Redefining the practice of medicine – Part 2

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]