MDs ‘cringe’ over wider assisted death rules
The medical world was in upheaval Thursday after a parliamentary committee advised extending doctorassisted death to mature children, the mentally ill and non-terminal patients — and requiring even Catholic- run hospitals to provide the service.
The issue had already divided medicine along moral and practical lines.
The Liberal- dominated panel’s call for broad inclusion criteria and tough requirements on doctors and health facilities to comply with the law raised more eyebrows, and questions.
Physicians who care for children, for instance, were appalled at the prospect of letting some minors receive lethal injections, said Dr. Dawn Davies, a spokeswoman for the Canadian Paediatric Society.
“One of my residents kind of cringed and clutched her stomach (when told of the committee’s recommendation Thursday). That is the reaction,” said Davies, a palliative- care physician at Edmonton’s Stollery Children’s Hospital.
“The weight of the opini on is going to be overwhelmingly that pediatricians themselves are not going to want to participate.”
The panel of MPs and senators was tasked with sketching the outline of a law implementing assisted death by June 6, after the Supreme Court of Canada ruled it was a constitutional right.
The court said the service should apply to people experiencing intolerable suffering from an illness that cannot be reversed, but did not narrowly delineate who does and does not have a right to help ending their lives.
The committee’s report expanded on the judges’ prescription, arguing assisted death ought to be available — subject to some safeguards — to patients who are under 18, have a mental illness or suffer from a non- fatal disease — not just adults with a terminal condition as some jurisdictions specify.
As well, Canadians diagnosed with a disease like dementia that will eventually leave them incapable of informed consent should be able to opt for aided dying in advance, the blueprint suggested.
“What they ended up doing was actually quite broad and inclusive, more so than some might have expected,” said Dr. James Downar, a critical- care physician at Toronto’s University Health Network. “When you start to look at non-terminal, mature minors, people get very concerned.”
Still, those issues would likely have ended up being litigated in court eventually, said Downar, a former adviser to the Dying with Dignity advocacy group.
And experience from places where assisted death is already legal suggest that 80% of those who take advantage of it are, in fact, terminally ill, he said.
The committee’s recommendation that doctors opposed to assisted death must make an “effective referral” of patients to another physician is also a problem, said Dr. Cindy Forbes, president of the Canadian Medical Association. For some, that is akin to actually taking part in the death process, she said.
Forbes said conscientious objectors should be asked only to tell patients it is an option, and direct them to an agency that can help them.
Also generating debate was the committee’s proposal that all publicly funded hospitals, hospices and other health facilities be required to provide assisted dying. That would include Catholic-administered institutions that are opposed to the concept on religious grounds.
An archbishop who sits on the board of Edmonton’s Covenant Health, for instance, said recently that Covenant’s taxpayer- funded hospitals and other facilities would “obviously” not provide the service.
It and other Catholic health organizations said Thursday they would not comment on the committee report. But Covenant, for one, suggested it is not about to bend on the issue, saying in a statement its facilities could refer those who ask for assisted death to another institution, “as we do with other services that are not provided at our sites.”
Including t hose with mental illness under the law would leave specialists with a “very complex” and unprecedented task: to determine if a patient’s disease is irremediable, and their thinking about assisted death not distorted by the illness itself, said Dr. Sonu Gaind, president of the Canadian Psychiatric Association.