We are a na­tion of laws and con­science


National Post (Latest Edition) - - ISSUES 7 IDEAS - Dr. Ra­mona Coelho, Lon­don, Ont. Dr. Lu­cas Vi­vas, Toronto Cather­ine Fer­rier, MD, Mon­treal Ri­cardo Di Cecca, Burling­ton, Ont.

Re: When re­li­gion must yield to the law, Derek Smith, June 12. Derek Smith claims that rules are essen­tial to pre­vent re­li­gious physi­cians f rom harm­ing oth­ers. A physi­cian not will­ing to ar­range the killing ( MAiD — Med­i­cal As­sis­tance in Dy­ing) of a pa­tient is now seen by some as caus­ing harm. While that is de­bat­able in our plu­ral­is­tic so­ci­ety, what is clear is that the pro­tec­tion of the pa­tient’s life has al­ways been the foun­da­tion for the trust in the pa­tient- physi­cian re­la­tion­ship.

Groups rep­re­sent­ing Jews, Mus­lims, Chris­tians, Sikhs and sec­u­lar hu­man­ists have all said that ef­fec­tive re­fer­ral isn’t a work­able so­lu­tion for pa­tient ac­cess. The Col­lege of Physi­cians and Sur­geons of On­tario has help­fully sug­gested that physi­cians who can­not adopt their pro- MAiD eth­i­cal frame­work should leave or re­train. Is that a com­pas­sion­ate or cre­ative re­sponse to this co­nun­drum? We all are pay­ing for our health sys­tem and there­fore we all be­long.

These doc­tors have been vo­cal about their will­ing­ness to give in­for­ma­tion and not ob­struct pa­tient wishes. Ev­ery­where else has a more re­spect­ful sys­tem. Why would co­er­cion be part of the equa­tion here in On­tario?

Derek Smith’s men­tions frail pa­tients, un­able to use a phone to self- re­fer. I am a doc­tor with years of home care ex­pe­ri­ence of the most vul­ner­a­ble. I have met new pa­tients who were iso­lated, poor, mal­nour­ished, in pain, and some sui­ci­dal. One can imag­ine that help­ing that pa­tient ac­cess MAiD would not be any­one’s pri­or­ity nor would that pa­tient be in a state to choose such a ser­vice.

For frail and vul­ner­a­ble pa­tients to live in the com­mu­nity, they need a full care team. Any­one on the care team could help make the phone.

There are many ways to ac­com­mo­date both physi­cian and pa­tient in these tricky sit­u­a­tions. Co­er­cion need not be one of them and is not a cre­ative nor a Cana­dian so­lu­tion. Derek Smith is con­cerned that re­li­gious physi­cians may im­pede ac­cess to as­sisted death in “frail pa­tient( s) who can­not make a MAiD phone call.”

A pa­tient so iso­lated that they can­not make a phone call is not in need of killing: they are in need of so­cial sup­ports and care so that they may not be alone in their fi­nal ill­ness.

It is im­pos­si­ble that a pa­tient in such iso­la­tion would re­ally have re­ceived “ad­e­quate pal­lia­tive care”, and fa­cil­i­tat­ing their death will only re­sult in less mo­ti­va­tion to fund and pro­vide the high- qual­ity pal­li­a­tion that our most vul­ner­a­ble so des­per­ately need.

Rather t han spend­ing time and re­sources try­ing to com­pel good doc­tors to lose their in­tegrity or leave the pro­fes­sion, the Col­lege of Physi­cians and Sur­geons and the Min­istry of Health should be fo­cus­ing on pro- vid­ing bet­ter end-of-life care to all On­tar­i­ans. Derek Smith op­poses the law­suit against the Col­lege of Physi­cians and Sur­geons of On­tario by doc­tors who are not will­ing to send pa­tients to be eu­th­a­nized. To sup­port his ar­gu­ments, he cre­ates an imag­i­nary world in which a med­i­cal need is be­ing de­nied to frail peo­ple in emer­gency sit­u­a­tions by re­li­gious zealots who refuse to do their duty.

Medicine is an an­cient and univer­sal pro­fes­sion whose pur­pose is to di­ag­nose, treat and pre­vent dis­ease, and to re­lieve symp­toms where cure is not pos­si­ble.

Canada is one of a tiny mi­nor­ity of coun­tries that per­mit doc­tors to kill pa­tients, an act that re­mains anath­ema to the world­wide med­i­cal com­mu­nity. Even among sup­port­ers of eu­thana­sia there are some who now ques­tion the role of medicine in its ad­min­is­tra­tion.

Con­sider his imag­i­nary frail pa­tient, want­ing eu­thana­sia ( as a now- le­gal per­sonal choice, not a med­i­cal need), but un­able to use a tele­phone or a com­puter to ac­cess a cen­tral­ized re­fer­ral sys­tem.

Does that per­son ex­ist? How does he get gro­ceries or do his bank­ing? If hos­pi­tal­ized, is she not sur­rounded by a host of other peo­ple to whom the re­quest can be made? Is there any­one so iso­lated they can­not find one per­son to help them get what they want? What is Dy­ing with Dig­nity for, if not for that?

What “emer­gency” need for death does he have in mind?

His com­par­i­son be­tween re­fus­ing eu­thana­sia and a re­li­gious de­nial of ur­gent blood trans­fu­sion for a child is lu­di­crous and pa­thetic. The lat­ter has to do with sav­ing life, the for­mer with end­ing it.

If the “emer­gency” is un­con­trolled pain, he should be scream­ing about the real prob­lem of ac­cess to pal­lia­tive care, not ac­cess to death.

And what about this be­ing all about re­li­gion? The el­i­gi­bil­ity cri­te­ria in the law have noth­ing to do with re­li­gion and ev­ery­thing to do with pro­tect­ing pa­tients from choos­ing death with­out hav­ing a chance at lifep­re­serv­ing op­tions. Many ob­ject­ing doc­tors have no re­li­gious af­fil­i­a­tion: they just want the free­dom to keep car­ing for pa­tients in­stead of send­ing them to their death.

We can’t have a de­bate un­less we’re liv­ing in the same world. At the heart of f reedom is the right of con­science. When it is un­der­cut or coerced by the state, it be­comes to­tal­i­tar­ian and dan­ger­ous.

To para­phrase C. S. Lewis: t he road to perdi­tion is a grad­ual one — a gen­tle slope, soft un­der­foot, with­out sud­den curves, with­out mile mark­ers, with­out sig­nage.


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