these problems, then why aren’t constitutional experts like Major and Bakan? Or bioethics specialists like Schüklenk? Why aren’t the problems associated with the actual delivery of the procedure being discussed as openly as Canada’s potential implementation of it?
Bad news is easy to find: the UK’s Liverpool Care Pathway
This information isn’t hard to find. Louise Smith, an elder abuse activist in London, scours the media daily looking for articles about end-of-life care. On average, she publishes 20 links a day. Her aim, she says, is to present a balanced view on issues affecting the elderly. Although she is against assisted suicide, she publishes links to articles representing both sides of the debate. Even so, much of what she publishes is troubling. For example, while Van Laer’s comments give us a glimpse into Belgium’s difficulties, it’s clear that other countries, like England, are having problems too.
The UK’s Liverpool Care Pathway was developed from a model of care used in hospices. With few spots available in palliative care wards, practitioners saw a need to develop an approach to help those dying at home, in long-term care facilities and hospitals. The pathway was designed for the last stages of life, defined as roughly the last 24 to 72 hours, and depended upon the cessation of patients’ appetites and needs for hydration. Patients were given high but not lethal doses of analgesics while the body’s natural need for sustenance dwindled.
It was not a means of hastening death so much as a means of recognizing when it was imminent and withdrawing life-sustaining medications, food and water in order to allow patients to slip away peacefully. The average life expectancy of a patient put on the LCP was 33 hours.
However, 10 years after its inauguration, its use was halted. This was because criticism led Norman Lamb, MP and British Minister of State Care for Support, to form a review panel independent of the government and the National Health System. It was headed by Baroness Julia Neuberger, a rabbi and member of the British House of Lords. The panel strongly suggested the LCP be stopped for the following reasons:
It is clear to us, from written evidence we have received and what we have heard at all relatives’ and carers’ events, that there have been repeated instances of patients dying on the LCP being treated with less than the respect that they deserve. It seems likely that similar poor practice may have taken place in the case of patients with no close relatives, carers or advocates to complain or where families have not felt able or qualified to question what has taken place. This leads us to suspect this is a familiar pattern, particularly, but not exclusively, in acute hospitals. Reports of poor treatment in acute hospitals at night and weekends – uncaring, rushed and ignorant – abound.
The report also states that families were often not consulted before the pathway was started and some patients were so heavily drugged they were unable to say goodbye. However, the worst finding by far is that elderly but non-terminal patients were frequently put on the pathway without any consultation at all. One family of a 95 year-old woman, brought in for a scrape on her face, were told the woman was considered terminal. When they asked for an explanation, none was provided. It’s clear that although the LCP was not meant to be a euthanasia protocol, that’s how it was being used.
Incentive payments given to UK hospitals who euthanized patients
And there were other reasons for cynicism. British journalist Steve Doughty used the FOIA to uncover a pattern of government payments that were as telling as they were chilling. These documents revealed that hospitals that failed to meet target numbers for patients put on the pathway were in danger of losing significant government funding. This might account for other sinister observations made in the report: ageism against the elderly was “strongly suspected” and “financial incentives” meant many patients were put on the pathway “prematurely.” For anyone who doubts the existence of a slippery slope, and doubts the danger assisted suicide poses for the elderly, reading this review is imperative.
The CBC’s treatment of assisted suicide, in light of this, is worrisome. Although the stated purpose of the Last Right series is to follow ordinary Canadians as they face death, the inclusion of experts who clearly favour assisted suicide takes the series beyond that scope. Coupled with powerful stories, the basic premise — that this type of suicide is humane — is hard to resist. For example, it’s hard not to feel empathy for Valerie Kennett as she describes her last minutes with her husband Bill, who took his life after a diagnosis of ALS; it’s hard not to feel empathy as Harriet Scott struggles with end stage liver cancer long enough to see her son return from Europe.
Why is the CBC promoting euthanasia?
But the portrayal of these stories comes at a cost. They are powerful precisely because we rarely see stories of suicide, or suicidal wishes, examined so closely. And that is because there are self-imposed media guidelines that advise against it, guidelines that the CBC has, in this instance, ignored. Most countries have such policies, based on the World Health Organization’s suggestions. One country that makes this policy very clear is Austria. Their media pamphlet states that articles about suicide should not:
1. give details of the person – their name, photo or life circumstances
2. give details on the suicide method
3. reconstruct the suicidal act
4. use simplifications to explain the suicide
5. describe the person or suicidal act as heroic
6. romanticize suicide
7. interview friends and family of the suicide victims
8. alternatives to suicide should be clearly stated
9. community resources, if possible, should be listed
Of fifteen guidelines, the CBC failed on the nine above. It’s a shame they did. There are good reasons for conforming to the ethical standards these guidelines represent and those can be explained by a phenomenon known as the Werther Effect.
Anyone who has experienced an inordinate delay at a subway station will know what I’m talking about. Subway jumpers are rarely reported and that’s because doing so can create a contagion of suicides. The name for this phenomenon is taken from a 1774 Goethe novel where a young man named Werther kills himself. Because the book inspired so many copycats, it was eventually banned in several countries.
Copycat suicides are real
Canada has had its own Werther and he lived in Quebec City. The 1999 suicide of 33 year-old television reporter Gaétan Girouard is often cited in discussions of this phenomenon. Immediately after his death, a cluster of six suicides took place in the small municipality of Ste. Foy, where his suicide occurred. By the time a month passed, 50 had taken place in the region. Five professors at the Université du Québec à Montréal conducted an analysis of the media handling of Girouard’s suicide. They concluded that “most guidelines for responsible reporting of a suicide were not applied,” and “fifteen reports…regarded Girouard’s suicide as acceptable.” Even Girouard’s own father chimed in, stating that “I respect his choice. To come to this point, he must have suffered a lot.”
These heroic sentiments had consequences. In total there were 195 more suicides for the region in 1999 than in 1998, and five of the six suicides, in the cluster found near Girouard’s home, directly imitated his: these suicides also used belts to hang themselves. The negative impact was so dramatic that Quebec’s coroner-in-chief stepped in, asking the news media to stop covering the event.
The implications for assisted suicide are clear
If suicide becomes an accepted response to serious illnesses, or even just a boredom with life, it may, like a viral infection, become contagious and spread. Elderly patients who want to live, even in reduced circumstances, will be made to feel burdensome and those who support them made to feel judged.
Believers in assisted suicide will argue that their reasons for choosing death are atypical; however, the basic template for all suicides is the same: an individual’s level of distress is such that he or she wants to stop living. And contrary to the belief that it is their lives that are solely affected, the truth is that suicide touches us all. For example, if we recognize the need to suppress information about subway suicides, surely that means we also recognize suicides happen in a social context, and that the vulnerable among us may be adversely affected.
In 1993 ALS victim Sue Rodrigues asked: “Whose body is this? And who owns my life?” To committed individualists those sound like the right questions to ask, but are they? Isn’t there a more pressing question that casts a wider net? Shouldn’t we be asking: “Who among us deserves more protection: the dying person with little time left, or the elderly or disabled person whose life might be unfairly taken?”
The CBC’s program Last Right, and the surviving family members they interviewed, lauded suicide as viable alternative to dying naturally. Were those doing so aware that suicide can be contagious? Were they aware that middle-aged Canadians, aged 40 to 59 have the highest suicide rates? And that men in that age group, typically, respond very badly to bad diagnoses? I hope they weren’t. And I hope someone tells them about Gaétan Girouard and unintended consequences of his death. It’s a story I think they need to hear.
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