Category: Procedures & Services

Quebec Euthanasia Guidelines

Practice guide issued by Quebec health care profession regulators

Introduction

Sean Murphy*

Quebec’s Act Respecting End of Life Care (ARELC) was passed in June, 2014 and comes into effect in December, 2015.  When enacted, the  law purported to legalize euthanasia in the province, but its actual legal effect was questionable because Canadian provinces do not have jurisdiction over criminal law.  Only the Canadian federal government can make laws governing homicide and suicide.

However, in February, 2015, the Supreme Court of Canada released its decision in the case of Carter vs. Canada. The Court struck down the criminal prohibition of homicide and assisted suicide to the extent that it prevents the provision of physician assisted suicide and physician administered euthanasia for a certain class of patients.  The Court specified that the law cannot prevent the procedures for competent adults who are suffering intolerably as a result of a grievous and irremediable medical condition, which cannot be relieved by other means acceptable to the patient.  The declaration of invalidity was suspended for one year to allow the government time to revise the law.

The federal government under Conservative Prime Minister Stephen Harper took no action until mid-July, when it appointed a panel to study the issue and offer advice about legislative options.  The government was defeated in the federal election in October, and it remains unclear what direction the new Liberal government will take.

ARELC thus comes into force about two months before the Supreme Court ruling in Carter takes effect, while the criminal prohibition of euthanasia and assisted suicide is still in place.  However, the guidelines for euthanasia in ARELC are actually more restrictive than those proposed by the Supreme Court of Canada in Carter, so it seems doubtful that the federal government will challenge the Quebec law.

In August, 2015, the state regulators of the professions of medicine, pharmacy and nursing jointly issued an 88 page Medical Aid in Dying Practice Guide to direct the provision of euthanasia in Quebec.  The Guide appears to be available only in French, and is currently accessible only through a password protected portal on the Collège des médecins du Québec website, or by making an access to information request.  However, the Guide also states that it can be reproduced as long as the source is acknowledged.

What follows is a partial machine assisted English translation of the Guide set opposite the original French text.  For ease of reference, each translated segment is identified by a translation number (T#).  Only those parts of the Guide that appear to have some relevance to freedom of conscience are reproduced here.

Go to translation

Beware of assisted-suicide zealots

National Post

Will Johnston

For at least a few more months, the Canadian medical system will continue to be a safe space, free of assisted suicide and euthanasia. But all that is about to change. In order to ensure our hospitals and palliative care centres remain places where patients feel safe and secure, we must respect doctors’ conscience rights, rather than listen to activists who seek to impose their one-size-fits-all policy on the rest of us.

For instance, the palliative care centres in Quebec that refuse to have anything to do with euthanasia, for reasons of medical judgment and ethics, have apparently angered Jean-Pierre Menard, the lawyer who helped write Quebec’s euthanasia law, Bill 52. The act specifically states that palliative care centres are not required to provide euthanasia service — but maybe to Menard, those were just soothing words to get the bill passed. Now Menard says money should be taken away from palliative services that won’t provide euthanasia on their premises. And the minister of health, Gaetan Barrette, has threatened to revoke the hospital privileges of doctors who won’t comply. . . . [Full text]

You shouldn’t lose your job because of your morals. Neither should your doctor.

You shouldn't lose your job because of your morals. Neither should your doctor.
We want doctors to be able to serve their patients instead of being pushed out of the practice of medicine.

But we need your help. Governments and medical associations will only agree if there is public support.

Visit MoralConvictions.ca to learn more and make sure your voice is heard.

Euthanasia, assisted suicide: Canadian Catholic bishops defend freedom of conscience

The Canadian Conference of Catholic Bishops has provided the federal External Panel on Options for a Legislative Response to Carter v. Canada with a five point submission stating the opposition of the Catholic Church to physician assisted suicide and euthanasia, describing the latter practice as “murder.”

The fifth point in the submission was directed to freedom of conscience for health care workers:

On safeguarding freedom of conscience and religion, the Catholic Church believes and teaches:

“Freedom is exercised in relationships between human beings. Every human person, created in the image of God, has the natural right to be recognized as a free and responsible being. All owe to each other this duty of respect. The right to the exercise of freedom, especially in moral and religious matters, is an inalienable requirement of the dignity of the human person. This right must be recognized and protected by civil authority within the limits of the common good and public order. ” – Catechism of the Catholic Church, n. 1738

It is the conviction of all the Bishops of Canada, together with the other clergy and members of the consecrated life, united with our Catholic faithful, that our country must at all cost uphold and protect the conscience rights of the men and women who work as caregivers. Requiring a physician to kill a patient is always unacceptable. It is an affront to the conscience and vocation of the health-care provider to require him or her to collaborate in the intentional putting to death of a patient, even by referring the person to a colleague. The respect we owe our physicians in this regard must be extended to all who are engaged in health care and work in our society’s institutions, as well as to the individual institutions themselves. . .

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]