Canadian doctors
Seek freedom to choose whether they offer medical aid in dying.
Canada’s doctors say they should be free to choose whether to help terminally ill patients kill themselves if the federal ban outlawing euthanasia is overturned.
Delegates at the Canadian Medical Association’s annual general meeting in Ottawa overwhelmingly passed a motion Tuesday supporting the “right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying.”
The CMA is formally opposed to euthanasia — a stance its leaders indicated would now be revisited as the emotionally charged issue takes on new urgency in Canada.
The Supreme Court of Canada is set to hear in October a constitutional challenge of the criminal ban on doctor-assisted death, while Quebec has introduced Bill 52, legislation allowing doctors to help end the lives of terminal patients suffering “unbearable physical or psychological pain.”
The CMA defines “medical aid in dying” as euthanasia or physicianassisted death. Euthanasia is “knowingly and intentionally performing an act, with or without consent, that is explicitly intended to end another person’s life.” The act is undertaken with empathy and compassion and without personal gain.
Physician-assisted death means that a doctor knowingly and intentionally provides a person with the knowledge or means, or both required to end their own lives, including counselling about legal doses of drugs, prescribing such lethal doses or supplying the drugs.
“I think the decision you saw this morning was rather resounding — 91 per cent of the folks in the room felt that physicians should be free to choose according to their conscience as legislation changes in this country,” outgoing CMA president Dr. Louis Hugo Francescutti said.
“We delivered a very clear, concise message to Canadians that physicians will always be there, in this most difficult time, which is end of life.”
“Conscientious objection” is usually invoked when a doctor refuses to provide a treatment based on his or her own personal, moral or religious beliefs.
“This is the other side of that, which is almost conscientious permission,” said CMA ethics director Dr. Jeff Blackmer.
If the federal ban were lifted, “One how they die.
“I may be the first person in the country once Bill 52 passes who will be asked by a patient to kill them, or to end their life, or to make sure they’re comfortable,” said Genge, of the Montreal Neurological Institute.
“My ALS patients are very bright. They can be anyone of you in the room. I have taken care of a number of physician friends as they have died, I’ve taken care of the wives of physicians as they have died,” she told delegates.
The disease typically doesn’t affect intellect or cognition, she said. “It causes you to lose your strength, your ability to speak and your ability to breathe.”
One recent patient, a lawyer, wanted to know that when he could no longer perform certain functions “that there was a way for him to exit this world without suffering.”
He was very specific about what that meant, she said. He said, “I don’t want my wife to wipe my bum. I don’t want anyone to carry me up the stairs. And when I can no longer speak, I do not want to live.’”
Two years after his diagnosis, he went into respiratory failure and was administered palliative sedation, which is legal in Canada, until he died.
Dr. Paul Parks, an emergency physician from Medicine Hat, said he sees patients with late-stage congestive heart failure who are “literally drowning in their own fluids.” They’re placed on morphine drips and sedatives, but “we’re also actively facilitating their death.”
In the Netherlands, where euthanasia by legal injection and assisted suicide has been legal since 2002, about 14,000 people request medical aid in dying each year.
Of those, 3,800 are granted, said Eric Van Wijlick, of the Royal Dutch Medical Association. Most — 90 per cent — are cancer patients. of the options would have been to say our policy is unchanged. We could say ethics trumps the law,” he said. In Belgium, where euthanasia has been legal since 2002, the Belgian Medical Association continues to urge its doctors not to participate.
“If the l aw (in Canada) does change we will support our members who decide to participate,” Blackmer said.
Of 4,823 doctors who responded to a CMA survey in June, one-quarter said they would be “likely” or “very likely” to participate in physicianassisted death if requested by a patient.
One Calgary doctor said dying farm animals are often treated better than dying patients.
A Montreal neurologist told an emotional story of a lawyer with Lou Gehrig’s disease, whose first question after the dreaded diagnosis was, “Are you sure?” His second question: “When it’s time, will you help me die?”
Except for pockets of excellence, palliative care is inadequate and overburdened and there are times where no amount of oxygen or morphine can relieve suffering, several doctors said.
“Just because we have a respiratory drive, a swallowing reflex and a beating heart doesn’t mean we have a life,” said Calgary family physician Dr. Sarah Bates.
Bates’s mother was diagnosed with Alzheimer’s in her 50s; her 43-year-old sister has just been diagnosed with the memory-robbing disease. “These issues weigh very heavily on my mind,” she said.
“There are times when the most appropriately kind thing to do is to stop the heart beating.”
Montreal neurologist Dr. Angela Genge is among doctors already grappling with an impending change in law in Quebec that would allow patients to choose when and