Category: Euthanasia

The intersection of freedom of conscience and assisted dying

One MP’s views on balancing the needs of patients and doctors who have personal issues providing assisted dying

Macleans

Garnett Genuis

Garnett Genuis, the Conservative MP for Sherwood Park—Fort Saskatchewan in Alberta, has served on the Physician-Assisted Dying Committee.

Parliament will imminently be dealing again with the issue of physician-assisted suicide / euthanasia. If government legislation follows the direction given in the report of the Liberal-dominated joint committee, we are in for (among other things) a significant change in the way Canadian law treats freedom of conscience.

The court was clear in Carter that nothing in their decision would require anyone to be involved in euthanasia or assisted suicide if they did not wish to be. In this respect, I think the court got it right. Freedom of conscience is protected by the Charter itself. Euthanasia and assisted suicide were considered murder until just this year; it’s understandable that many healthcare providers remain uncomfortable with it. . . [Full text]

 

Everybody’s a winner when euthanasia combines with organ donation, say doctors

BioEdge

Michael Cook

Several Dutch and Belgian doctors have proposed legal reforms to increase the popularity of combining euthanasia and organ donation in the Netherlands and Belgium.

Writing in the Journal of Medical Ethics, they report valuable unpublished information about the prevalence of the procedure. So far, it has been performed only about 40 times in the two countries. However, there is “a persisting discrepancy between the number of organ donors and the number of patients on the waiting lists for transplantation” – which euthanasia patients could help to balance.

The authors stress that euthanasia is not a cure-all for the organ shortage. Most euthanasia patients suffer from cancer, which is a contraindication for organ transplantation. However, 25 to 30% of them do not, so there is obviously a real possibility of expanding the supply.

Furthermore, the authors say, public perception of this formerly abhorrent practice is increasingly positive:

. . . transplant coordinators in Belgium and the Netherlands notice a contemporary trend towards an increasing willingness and motivation to undergo euthanasia and to subsequently donate organs as well, supported by the increasing number of publications in popular media on this topic.

Ethically, the procedure is basically uncontroversial as long as the patient is not pressured to donate, they contend.

In the context of organ donation after euthanasia, the right of self-determination is a paramount ethical and legal aspect. It is the patient’s wish and right to die in a dignified way, and likewise his wish to donate his organs is expressed. Organ donation after euthanasia enables those who do not wish to remain alive to prolong the lives of those who do, and also—compared with ‘classical’ donation after circulatory death—allows many more people to fulfil their wish to donate organs after death.

However, there are some legal hitches in both countries. In the Netherlands, unlike Belgium, euthanasia is regarded as an “unnatural death” which has to be reported to the public prosecutor. This could delay donations. If the law were changed to allow the cause of death to be reported as the underlying condition, the procedure would be more expeditious. And “In Belgium, the current policy of determination of death by three independent physicians could be abandoned, facilitating a more lean procedure with only one physician.”

Public perceptions need to be managed as well. At the moment, it is necessary to maintain a strict separation between the request for euthanasia and the need for the organ. Partly this is needed to ensure that the donor is not being pressured. But the public also needs to have confidence that physicians will give objective advice.

Finally, there is the tradition of the dead donor rule “that donation should not cause or hasten death”. The authors imply that this could be scrapped for euthanasia volunteers:

Since a patient undergoing euthanasia has chosen to die, it is worth arguing that the no-touch time (depending on the protocol) could be skipped, limiting the warm ischaemia time and contributing to the quality of the transplanted organs. It is even possible to extend this argument to a ‘heart-beating organ donation euthanasia’ where a patient is sedated, after which his organs are being removed, causing death.

The article’s proposals were not received with great enthusiasm in the UK where there is a simmering debate on assisted dying. Tory MP Fiona Bruce told the Daily Mail: “The paper confirms the worst fears expressed by Parliament when the House of Commons conclusively voted to stop the legalisation of assisted suicide in this country. The possibility of euthanasia achieved through live organ donation, such as by removing a patient’s beating heart, as posited in this paper is shocking and chilling.”

And Lord Carlile of Berriew, a Liberal Democrat peer who is a leading lawyer, said: “I have extreme concerns about the ghoulish nature of the combined euthanasia and organ donation systems in the Netherlands and Belgium. Both can result in unbearable and irresistible pressure on an individual to die, and on a doctor to encourage death.”

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The CCRL strongly opposes the College of Nurses of Ontario’s Physician-Assisted Death: Interim Guidance for Nursing in Ontario

News Release

Catholic Civil Rights League

TORONTO, ON March 24, 2016 – The Catholic Civil Rights League (CCRL) sent the following letter to the College of Nurses of Ontario (CNO) in opposition to Physician-Assisted Death: Interim Guidance for Nursing in Ontario on grounds that its main recommendation seriously violates a nurse’s freedom of conscience and religion.

College of Nurses of Ontario
101 Davenport Rd. Toronto,
ON M5R 3P1

March 24, 2016

RE: College of Nurses of Ontario’s Physician-Assisted Death: Interim Guidance for Nursing in Ontario

The Catholic Civil Rights League (CCRL) strongly opposes the College of Nurses of Ontario’s Physician-Assisted Death: Interim Guidance for Nursing in Ontario on grounds that its main recommendation seriously violates a nurse’s freedom of conscience and religion. Page 3 of the document states:

…some nurses may have conscientious objections to participating in physician-assisted death. Both the Special Joint Committee on Physician-Assisted Dying of the Parliament of Canada and the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying have recommended that health care professionals who have conscientious objections should refer or transfer a client to another health care provider. If no other caregiver can be arranged, you must provide the immediate care required.

We are hopeful that your suggestion of “immediate care” is in the noble tradition of the nursing profession to preserve life, and to provide medical assistance to save lives.  However, our fear is that your proposed guideline is suggestive that a nurse will be obliged in such circumstances to engage in the new Orwellian concept of “medical aid in dying”, a prospect for which polling suggests a majority of your membership vigorously disagrees.

If the final statement and the directive “you must provide the immediate care required” is intended to mean “medical aid in dying”, then your College has asserted the most jarringly outrageous example of forcing a health care professional to violate his or her conscience that has been proposed by any regulatory body in Canada. It even outweighs the aforementioned recommendations of the Special Joint Committee on Physician-Assisted Dying of the Parliament of Canada and the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying.

Whereas the CCRL submits that euthanasia and assisted suicide in itself is morally and ethically wrong, compelling another person to be involved in this morally and ethically depraved act is no less wrong.  As interveners in Carter,the CCRL focussed on the impact to health care in general and to the conscience rights of health care workers specifically.  We strongly advocated for a robust understanding and protection of the Charter right of freedom of conscience and religion.

The right to avoid moral complicity in assisted suicide and euthanasia is an essential part of one’s religious and conscientious freedom.

The CCRL appeals to the College of Nurses of Ontario (CNO) to strike from the interim guidance document the necessity to “provide the immediate care required” if “no other caregiver can be arranged.” This compulsion is morally unacceptable.

It is also unacceptable that nurses are treated so poorly, by their own governing college, no less. Instead of limiting nurses’ rights and violating their constitutional right to freedom of conscience and religion, the CNO ought to instead advocate for nurses who conscientiously object to euthanasia and assisted suicide.

As with any regulatory entity, the CNO has no business second-guessing the validity of sincerely held religious beliefs, exercised in the course of one’s professional judgment.

Christian Domenic Elia, PhD
Executive Director
Catholic Civil Rights League (CCRL) celia@ccrl.ca

Philip Horgan
President
Catholic Civil Rights League (CCRL) ccrl@ccrl.ca

About the CCRL

Catholic Civil Rights League (CCRL) (www.ccrl.ca) assists in creating conditions within which Catholic teachings can be better understood, cooperates with other organizations in defending civil rights in Canada, and opposes defamation and discrimination against Catholics on the basis of their beliefs. The CCRL was founded in 1985 as an independent lay organization with a large nationwide membership base. The CCRL is a Canadian non-profit organization entirely supported by the generosity of its members.

For further information:

Christian Domenic Elia, PhD
CCRL Executive Director
416-466-8244 @CCRLtweets

Canadian Association of Physician Assistants wants objecting physicians forced to refer for euthanasia, assisted suicide

Sean Murphy*

A policy statement by the Canadian Association of Physician Assistants asserts that physician assistants “should play a supportive role” in euthanasia and assisted suicide and states that physician assistants should be allowed to personally provide the procedures under the direction of a physician.

PAs as well as other health professions can play an active role in helping to facilitate PAD and supporting physicians throughout the process.

 

The statement purports to respect objecting physician assistance “freedom of choice” (the term used is not “freedom of conscience”) , stating that those “who have a conscientious objection based on moral and/or religious beliefs should not be required to assist in this process.”  However, it adds that the Association “supports the requirement for an effective referral process” – which would require physicians unwilling to kill patients or help them commit suicide to find someone willing to do so.

Hospitals should be able to opt out of doctor-assisted death, expert says

Ottawa Citizen

Elizabeth Payne

Neither doctors nor the institutions where they work should be forced to offer physician-assisted suicide, an expert on end-of-life decision making said Monday.

Judith Wahl, of Toronto’s Advocacy Centre for the Elderly, said Ontario should be able to create a system in which physician assisted death is accessible for those who qualify and want it, without forcing institutions and physicians to act against their beliefs.

“The provincial government can authorize those exemptions. I think people should be able to opt out and facilities should be able to opt out. I think we have to look at the system as a whole.”

With months to go until there is a law on physician assisted dying, the issue is already controversial. Catholic hospitals and health institutions across Ontario  –  including Bruyere Continuing Care in Ottawa  –  say they will not offer physician assisted death once it becomes law later this year. Bruyere is Ottawa’s only hospital with an acute palliative care ward. . . [Full text]