Carstairs to advise government on palliative care

In March, Prime Minister Jean Chretien named Carstairs, already the Leader of the Government in the Senate, Special Advisor to the Minister of Health for Palliative Care. A point of contention for some pro-lifers is the fact that Carstairs has repeatedly attempted to advance euthanasia and doctor-assisted suicide.

In 1995, the Senate Special Committee on Euthanasia and Assisted Suicide, of which Carstairs was a member, released its report On Life and Death, which recommended (among other things) that “compassionate homicide” be designated as a new, less serious category of murder.

At Carstairs’ urging, a Senate committee was formed to conduct a five-year review of On Life and Death. Last June, pro-lifers were generally pleasantly surprised when the Senate social affairs committee – and again Carstairs was a member – released its report, entitledQuality End-of-Life Care: The Right of Every Canadian. The report recommended improving palliative care, although it left open questions on doctor-assisted suicide and compassionate homicide while failing to address or define the moral problem of withdrawing or withholding treatment.

Not only has Carstairs been active on committees that examine end-of-life issues, she has sponsored legislation that would have permitted euthanasia or doctor-assisted suicide in Canada. In 1999, she introduced Bill S-2, the Medical Decisions Facilitation Act, and although it did not pass it would have opened the door to euthanasia. As The Interim noted at the time, Section 4 of that bill could have allowed “the intentional starvation and dehydration of elderly, incompetent or disabled (vulnerable) patients who are not terminally ill,” because it defined “artificial nutrition and hydration as life-sustaining medical treatment rather than basic medical care.” Bill S-2 would have also granted doctors immunity from prosecution if they starved patients to death at the request of the patient, family or government-appointed proxy.

Pro-lifers are generally concerned about the political tactics of euthanasia supporters who call for improved palliative care to go hand-in-hand with a liberalization of euthanasia laws, such as happened in Oregon in 1994 when a referendum on the issue was passed. Experts such as Wesley Smith, author of The Culture of Death: The Assault on Medical Ethics, say there has been no improvement in Oregon’s palliative care services since euthanasia became legal in 1996.

Jean Echlin, a nursing consultant with 24 years experience in palliative care and Vice-President of the Euthanasia Prevention Coalition, told The Interim that she is pleased with the appointment because recently Carstairs has been saying the right things. She noted Carstairs has called for “quality of life at the end of life for every Canadian” to be entrenched in the constitution.

Echlin said “something happened that opened the flood-gates of compassion” as Carstairs now aggressively promotes palliative care and has not recently openly advocated for changes on euthanasia. Furthermore, considering her senior post in the Senate, Echlin believes Carstairs will be an effective advocate for palliative care in the government.

Indeed, since her appointment, Carstairs has been saying the right things. In a March 30 announcement on funding for several palliative care projects, Carstairs said “People have a right to die in relative comfort, as free as possible from stress. In Canada, only five per cent of dying Canadians are receiving integrated interdisciplinary palliative care. We need to do more to ensure this type of care will be available for all Canadians.”

To ensure that Carstairs promotes proper palliative care – that is, palliative care without references to nutrition and hydration as a potentially optional “treatment” – the EPC is preparing information for her and has requested a meeting. Echlin said she plans to tell Carstairs that there is a need for more thorough palliative care training for the medical profession, funding for homecare and institutions that provide palliative care, support for families that take care of loved ones and recognition that palliative care must address the physical, emotional and spiritual needs of patients.

But Jakki Jeffs, executive director of Alliance for Life (Ontario), told The Interim that considering her history, Carstairs’ appointment to head up palliative care is like “putting the wolf in charge of the sheep’s pen.”

Jeffs said she has not heard Carstairs renounce her enthusiastic support for euthanasia. Jeffs has long worried that euthanasia activists would “hijack” the palliative care agenda and said Carstairs might use the process and her newfound influence with the health minister to advance her cause of allowing terminally ill people to be killed by doctors through direct actions or the withdrawal of normal care such as assisted feeding.

“My biggest fear is that she will try to redefine palliative care,” said Jeffs, noting both the Canadian Palliative Care and Ontario Palliative Care associations currently oppose euthanasia but that could easily change if the definition of palliative care is altered.

Jeffs promised to keep a close eye on Carstairs, although she admits “I hope I’m wrong to be skeptical.”