Tag: Collège des médecins du Québec

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

Quebec MDs to get euthanasia guide to prepare for legalized assisted death

Unclear whether other provinces and territories will adopt a similar practice

The Canadian Press

Sheryl Ubelacker

The college that regulates Quebec doctors will soon provide practitioners with detailed guidelines – including what drugs to use – for euthanizing terminally ill patients who seek help to end their lives.

But it’s unclear whether other provinces and territories will adopt a similar practice when doctor-assisted death becomes legal across the country early next year.

With the passage of Bill 52 in June 2014, Quebec became the first jurisdiction in Canada to legalize medical aid in dying for mentally competent patients who meet a strict set of criteria. The law goes into effect in December, allowing physicians to begin helping patients with an incurable condition and intolerable physical or psychological suffering to die. . . [Full Text]

Internal memos show how a handful of Canadian lawyers launched a national campaign against doctors’ conscience rights

LifeSite News

Steve Weatherbe

March 11, 2015 (LifeSiteNews.com) – Only a few weeks after Ontario’s College of Physicians and Surgeons voted to compel the province’s doctors to refer and even perform operations they consider immoral, Saskatchewan’s College is scheduled to follow suit. But all Canada’s provincial governing bodies have been urged to get on the bandwagon as part of a national campaign from an obscure, federally-funded coterie of pro-abortion, pro-euthanasia academics.

According to Sean Murphy, director of the British Columbia-based Protection of Conscience Project, the pro-abortion Conscience Research Group is the prime mover behind efforts by the leadership of the Ontario and Saskatchewan medical professions to force their members to do abortions, assist at suicides, and euthanize their patients upon request.

“Based on the correspondence I’ve seen,” Murphy told LifeSiteNews, “there does appear to be a movement to impose this on all doctors in Canada.” . . .[Full text]

Uniform coercive policy urged for all Canadian physicians

Project submission to the Saskatchewan College of Physicians discloses details

News Release

Protection of Conscience Project

The Protection of Conscience Project has charged that a controversial policy proposed by the College of Physicians and Surgeons of Saskatchewan is unjustified.

The policy, Conscientious Refusal, will require all Saskatchewan physicians who object to a procedure for reasons of conscience to facilitate the procedure by referring patients to a colleague who will provide it, even if it is homicide or suicide.

The Project noted that the burden of proof was on the policy’s supporters to prove that the policy is justified and that no less oppressive alternatives are available.  “They failed to do so,” states the submission. “The policy should be withdrawn.”

“Conscientious Refusal fails to recognize that the practice of medicine is a moral enterprise, that morality is a human enterprise, and that physicians, no less than patients, are moral agents” said the Project, describing the policy as “profoundly disrespectful of the moral agency of physicians.”

Using documents provided by the College, the Project’s submission traces the origin of the policy to a meeting in 2013. The meeting was apparently convened by the Conscience Research Group (CRG), activist academics whose goal is to compel physicians unwilling to provide morally contested procedures like abortion or euthanasia to refer patients to someone willing to do so. They presented a coercive model policy that had been drafted to achieve that goal.

According to a CPSS memo, College attendees included Saskatchewan Associate Registrar Bryan Salte, Dr. Gus Grant, Registrar of the College of Physicians and Surgeons of Nova Scotia, Andréa Foti of the Policy Department of the College of Physicians and Surgeons of Ontario and a representative of the Collège des Médecins du Québec. They agreed upon a text virtually identical to the CRG model.

In May, 2014, Bryan Salte proposed the policy to Registrars of the Colleges of British Columbia, Alberta, Manitoba and Ontario, who, he reported, agreed to review it and consider implementing it. He later urged all of the Registrars of Colleges of Physicians in Canada to adopt the coercive policy or one very like it, noting that “physician assisted suicide, in particular” would be present a challenge for administrators.

“Any College that is an outlier, either because it has adopted a different position than other Colleges, or because it has not developed a policy, will potentially be placed in a difficult position,” he warned.

The CPSS memo discloses that, unbeknownst to physicians, officials in several provinces have been making plans behind closed doors to suppress freedom of conscience in the medical profession.

“One of the disturbing aspects of the story,” notes the submission, “is what appears to be a pattern of concealment, selective disclosure, and false or misleading statements that all serve the purpose of supporting the policy.”

The Project’s most recent submission to the College of Physicians and Surgeons of Ontario identifies a similarly troubling pattern, describing briefing materials supplied to College Council in support of its controversial policy as “not only seriously deficient, but erroneous and seriously misleading.”

Project Submission to the College of Physicians and Surgeons of Saskatchewan (2015)

Project Submission to the College of Physicians and Surgeons of Ontario (2015)

Redefining the Practice of Medicine- Euthanasia in Quebec, Part 9: Codes of Ethics and Killing

Abstract

Redefining the Practice of Medicine- Euthanasia in Quebec, Part 9: Codes of Ethics and KillingRefusing to participate, even indirectly, in conduct believed to involve serious ethical violations or wrongdoing is the response expected of physicians by professional bodies and regulators.  It is not clear that Quebec legislators or professional regulators understand this.

A principal contributor to this lack of awareness – if not actually the source of it – is the Code of Ethics of the Collège des médecins, because it requires that physicians who are unwilling to provide a service for reasons of conscience help the patient obtain the service elsehere. The President of the Collège was pleased that law will allow physicians to shift responsibilty for finding someone willing to kill a patient to a health system administrator, avoiding an anticipated problem caused by the requirement for referral in the Code of Ethics.  However, the law does not displace the demand for referral in the Code, and can be interpreted to support it.

The Collège des médecins Code of Ethics demand for referral conflicts with the generally accepted view of culpable indirect participation.  Despite this, it continues to be used as a paradigm by other  professions, notably pharmacy.  It is thus not surprising that the College of Pharmacists also anticipates difficulty over the issue of referral.  Like the Collège des médecins, the College of Pharmacists would like to avoid these problems by allowing an objecting pharmacist to shift responsibility for obtaining lethal drugs to a health systems administrator.

Nurses cannot be delegated the task of killing a patient, it is not unreasonable to believe that nurses may be asked to participate in euthanasia in other ways. Thus, there remain concerns about indirect but morally significant participation in killing.  Their Code of Ethics imposes a duty to ensure both continuity of care and “treatment,” which is to include euthanasia.  However, under ARELC, an objecting nurse is required to ensure only continuity of care.  This should not be interpreted to require nurses to participate in euthanasia, though they may be pressured to do so.

As a general rule, it fundamentally unjust and offensive to human dignity to require people to support, facilitate or participate in what they perceive to be wrongful acts; the more serious the wrongdoing, the graver the injustice and offence.  It was a serious error to include this a requirement in code of ethics for Quebec physicians and pharmacists. The error became intuitively obvious to the Collège des médecins and College of Pharmacists when the subject shifted from facilitating access to birth control to facilitating the killing of patients.

A policy of mandatory referral of the kind found in the Code of Ethics of the Collège des médecins  is not only erroneous, but dangerous.  It establishes the priniciple that people can be compelled to do what they believe to be wrong – even gravely wrong – and punish them if they refuse.  It purports to entrench  a ‘duty to do what is wrong’ in medical practice, including a duty to kill or facilitate the killing of patients. To hold that the state or a profession can compel someone to commit or even to facilitate what he sees as murder is extraordinary.

Quebec’s medical establishment can correct the error by removing the mandatory referral provisions of their codes of ethics that nullify freedom of conscience.  This would prevent objecting physicians and pharmacists from being cited for professional misconduct for refusing to facilitate euthanasia or disciplined for refusing to facilitate other procedures to which they object for reasons of conscience, including contraception and abortion.  This would almost certainly antagonize consumers who have been conditioned to expect health care workers to set aside moral convictions.

It remains to be seen whether the Quebec medical establishment will maintain the erroneous provisions, preferring to force objecting health care workers to become parties to homicide rather than risk occasionally inconveniencing people, such as the young Ontario woman and her supporters who were outraged because she had to drive around the block to obtain The Pill. [Full Text]