Ensuring access to euthanasia by encouraging physician participation: it’s complicated

Sean Murphy*

In July, 2017, Canadian euthanasia/assisted suicide (EAS) practitioners and advocates alleged that patient access to euthanasia and assisted suicide was in danger because of “barriers” and “disincentives” to physician participation. Dr. Stefanie Green, president of their professional association, described the situation as “a crisis.”1 There was, in fact, no crisis — only a false perception of crisis fuelled by unrealistic expectations about levels of physician participation in euthanasia and assisted suicide.2

Nonetheless, it is reasonable for policy makers to respond to their concerns that physicians are discouraged from participating in euthanasia and assisted suicide. Indeed, objecting physicians are less likely to experience disadvantage and coercion if policy-makers seriously consider suggestions by EAS practitioners and advocates about how to encourage physician participation in euthanasia.

Removing barriers and disincentives to physician participation

Minimizing procedural and administrative requirements
Returning to the complaints and concerns of Canadian euthanasia practitioners (see Canada’s Summer of Discontent2), reducing or streamlining procedural requirements and minimizing burdensome paperwork might encourage more physicians to participate. However, this raises a question that may prove difficult to answer. Is a procedural requirement a “barrier” — or a necessary safeguard? A “disincentive” — or an essential ethical prerequisite? The difficulty is illustrated by developments in Belgium. . . .[Full text]

Canada’s summer of discontent: euthanasia practitioners warn of nationwide “crisis”

Shortage of euthanasia practitioners “a real problem”

Sean Murphy*

There were 803 euthanasia/assisted suicide (EAS) deaths in Canada during the first six months after the procedures were legalized. In the second half of the first year (ending in June, 2017) there were 1,179 — a 46.8% increase, and about 0.9% of all deaths. Health Canada correctly states that the latter figure falls within the range found in other jurisdictions where euthanasia/assisted suicide are legal, but the Canadian EAS death rate in the first year was not reached by Belgium for seven to eight years. The dramatic increase of EAS deaths in the last half of the first year would have had a direct impact on EAS practitioners, and this may be why they ended the first year by sounding the alarm about access to the service. . . .[Full text]

Quebec euthanasia rates on track to match Belgian 7-8 year rates after 2 years

Sean Murphy*

Available statistics indicate that Quebec is on track to reach euthanasia rates  after two years that correspond to Belgian rates after seven to eight years (i.e., per 100,000 population and as a percentage of deaths from all causes).

Not all Quebec euthanasia statistics have been made public.  However, the following points appear to be of interest:

  • Almost 20 requests for euthanasia were made weekly in the province in the first half of 2017, slightly higher than the last half of 2016.
  • The percentage of requests that did not result in euthanasia increased slightly from about 37% to 40%
    • Increases in this category, when reported, were attributed mainly to patients becoming incompetent, dying or withdrawing their requests.

The Project’s analysis is available at Euthanasia Statistics: Quebec.

 

New Canadian organization for midwives concerned for freedom of conscience

Sean Murphy*

A new Canadian organization for midwives has been formed.  Canadian Midwives for Life describes itself as a not-for-profit group that attempts to speak for Canadian midwives “who recognize the dignity and inviolability of human life from the moment of fertilization.”  Among the objectives of CMFL: “Understand their own personal boundaries in midwifery practice and the implications of conscientious objection.”

Physicians support assisted death for mature minors, but not mental illness

CMAJ

Lauren Vogel

Doctors attending a session on medical aid in dying at the Canadian Medical Association (CMA) General Council supported the use of advance directives and allowing mature minors to access assisted death. However, they split on opening up the service to otherwise healthy people with mental illness.

In a poll, 83% said they would support the use of advance directives to request medical aid in dying in cases where a person was otherwise unable to give consent. Some 69% would support opening the service to “mature minors,” including cases in which a guardian might request assisted death for a terminally ill infant, for example. However, after roundtable discussions, less than half (46%) of doctors polled said they would support assisted death on the basis of mental illness alone. . .  [Full text]