Category: Canada

Redefining the practice of medicine – Part 2

Winks and nods and euthanasia in Quebec

Re:  Bill 52: An Act respecting end-of-life care (June, 2013)

Sean Murphy*

Part 1: Bill 52 in detail

Abstract

An Act respecting end-of-life care (Bill 52) purports to establish a right to euthanasia for a certain class of patients by including it under the umbrella of “end-of-life care.” Those seeking euthanasia may not be near the end of their lives and may not be terminally ill, but they are apparently classed as “end-of-life patients” because they have chosen to end their lives.

Section 25 introduces a term not used by the medical profession, “terminal palliative sedation” (TPS). By this the Quebec government means an irreversible procedure intended to kill the patient slowly. Any patient is eligible for TPS, and a proxy can consent to it on behalf of an incompetent patient.

Section 26 permits patients to be killed quickly by “medical aid in dying”(MAD) if they are competent adult Quebec residents suffering from an incurable serious illness, in an advanced state of irreversible decline and suffering from constant and unbearable physical or psychological pain. The patient need not be terminally ill and is free to refuse effective palliative treatments.

A qualifying patient must personally make a written request for MAD “in a free and informed manner.” It must be signed in the presence of professional, who must also sign the request. The attending physician must confirm the eligibility of the patient and the free and informed nature of the request. He must verify the persistence of suffering and a continuing desire for euthanasia, speak to other members of the health care team and see that the patient is able to discuss the decision with others. However, the physician cannot advise family members unless the patient so wishes. Thus a physician may kill a patient without the knowledge of the family. Finally, the attending physician must obtain a written opinion of an independent physician confirming eligibility for euthanasia.

Only physicians may provide euthanasia (MAD), and, having done so, must “take care” of a patient until he dies. Physicians who provide TPS or MAD must report the fact to institutional authorities. They must report all euthanasia cases to the Commission on End-of-Life Care.

The Act appears to assume that the regulators will establish “clinical standards” for euthanasia but does not assign them a central role, making institutional authorities primarily responsible for it.

Canadian criminal law is not affected by the Act. It continues to apply to the killing of patients by physicians, but also to any act or omission done for that purpose, including the making and distribution of MAD guidelines and protocols.

First degree murder is defined as murder that is “planned and deliberate.” A physician who does what the Act requires will have provided excellent evidence that the killing was intentional, planned and deliberate. Conforming to the Act respecting end-of-life care would seem to increase the likelihood that a physician – and anyone counselling, aiding, abetting his act – could be charged and convicted for first degree murder, for which the punishment is life imprisonment without parole for 25 years. [Full commentary]

Redefining the practice of medicine – Part 1

Winks and nods and euthanasia in Quebec

Re:  Bill 52: An Act respecting end-of-life care (June, 2013)

Sean Murphy*

Part 1: Overview

Abstract

An Act respecting end-of-life care (Bill 52) is intended to permit physicians, in defined circumstances, to kill their patients as part of the redefined practice of medicine. However, the procedure cannot become part of medical practice in Quebec unless the medical profession itself (broadly speaking) formally accepts it as a form of health care.

The strategy of the Quebec government includes three key elements:

a) A statute that authorizes and allows the regulation of “medical aid in dying” (MAD) but does not define the term, so as to avoid conflict with the criminal law and constitutional challenges to the law;

b) Compliant medical regulators, professionals and health care authorities who are expected to define MAD to include euthanasia, thus establishing it as a legitimate aspect of health care;

c) Refusal to prosecute physicians who kill patients in accordance with MAD guidelines, thus circumventing the criminal prohibition of euthanasia.

While the federal government could, in theory, appoint and pay lawyers to act as prosecutors to enforce the criminal law, this would be especially contentious in Quebec and would involve political and practical problems. If Bill 52 passes, it seems unlikely that Quebec physicians who provide euthanasia under MAD guidelines will be prosecuted. The province formerly refused to enforce Canada’s criminal law on abortion for over twenty years, so a policy of refusing to prosecute physicians providing euthanasia could have similar staying power.

Though Bill 52 does not actually require or authorize the killing of patients, from a practical perspective, the text of the statute is a “mere technicality.” Nonetheless, it is not a mere technicality that the medical establishment and not the statute will have directed that patients can be killed in order to relieve their symptoms.

On the contrary: it is profoundly significant. Having formally approved of euthanasia, the medical establishment (meaning all of those who collaborate in drawing up MAD guidelines and protocols) will be at particular pains to defend and enforce the decision. In the end, freedom of conscience for Quebec health care workers who object to euthanasia may come to mean nothing more than the freedom to find another job, or the freedom to leave the province.  [Full commentary]

Over 500 physicians have signed up against Quebec euthanasia bill

The Physicians’ Alliance for the Total Refusal of Euthanasia, a Quebec organization, is comprised mainly of physicians whose focus of practice is on dying patients.  The group is adamantly opposed to euthanasia.  Over 500 physicians have identified themselves as supporting its Total Refusal of Euthanasia Declaration.  The Alliance has issued a news release denouncing the Quebec government’s new euthanasia bill.

Dr. Catherine Ferrier of the Montreal General Hospital is concerned that virtually all of her patients in the geriatric clinic would be eligible for euthanasia, and that the spectre of euthanasia would haunt “every interaction” with her patients were it to be legalized.  While she is doubtful about whether or not the euthanasia bill can be stopped, she said ” I am certainly never going to kill a patient.” [CJAD]

Dr. Gerald van Gurp, whose opposition to euthanasia is informed by developments in his homeland, the Netherlands, is a palliative care and emergency physician at Montreal’s Hotel Dieu Hospital.  He argues that most Quebeckers do not have access to quality palliative care, and that the solution to that problem is to provide access to high-quality palliative care, not euthanasia. [Montreal Gazette]

Dr. van Gurp said that he would not continue to provide home palliative care for terminally ill patients if the euthanasia bill passes.  “I’m not going there,” he said.

Speaking for the Alliance, Dr. Marc Beauchamp described the bill as “an enormous revolution in ethics and law.” [CBC News]

Catholic Civil Rights League notes threat to freedom of conscience in Quebec euthanasia bill

The Catholic Civil Rights League has issued a news release concerning the euthanasia bill introduced by the Quebec government.  In addition to expressing the League’s opposition to euthanasia, the release warned that the bill threatens freedom of conscience for health care workers opposed to euthanasia.

Also of concern to the League, while this proposed legislation allows doctors to refuse to participate in euthanasia requests, it implies that they must participate in a process referring the request to a more willing provider. There appears to be no provision for the religious and conscientious rights of other members of the health care team.  As we have seen on the question of abortion, legalization can lead to pressure on health care workers to participate in activities they find morally objectionable.

 

Defiance of law predicted as Quebec moves toward legalization of assisted suicide

The Canadian Broadcasting Corporation reports that the government of Quebec will introduce legislation to legalize physician assisted suicide in the province between 7 and 14 June, 2013.  The draft bill is expected to assert that physician assisted suicide is a form of health care, and thus (under Canada’s constitutional division of powers) subject to provincial regulation, not the Criminal Code, a federal law that prohibits the procedures.  Depending upon the wording of the bill, the proposed legislation could include euthanasia by physicians.  Dr. Paul Saba of Physicians for Social Justice, a group that opposes the legislation, states that he will refuse to assist or refer any patient who asks for assisted suicide or euthanasia, regardless of the law or the policies of the Collège des médecins du Québec (Quebec College of Physicians), the state regulator of the practice of medicine.  [CBC]