Keep euthanasia off the record: doctors
Practitioners in Quebec fear life insurance benefits would be denied to families
Doctors’ leaders in Quebec are poised to recommend euthanasia be kept off death certificates.
Instead, doctors could be encouraged to classify deaths by lethal injection as “natural” deaths on public death records.
As part of new guidelines, Quebec’s College of Physicians is considering recommending doctors list the underlying illness as the cause of death in cases of “medical aid in dying,” not euthanasia.
The college’s leaders say they want to ensure life insurance benefits are not denied to families in cases of euthanasia.
They emphasize Quebec’s assisted-death law will require any doctor who administers euthanasia to report each death to a special oversight body. That information will be kept confidential or shared with the college and/or hospitals.
Euthanasia opponents are denouncing the proposal as an attempt to conceal the truth. It is also creating unease among some doctors, who worry misstating the cause of death on certificates could make it difficult to track assisted death numbers, once the practice becomes legal in Canada in February, and whether it is being performed legally.
An assisted death is not a “natural” death by definition, said Dr. William Cunningham, a Victoria emergency and family physician and past president of Doctors of B.C.
“Which then raises the whole ethical issue, the one of honesty and integrity: should a doctor knowingly fill out something incorrectly?”
Under Bill 52, Quebec’s aid in dying law, due to come into force Dec. 10, mentally fit adults suffering an incurable illness and in an advanced and irreversible state of decline will be permitted to ask for euthanasia.
“Probably our proposal will be to write on the death certificate (that) the cause of death (was) the basic pathology that was behind the reason why physician-assisted death was used,” said Dr. Yves Robert, secretary of Quebec’s College of Physicians.
“The consensus was to say that. It’s a guideline and maybe it will be updated as further discussion occurs.”
Robert said the college worries insurance companies could use the death certificate to deny a claim or refuse to pay beneficiaries in cases of assisted death — even though the Quebec law contains a provision that a person’s decision to seek euthanasia cannot be used as a reason to deny death benefits to the family.
“Whatever is written on the death certificate, it is mandated by the law that a report on the whole process must be reported to the commission on end-oflife care and/or the college,” he said.
The person’s medical records will also contain a form dated and signed by the patient that makes clear his or her request for aid in dying, Robert added.
There is no “cover up,” he said. “Surveillance (of physician-assisted death) is not done by death certificates. It is done through reports required by the law.”
Jean-Pierre Ménard, a lawyer commissioned by the Quebec government to review Bill 52, said a patient may have personal or religious reasons for wanting an assisted death kept confidential.
“You may decide, ‘ OK, doctor, I’m at the end of my life, I just want to stop the suffering. I don’t want my family to be involved in the process because maybe they will disagree with me, they may pressure me, so I prefer this is going to be between you and me.’ ”
Assisted dying “is done with full, free and informed consent of the patient,” Ménard said. “It belongs to the patient to decide if he wants his relatives to be aware of the condition of his death.”
Groups opposed to euthanasia say the act demands full disclosure and public accountability.
“You are talking about the intentional killing of a patient by a doctor. And now we’re suggesting that we’re going to cover up that intentional killing of a patient by a doctor and call it something else,” said Hugh Scher, a Toronto lawyer who represented the Euthanasia Prevention Coalition before the Supreme Court of Canada, which overturned the Criminal Code ban on doctor-assisted death in February.
“How is anybody supposed to have any confidence in a publicly administered system of euthanasia that is based upon a fraud?”
Most life insurance policies have a two-year suicide clause, meaning if the insured person takes his or her life within two years of buying the policy, no benefit is paid.
However, most people seeking euthanasia or assisted-suicide will likely have bought insurance years earlier, said Wendy Hope of the Canadian Life & Health Insurance Association.
“Even if (the death certificate) does say ‘euthanasia’ or ‘assisted death,’ if it’s after the two-year exclusion period, there would be no concern,” Hope said.
Cunningham said that once the Supreme Court ruling legalizing doctor-hastened death comes into effect in February, “there has to be some way of monitoring what is going on” in every jurisdiction in the country.
The only consistent document, he said, is the death certificate.
The Canadian Medical Association said it is seeking “clarity” on the issue.
“I think there are members of the profession who say, ‘let’s make sure we’re as accurate and as honest as we can be in our reporting and, if it is assisted dying, let’s say that,’ ” said Dr. Jeff Blackmer, the CMA’s vicepresident of medical professionalism. “I think it’s important, whether it’s on the death certificate or somewhere else, to capture what did occur.”
Some doctors say a coroner or medical examiner should investigate every assisted death.
“The trouble with calling them all ‘natural’ — and I have to say I would not be in favour of that — is that there is no way of knowing if the person who helped the patient did this legitimately or not,” said Dr. Pauline Alakija, a board-certified forensic pathologist in Alberta. “You need oversight to make sure these are not lumped in with all other natural deaths. You need someone to be able to investigate each of these deaths to make sure the consent was proper and that everything was done legally.”
She said the provinces could create a new legal category of death: medically assisted death.
“The important thing is that there be legislation in each province allowing for this new manner of death,” Alakija said. “If each province proceeds differently, we will not be able to assess what is happening nationally.”
Surveillance (of physician-assisted death) is not done by death certificates. It is done through reports required by the law.
DR. YVES ROBERT SECRETARY OF QUEBEC’S COLLEGE OF PHYSICIANS