Protection of Conscience Project News
Service, not Servitude
No one should be forced to kill or participate in killing. But if a recommendation of a Quebec euthanasia commission to legalize doctor-administered death are followed (discussed in more detail here) every Quebec physician will be conscripted to participate in homicide as a condition of practicing medicine. Read more . . .
Although euthansia and assisted suicide are criminal offences in Canada, and criminal law is under the jurisdiction of the federal government, the government of Quebec has announced that it will legalize assisted suicide and euthanasia provided by health care workers. [National Post] The commission that recommended this step also recommended that objecting physicians be forced to facilitate the procedures by referral.
It appears that the provincial government will claim that assisted suicide and euthanasia are forms of medical treatment. Since health care is under provincial and not federal jurisdiction, the province will likely argue that the prohibition of these services within the context of health care trespasses on provincial jurisdiction. This was one of the claims of the BC Civil Liberties Association in Carter v. Canada, which it won.
However, the claim was not adjudicated in Carter because it was not actually argued during the trial.
The province also has the constitutional authority to enforce and administer criminal law, so that it could, in theory, instruct prosecutors not to pursue charges against health care workers who provide the procedures in accordance with government guidelines. It could do this pending the outcome of litigation, and even if the criminal prohibition stands. This is the approach taken in England with respect to assisted suicide, though the English guidelines indicate that health care workers must not be involved.
Should the provincial government refuse to prosecute health care workers who provide the services, it would be possible for the federal government to order the federal police force, the Royal Canadian Mounted Police, to investigate allegations, and to appoint and pay lawyers to act as prosecutors. However, this would be especially contentious in Quebec, since the current government is ideologically committed to the separation of Quebec from Canada and the establishment of the province as an independent nation state. Nationalist elements in Quebec would see that kind of federal intervention as not only a constitutional violation of provincial jurisdiction, but as violation of sovereignty.
Thus, divisions among health care workers on this issue may involve complexities and nuances not encountered elsewhere, and those who resolutely refuse to provide or facilitate assisted suicide and euthanasia may find their circumstances unusually challenging. Nonetheless, prominent Quebec physicians have formed The Physicians’ Alliance for Total Refusal of Euthanasia. The Alliance is directly challenging the medical regulatory authority:
45 year old identical twin brothers were killed by lethal injection at Brussels University hospital, in Jette, Belgium, by physicians acting under the country’s euthanasia law. The twins, who were deaf, had learned that they were going blind, and decided to be killed rather than never see each other again. The Belgian government has prpoosed an amendment to further expand grounds for euthanasia. [Daily Mail]
The Belgian Socialist party has submitted proposals to amend the country’s euthanasia law to permit euthanasia of children and persons suffering from dementia. According to news reports, children would have to be suffering from an incurable illness to qualify.[Daily Mail] The text of the proposed legislation does not yet appear to be available.
However, two bills submitted by Marleen Temmerman to the Belgian Senate in May, 2012 made the same kind of proposals. Draft law No. 4-431/1 makes euthanasia available to children who are able to “discern” that they want it if they otherwise meet the legal criteria for euthanasia of adults. Alternatively, their parents can make the request.
Draft Law No. 4-676/1 makes euthanasia available to patients with dementia. This bill also appears to impose a requirement on conscientious objectors to refer patients to physicians willing to kill them by modifying the existing protection of conscience provision in the Belgian euthanasia law. The existing law requires an objecting physician to transfer a patient’s medical file to another physician if requested to do so by the patient or surrogate decision maker. The onus remains on the patient or surrogate diecision maker to find a willing physician. Draft Law. No. 4-676/1 would add the following provision to the law:
Si aucun médecin n’a été désigné par le patient ou par sa personne de confiance, le médecin qui refuse d’accéder à une demande d’euthanasie communiquera le dossier médical à un autre médecin en vue d’assurer la continuité des soins.
If no physician has been designated by the patient or by his surrogate decision maker, the physician who refuses to comply with a request for euthanasia must tranfer medical records to another physician to ensure continuity of care.(Machine assisted translation)
On the face of it, this does not appear to add anything new. However, the commentary on the section provided by Temmerman indicates that what she has in mind is the addition of a requirement that an objecting physician find a colleague willing to kill the patient:
La loi sur l’euthanasie n’offre pas de solution pour le cas où le médecin traitant refuse d’accéder à la demande d’euthanasie, où le patient n’est plus en mesure de désigner un autre médecin et où il n’a pas désigné de personne de confiance. Le patient a pourtant droit à l’exécution de sa déclaration anticipée et à la continuité des soins. C’est pourquoi le médecin qui refuse d’accéder à la demande d’euthanasie doit transmettre lui-même le dossier médical à un médecin qui soit disposé à appliquer la volonté exprimée par le patient.
The law on euthanasia does not offer a solution for the case in which the doctor refuses to grant the request for euthanasia, where the patient is no longer able to appoint another doctor and did not appoint a surrogate decision maker. The patient nevertheless entitled to enforce his advance directive and ensure continuity of care. This is why the doctor who refuses to comply with the request for euthanasia must transfer the medical file to a medical doctor who is willing to implement the wishes of the patient. (Machine assisted translation)
In July of this year, the Belgian Federal Commission for the Monitoring and Assessment of Euthansia recommended that medical students should be taught how to kill patients properly, and that continuing medical education should include such instruction:
La commission rappelle qu’elle estime que le curriculum des études médicales devrait comporter une formation préparant les futurs médecins à affronter les problèmes que pose la gestion de la fin de vie, y compris la pratique des soins palliatifs et la mise en oeuvre correcte d’une euthanasie. De même, les divers cycles d’enseignement postuniversitaire et les activités de recyclage devraient être encouragés à inclure une telle form.
The Committee recalls that it considers that the curriculum of medical education should include training preparing future physicians to deal with the problems posed by the management of the end of life, including the practice of palliative care and the proper implementation of ‘euthanasia. Similarly, the various cycles of postgraduate education and recycling activities should be encouraged to include such training. (Machine assisted translation)
The Commission did not appear to recognize that some medical students might have conscientious objections to a requirement that they be required to kill a patient as a condition of graduation. On the other hand that Commission may have intended only that medical students be provided with information about how to kill patients properly, without a requirement that they actually demonstrate their competence.
Those who, for reasons of conscience, refuse to facilitate morally contested procedures by referral or other indirect means should take note of the World Medical Association’s reaffirmation of its position against physician “participation” in executions, which now includes a statement that physicians must not facilitate executions by importing drugs for executions. Similarly, the British group, Reprieve, has embarked upon a campaign to have drug companies sign a Pharmaceutical Hippocratic Oath against the use of their products in executions. [Bioedge]