To kill — or not to kill? That is the question.

An answer for a Dying With Dignity clinical advisor

Sean Murphy*

I just can’t understand why as learned as you are, you tenaciously use the verb KILL to refer to MAD. You cannot ignore that this verb requires a non-consenting victim. It makes of you a malicious pro-lifer who does not mind lying. MAD must be requested ! Camus wrote: «To misname things amount to adding to the world’s misery»…in La Pléiade, Oeuvres complètes p. 908.

This message was left for the Project Administrator by a member of the Clinicians’ Advisory Council of Dying With Dignity (DWD) Canada after he/she had downloaded several papers from the Administrator’s Academia web page.

The downloaded papers do not challenge the legalization of euthanasia and assisted suicide (EAS). The substantive morality of the procedures and their legalization is outside the scope of Project advocacy. The papers simply defend practitioners unwilling to be parties to killing their patients by providing or facilitating EAS services.

Unfortunately, the DWD Clinical Advisor was exasperated by the description of euthanasia and assisted suicide as “killing.” This, he/she exclaims, is a malicious lie that adds to the world’s misery.

Such a cri de cœur calls for a thoughtful discussion of the question it raises.

Does providing euthanasia and assisted suicide entail killing — or does it not? [Full text]

Court challenge raises issue of “reasonable apprehension of bias”

Sean Murphy*

Documents filed in an important Canadian court case bring into question the value and purpose of “public consultations” held by medical regulators, at least in the province of Ontario.

In March, 2015, the College of Physicians and Surgeons of Ontario (CPSO) approved a highly controversial policy, Professional Obligations and Human Rights.  The policy requires physicians  to facilitate services or procedures to which they object for reasons of conscience by making an “effective referral” to a colleague or agency willing to provide the service.  A constitutional challenge to the policy was dismissed by  the Ontario Divisonal Court in 2018.[1] An appeal of that ruling will be heard by the Ontario Court of Appeal on January 21-22, 2019.

Among the thousands of pages filed with the trial court are a number dealing with the public consultation conducted by the CPSO from 10 December, 2014 to 20 February, 2015.  In response to its invitation to stakeholders and the public, the CPSO received 9,262 submissions about the proposal, the great majority of which opposed it.[2]

College officials  finalized the wording of the policy on 19 January, 2015,[3]   a month before the consultation ended; only about 565 submissions would have been received by then.[4]  727 submissions had been received  by the time the policy was sent to the Executive Committee on 28 January,[5]  which promptly endorsed it and forwarded it to the College Council for final approval.[6]

According to the briefing note supplied to the Council, by 11 February, 2015 the College had received 3,105 submissions.[7]  Thus, the final version of the policy was written and approved by the College Executive before about  90% of the submissions in the second consultation had been received.

Submissions received by CPSO from 10 Dec 2014 to 20 Feb 2015

During the first 40 days ending 11 February, the College received an average of about 18 submissions per day.  Assuming someone spent eight full hours every working day reading the submissions, about 22 minutes could have been devoted to each.  Three staff members dedicated to the task could have inceased this average to about an hour, so the first 700 submissions could conceivably have received appropriate attention.

Time available for analysis of submissions

However, this seems unlikely in the case of more than 8,000 submissions received later.

By 11 February about 183 submissions were arriving at the College every day, increasing to about 684 daily in the last ten days of the consultation – one every two minutes.   A College staffer working eight hours daily without a break could have spent no more than about two minutes on each submission, and only about one minute on each of those received in the last ten days  – over 65% of the total.

A minute or two was likely sufficient if College officials deemed consultation results irrelevant because they had already decided the outcome.  This conclusion is consistent with the finalization and approval of the policy  by the six member College Executive (which included the Chair of the  working group that wrote it [8]).  To do this weeks before the consultation closed was contrary to normal practice.  CPSO policy manager Andréa Foti stated that working groups submit revised drafts to the Executive Committee  after public consultations close[9] – not before.

One would expect government agencies that invite submissions on important legal and public policy issues would allow sufficient time to review and analyse all of the feedback received before making decisions. The CPSO’s failure to do so does not reflect institutional respect for thousands of individuals and groups who responded in good faith to its invitation to comment on the draft policy.  Rather, such conduct invites a reasonable apprehension of bias that is unacceptable in the administration of public institutions.

1. The Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2018 ONSC 579 (Can LII)  [CMDS v CPSO].

2. CMDS v CPSO, supra note 1  (Respondent’s Application Record, Volume 1, Tab 1, Affidavit of Andréa Foti [Foti] at para 121.

3.    Foti, supra note 2 at para 133.

4. Estimated daily average based on the total received by 28 January (727).

5. CMDS v CPSO, supra note 1  (Respondent’s Application Record, Volume 4, Tab WW, Exhibit “WW” attached to the Affidavit of Andréa Foti: Executive Committee Briefing Note (February, 2015) (CPSO Exhibit WW) at 1724.

6. CMDS v CPSO, supra note 1  (Respondent’s Application Record, Volume 4, Tab XX, Exhibit “XX” attached to the Affidavit of Andréa Foti: Proceedings of the Executive Committee – Minutes – 3 February, 2015) (CPSO Exhibit XX) at 1746-1748.

7. “Council Briefing Note: Professional Obligations and Human Rights – Consultation Report & Revised Draft Policy (For Decision)” [CPSO Briefing Note 2015].  In College of Physicians and Surgeons of Ontario, “Annual Meeting of Council, March 6, 2015” at 61.

8. Dr. Marc Gabel. See CPSO Exhibit WW, supra note 4 at 1722 (note 1), and CPSO Exhibit XX, supra note 5 at 1746.

9. Foti, supra note 2 at para 36.

Hawaii legalizes assisted suicide: Refusing to refer for suicide may incur legal liability

Sean Murphy*

Assisted suicide will become legal in Hawaii on 1 January, 2019, as a result of the passage of the Our Care, Our Choice Act. Introduced in the state House of Representatives only in January, it passed both the House and Senate and was approved by Governor David Ige on 5 April. Beginning next year, physicians will be able to write prescriptions for lethal medications for Hawaiian residents who are capable of informed consent, who are at least 18 years old, and who have been diagnosed with a terminal, incurable disease expected to result in death within six months.1

And beginning next year, Hawaiian physicians who refuse to facilitate assisted suicide by referring patients to a willing colleague may face discipline — including expulsion from the medical profession — or other legal liabilities. Hawaii could become one of only two jurisdictions in the world where willingness to refer patients for suicide is a condition for practising medicine.2 . . . [Full text]

Pharmacist freedom of conscience recognized in British Columbia

LifeSite News

Steve Weatherbe

VANCOUVER, British Columbia, March 9, 2017 (LifeSiteNews) – Christian pharmacists in British Columbia can now practice with a clear conscience.

Under the B.C. College of Pharmacy’s new ethics code, they cannot be forced to prescribe for abortions, euthanasia, or artificial contraception.

Cristina Alarcon, a Vancouver-area community pharmacist who was a driving force behind the new code, says it “covers everything.” For the first time, pharmacists can refuse to dispense any prescription that violates their conscience. [Full text]

 

Quebec euthanasia rate almost doubled in last half of 2016

Quebec euthanasia rate after one year passes Belgian rate at five year mark

Sean Murphy*

Since 10 December, 2015, euthanasia has provided by physicians in Quebec under the terms of An Act Respecting End of Life Care (ARELC).  Health and social services agencies established by the government throughout the province are state agencies responsible for the delivery and coordination of health care in the province administrative regions. These are called Centres intégrés de santé et de services sociaux (CISSS) and Centres intégrés universitaires de santé et de services sociaux [CIUSSS).  Some administrative regions (like Montreal and the Quebec City region) have more than one CISSS or CIUSSS.

These agencies are responsible for the delivery of euthanasia and are required to make reports to a commission established by the law (the Commission sur les soins de fin de vie) to monitor the administration of euthanasia.  According to the Commission, they are also required to post these reports on their websites.

As of 6 March, 2016, one of these agencies (Outaouais) had not posted the reports on its website.  Two (Outaouais and Abitibi-Temiscamingue) had neither posted the most recent report nor sent the report to the Commission, and did not respond to a request for it.

The Project has compiled the statistics provided by the other agencies in tables and charts.  Note that, in some cases, the number of patients lethally infused is higher than the number of requests because euthanasia was provided in response to a request made in the previous reporting period.

Quebec’s euthanasia rate almost doubled in the last half of 2016.  One year after legalization, Quebec has passed the euthanasia rate reached by Belgium after five years.  If Quebec’s rate continues without escalation throughout 2017, it will exceed that achieved by Belgium after nine years.