Bill 52 The Right to Choose the Best Treatment for You

By Jennifer Botincan Case Studies and Issues in PR Summer 2013

I swear by my life and my love of it that I will never live for the sake of another man, nor ask another man to live for mine. John Galt

SITUATIONAL ASSESSMENT
On 12 June 2013, Social Services Minister Vronique Hivon introduced Bill-52 - proposing medical aid in dying to terminally ill patients in Qubec. The 20 page bill details provisions associated with medical aid in dying citing conditions where the treatment option would be available. Medical aid in death is different from medically assisted suicide and other US end of life legislation (like Oregons Die with Dignity Act), but is similar in that criteria must be met. Its completely propelled through a patients own volition , consent must be offered numerous times (regardless of prior wishes, if a patient cannot communicate consent the process is ended), and there are numerous safeguards and opportunities to change their mind if they choose. Physicians administer the drugs once informed consent has been provided.

 Bill-52 was presented as a continuum in end of life care, therefore, a health care issue and not a criminal one. This allows the provincial government to legislate without federal interference. In 1993 medically assisted suicide was approved in extenuating circumstances, specifically for Suzanne Rodriguez, but the decision was later overturned by the Supreme Court of Canada In 2010 MP Francine Lalonde proposed Bill C-384, amending the Criminal Code of Canada to legalize euthanasia and assisted suicide, but it was defeated 228-59.

I have been hired by the Government of Qubec to create a PR campaign garnering support for Bill-52.

Lets analyse our environment.

SWOT ANALYSIS

Strengths
Studies and statistics from various sources Dignitas (private) and Oregon (public) dispelling many of the arguments against medically assisted suicide (slippery slope, negatively influences public, done for personal benefit etc.) Opening the topic up for debate questions and discussion lead to progress.

Patients would just be given another treatment option, but as with any other treatment option a patient can refuse it.
Completely voluntary both for physicians and patients. Personal convictions would always be respected. Transparent and non-partisan process with clearly defined provisions and definitions.
Consistent with Canadian ideal where freedom of choice should prevail over interests of the state.

Infographic Credit www.NationalPost.com

Weaknesses
Despite having Bill-52 passed in Qubec federal laws trump provincial laws. The topic itself is controversial and difficult to talk about, so many physicians and the public are not informed. Negative public perception - when we think of medically assisted suicide we think Dr. Jack Kevorkian. Historically assisted suicide legislation has been struck down, or overturned. Doesnt address bioethical concerns what is too much medical interference? First legislation of its kind in Canada paving the way, but going in blind. Lots of grey area in a very complex issue. The legislation is not complete there are questions of discrimination, as some people are not allowed to participate if they cannot provide consent, regardless if they used to be able to. No provision for people that include their wish for the option in wills.

Opportunities
Despite medical advances not all pain and suffering can be prevented or alleviated there is a need, albeit a small one, for this treatment option. Twelve Canadians have sought the services of Dignitas a Swiss assisted dying organisation, including Winnipeger Susan Griffiths. Since 1993 there have been at least nine private members bills proposing similar legislation. Palliative sedation, treatment refusal, and nourishment refusal is already being performed in Canada/Qubec. Medical aid in dying is a more formalized and humane way to end of life, much faster and more compassionate than options currently employed. Most Canadian adults have experienced watching a loved one die from a degenerative disease or terminal illness creating a deep empathy for other Canadians in the same position. This bill appeals to emotional sensitivities. There are numerous polls showing Canadians support medically assisted suicide. Having other provinces follow suit and pressure federal legislators to amend the Criminal Code of Canada .

Infographic Credit www.NationalPost.com

Threats
Although committing suicide is not illegal in Canada, assisting someone to commit suicide is. The Criminal Code of Canada is very explicit defining assisted suicide as murder and as such is punishable by law. Government officials may choose to prosecute physicians and families (although it would not be advantageous to the public to do so) to make an example of them. Currently the sentence is a maximum of 14 years. Public voter apathy Canadians are rather politically passive. Without votes in support of the bill it will not pass. Religious groups and lobbyists vehemently oppose assisting a patient in ending her life. These groups are very vocal and politically involved. The public may be misinformed if their side is the only one being heard.

What do we want to accomplish?

OBJECTIVE

 To educate the public and garner public support for legislation (Bill-52) to allow medical aid in dying in Qubec.

Who do we need to talk to?

AUDIENCES

 Patients people suffering from incurable illnesses and degenerative diseases

Family of people suffering from illness

Physicians

Public that supports dying with dignity

Media print and online

Groups that support our cause - Association Qubcoise pour le Droit de Mourir dans la Dignit (AQDMD), Dying with Dignity Canada, Farewell Foundation, and the Right to Die Society of Canada
Government Politicians (MLAs), Health and Welfare, Members of Legislative Assembly

STRATEGY
To position medical aid in dying as a last-resort treatment option, vice a religious/moral issue, thereby objectifying it for discussion/debate. To educate the public on what medical aid in dying is, completely voluntary for both patients and physicians, and why they should support it.

To make the public aware of regardless if they would choose a medically assisted death for themselves their support is needed to allow others to have the choice.
To stress that medical aid in death is not a replacement for palliative care, but another option which can be used in conjunction to it. There must be informed consent and at any time a patient can choose to not to proceed. To have people suffering from terminal illness, respected professionals (influencers and opinion leaders) discuss what medical aid in dying is why they support it and why you should, too. Aligning with other organizations that support death with dignity using their campaign tools modified to highlight support of Bill-52

What are we going to say?

KEY MESSAGES

 Over 80% of Canadians support medical aid in dying, yet our government does not. Our government is supposed to be a representative democracy. Make your voice and vote count by supporting Bill-52 the right to choose a dignified death. Almost fifty percent of people that seek medically assisted suicide services never go through with them. Providing choices gives us control, which one desperately needs when faced with a deadly prognosis. Medical aid in dying gives you another option, even if you dont chose to use it. Support Bill52 and support choice. When medical advances can do nothing to minimize pain and suffering there should be another choice other than starvation, refusing treatment, or suicide. Medical aid in dying should be an option and passing Bill-52 will provide it.

 Everyday our physicians make medical decisions and we trust them to do so. Supporting Bill-52 will give your physician another choice to provide you with more complete care options. The government should have no say in something as inherently private as your health and treatment option decisions. Supporting Bill-52 does not mean you do not love your family enough to care for them, it means you love them enough to respect their choices.

How are we going to do it?

TACTICS

 Influencer Relations - There is no formal training on dying with dignity - provide end of life options training to physicians to open the dialogue with their patients. Speaking tours where trusted medical professionals and celebrities (such as Terry Prachett) discuss medical aid in dying, answer questions and provide perspective to garner support Public documentary showings - Terry Prachett Choosing to Die and The Suicide Tourist Government Relations - Circulate petitions supporting medical aid in death legislation in Qubec Media Relations - Press kits and media releases for distribution in print and social media, both to educate and share personal perspectives and experiences

TIME TABLE AND BUDGET

To be determined

Did it work?

EVALUATION

Measurement
Google Analytics and media mention counts Attendance at public hearings Number of signatures on petitions Topics of debate at the public hearings (for or against) Polls showing support Similar bills being proposed in Canada Ultimately, whether the bill is passed

Any Questions?