Amir Attaran and the elves

 

A law professor makes much ado

Sean Murphy*

In a column in the on-line magazine iPolitics,1 University of Ottawa law professor Amir Attaran asserts that the “corrosive hostility” of the Canadian Medical Association to “physician-assisted dying” is evident in its “cowardly and stupid” position on the procedure. He claims that the Association “all but threatened” the Supreme Court of Canada that “doctors would rise up” to block it.

In his telling, ever since the Court ignored the threat and struck down the law, the CMA has been acting like a “sore loser,” trying to persuade physicians not to participate. As evidence, he quotes a CMA policy recommendation: “Physicians are not obligated to fulfil requests for assisted dying.” And he complains that the CMA won’t force physicians unwilling to kill patients or help them commit suicide to find someone who will.

Now, the CMA also states that all eligible people should have access to the services without undue delay, and physicians will work with others to ensure access to them,2 but Professor Attaran ignores this. His analysis of CMA policy is simple and scathing. Some physicians, he says, are “bigots,” and the CMA is siding with “those bigots” rather than with patients.

Professor Attaran identifies the bigots: physicians who believe that killing patients or helping them commit suicide is gravely wrong, or at least a bad idea, even in the circumstances defined by the Supreme Court. Those whom Professor Attaran denounces as bigots include physicians who believe they are ethically obliged to compassionately accompany and support dying patients, but not to kill them.

On the contrary, says Professor Attaran, they are “duty-bound” to kill patients or help them commit suicide precisely because the Supreme Court “pointedly” approved “physician-assisted suicide.”*  If physicians won’t help patients commit suicide, he rages, “then who does the CMA think should be obliged to help – elves, maybe?”

To which any number of physicians have already replied, “Not elves, but lawyers.”

[Full text]

[iPolitics version- Doctors aren’t obliged — legally or otherwise — to help people die]

 

A bureaucracy of medical deception

 Quebec physicians told to falsify euthanasia death certificates

Regulators support coverup of euthanasia from families

Sean Murphy*

A bureaucracy of medical deceptionIn the first week of September, the Canadian Medical Association (CMA) was reported to be “seeking ‘clarity'” about whether or not physicians who perform euthanasia should misrepresent the medical cause of death, classifying death by lethal injection or infusion as death by natural causes. The question arose because the Quebec College of Physicians was said to be “considering recommending” that Quebec physicians who provide euthanasia should declare the immediate cause of death to be an underlying medical condition, not the administration of the drugs that actually kill the patient.1 In fact, the Collège des médecins du Québec and pharmacy and nursing regulators in the province had already made the decision. In August, the three regulators issued a Practice Guide directing Quebec physicians to falsify death certificates in euthanasia cases.

The physician must write as the immediate cause of death the disease or morbid condition which justified [the medical aid in dying] and caused the death. It is not a question of the manner of death (cardiac arrest), but of the disease, accident or complication that led to the death. The term medical aid in dying should not appear on this document.2

Lawyer Jean Pierre Ménard correctly observed that Quebec’s euthanasia law does not require physicians to report euthanasia on death certificates.1  M. Ménard is an expert on euthanasia law consulted by the Quebec government and the CMA,3  but he seems unaware of guidelines relevant to the classification of deaths and medico-legal death investigations. . . [Full text]

Project Submission to the Canadian Provincial/Territorial Expert Advisory Group on Physician-Assisted Dying

Re:  Implementation of Supreme Court of Canada ruling in Carter v. Canada

I.    Introduction

I.1    The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience among health care workers. It does not take a position on the acceptability of morally contested procedures. For this reason, almost half of the questions in the Written Stakeholder Submission Form are outside the scope of the Project’s interests.

I.2    The completed Written Stakeholder Submission Form is in Appendix “A” of this submission. The responses are numbered for reference purposes.

II.    Scope of this submission

II.1    The responses in the Written Stakeholder Submission Form (Appendix “A”) are supplemented, in some cases, by additional comments in Part III. A protection of conscience policy is suggested in Appendix “B.”

III.    Additional comments on numbered responses

III.1    Role of Physicians (Response 11)

III.1.1    While the Quebec euthanasia kits are to include two courses of medication in case the first does not work,1 insufficient attention has been paid to the fact that euthanasia and assisted suicide drugs do not always cause death as expected.2

III.1.2    Physicians willing to perform euthanasia as well as to assist in suicide should disclose and discuss options available in the event that a lethal injection or prescribed drug does not kill the patient.

III.1.3    Physicians willing to prescribe lethal drugs but unwilling to provide euthanasia by lethal injection should consider what they may be expected to do if a prescribed drug incapacitates but does not kill a patient.

III.1.4    The possibility of this complication provides another reason for insisting that the physician who approves assisted suicide or euthanasia should be the one to administer the lethal medication or to be present when it is ingested. Expecting other health care workers to deal with this complication is likely to increase the likelihood of conflict in what will be an already emotionally charged situation. . . . [Full Text]

Ontario physicians unwilling to kill patients must help find someone who will

 College of Physicians and Surgeons demands “effective referral” for euthanasia, assisted suicide

For immediate release

Protection of Conscience Project

The College of Physicians and Surgeons of Ontario has quietly issued a directive that physicians who, for reasons of conscience or religion, are unwilling to kill patients or help them commit suicide, must help them find someone willing to do so.

The requirement appears in the policy Planning for and Providing Quality End-of-Life Care, approved in September by College Council:

8.3 Conscientious Objection

Physicians who limit their practice on the basis of moral and/or religious grounds must comply with the College’s Professional Obligations and Human Rights policy.

A note explains that limiting practice includes refusals to “provide care” (i.e., kill patients or assist with suicide.)

The College’s policy, Professional Obligations and Human Rights , demands that physicians who are unwilling to provide procedures for reasons of conscience or religion must make “an effective referral to another health-care provider,” which is defined as “a referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency.”

As a result of the demand for “effective referral,” Professional Obligations and Human Rights is the subject of a legal challenge filed by the Christian Medical and Dental Society and the Canadian Federation of Catholic Physicians’ Societies.  Among other things, the suit alleges actual bias or a reasonable apprehension of bias on the part of the working group that developed the policy.

Professional Obligations and Human Rights was approved by College Council in March, 2015, despite overwhelming opposition to the demand for “effective referral” that was evident in the returns during the public consultation.  The College issued a statement with the policy to the effect that it did not apply to euthanasia or assisted suicide.  It promised to revisit the issue after Parliament or the provincial legislature enacted laws in response to the Supreme Court of Canada decision in Carter v. Canada.

“It was obvious at the time that this was an ingenuous tactic that they hoped would defuse opposition to the policy, at least among Council members” said  Protection of Conscience Project Administrator, Sean Murphy.  “This development simply confirms the obvious.”

Podcast: Canadian Medical Association draft framework on euthanasia and assisted suicide

Podcast: Canadian Medical Association draft framework on euthanasia and assisted suicideOn August 25, 2015, delegates at the 148th Annual General Council of the Canadian Medical Association will be voting on a draft policy framework for euthanasia and assisted suicide.

The draft document warrants close attention because of its potential impact on freedom of conscience among health care workers who do not want to be involved with these procedures.

This podcast supplements the Project’s commentary on the draft framework, which includes an on-line annotated version.

Podcast Contents

Introduction (00:00-06:35)

  • The problem of referral
  • “Providing” or “participating”?

Principles Based Approach to Assisted Dying in Canada (07:09-11:27)

  • Carter v. Canada
  • Strategic Questions

Schedule A: Foundational Principles (11:27-19:05)

  • Equity
  • Respect for physician values
  • Solidarity

Schedule A: Recommendations (19:38-27:33)

  • Patient qualifications
    • Informed decision
    • Capacity
  • Process map for medical decision making
    • Stage 1 & 2: Requesting; Before undertaking
    • Stage 3: After undertaking

Schedule A: Recommendations (28:07-31:02)

  • Conscientious objection by a physician

Schedule B: Legislative criteria across jurisdictions (31:35-35:00)

  • Q3: Reconcile refusal and equitable access?

Summing up (35:32-39:12)