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Protection of Conscience Project

www.consciencelaws.org

Service, not Servitude
Background

Procedures and Services


ASSISTED SUICIDE AND EUTHANASIA

2015-Present

Ensuring access to euthanasia by encouraging physician participation: it's complicated

  • Sean Murphy* | . . . In July, 2017, Canadian euthanasia/assisted suicide (EAS) practitioners and advocates alleged that patient access to euthanasia and assisted suicide was in danger because of "barriers" and "disincentives" to physician participation. . .  There was, in fact, no crisis — only a false perception of crisis fuelled by unrealistic expectations about levels of physician participation in euthanasia and assisted suicide. Nonetheless, it is reasonable for policy makers to respond to their concerns that physicians are discouraged from participating in euthanasia and assisted suicide. . .
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Canada's Summer of Discontent
Euthanasia practitioners warn of nationwide "crisis"
Shortage of euthanasia practitioners "a real problem"

  • Sean Murphy* | . . . Dr. Jesse Pewarchuk of Victoria, British Columbia, had provided euthanasia or assisted suicide for more than 20 patients. However, in July, 2017, having concluded there was "no conceivable way" that providing euthanasia or assisted suicide ("MAID") made "economic sense" for any physician, he made public a letter announcing that he would no longer provide the services. . .
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Access to euthanasia and assisted suicide:
Letter to Canadian Federal and Provincial Ministers of Health

  • Protection of Conscience Project | . . .The issue of access to the services is frequently raised in connection with the exercise of freedom of conscience and religion by dissenting health care practitioners. This not infrequently generates heated controversy, and has already led to a constitutional challenge in Ontario in which the Project has again jointly intervened. However, informed public discourse and public policy making requires accurate, publicly available information about the actual extent of participation by medical professionals and institutions. . .
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L'accès à l'aide médicale à mourir:
Lettre aux ministres fédéral et provinciaux de la santé du Canada

  • Protection of Conscience Project | . . .Le problème de l'accès à ces services est souvent soulevé en lien avec les médecins qui exercent leur droit de liberté de conscience et de religion, en refusant de donner ces services. Ceci génère parfois des controverses sérieuses et a même conduit à une poursuite constitutionnelle en Ontario, dans laquelle le PCP est à nouveau intervenu conjointement. Cependant, pour un discours public informé et une législation juste, il faut que l'information sur la participation réelle des médecins et des institutions soit disponible. . .
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Dr. Robert's regrets: Towards death à la carte?

  • Dr. Yves Robert* | Just over a year after the adoption of the Act Respecting End-of-Life Care (hereafter the Act) in Quebec, the Minister of Health and Social Services recently announced his plan for a reflection on expanding the scope of Medical Aid in Dying (MAID). It would seem that we already want to relax the access criteria. . . If anything has become apparent over the past year, it is this paradoxical discourse that calls for safeguards to avoid abuse, while asking the doctor to act as if there were none.
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Developments in the Practice of Physician-Assisted Death Since Its Legalization in the Netherlands

  • Jacob J.E. Koopman, MD, PhD* | Public prostitution, freely available marijuana, conventional same-sex marriage—yet the Netherlands is, perhaps, best known around the world for pioneering physician-assisted death. Outside of the country, its reputation is easily misconceived and sometimes blown out of proportion. For example, in 2012 the Dutch were astonished to hear this assertion of former U.S. Senator and presidential candidate Rick Santorum . . .
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Euthanasia Statistics: Belgium

  • The Belgian Commission Fédérale de Contrôle et d'Évaluation de l'Euthanasie produces reports on the provision of euthanasia every two years.  The first report covers a period of about 15 months (2002-2003).  The Project has compiled the statistics in tables and charts, some of which are reproduced.  A full Excel file with links to original reports and sources can be downloaded.
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Euthanasia Statistics: Netherlands

  • The Regional Euthanasia Review Committees produce Annual Reports concerning euthanasia and assisted suicide in the Netherlands.  Project has compiled the statistics in tables and charts, some of which are reproduced.  A full Excel file with links to original reports and sources can be downloaded.
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Assisted Suicide Statistics: Oregon

  • The Oregon Public Health Division produces annual reports concerning the Oregon Death with Dignity Act.  Project has compiled the statistics in tables and charts, some of which are reproduced.  A full Excel file with links to original reports and sources can be downloaded.
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Euthanasia Statistics: Quebec

  • IQuebec health and social services agencies (CISSS and CIUSSS) are required to send reports to the commission established by Quebec's euthanasia law to monitor the administration of euthanasia in Quebec (Commission sur les soins de fin de vie). A full Excel file with links to original reports and sources can be downloaded.
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Assisted Suicide Statistics: Washington State

  • The Washington State Dept. of Health produces annual reports concerning the Washington Death with Dignity Act.  The Project has compiled the statistics in tables and charts, some of which are reproduced.  A full Excel file with links to original reports and sources can be downloaded.
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Standing Committee on Justice and Human Rights
House of Commons, Parliament of Canada (May, 2016)

  • Framework and Proceedings of Standing Committee on Justice and Human Rights of the Canadian House of Commons studying Bill C-14, to implement hysician assisted suicide and physician administered euthanasia in Canada
    Standing Committee
 

What's behind the demolition of conscience rights in Canada?

Autonomy, choice, and tolerance are being used to justify euthanasia but these grand principles don't apply to opponents

  • Margaret Somerville* | I've been puzzling about why Canadian "progressive" values advocates, particularly those passionately in favour of the legalization of euthanasia and physician-assisted suicide ("physician-assisted death" (PAD)), are so adamant in trying to force healthcare professionals and institutions who have conscience or religious objections to these procedures to become complicit in them.
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Shocking news

Assisted dying means euthanasia and assisted suicide
Ethical, medical and legal perspectives in tension at committee hearing

  • Sean Murphy* Wayne Kondro protests against the use of the words "euthanasia" and "physician-assisted suicide" during parliamentary hearings conducted by the Special Joint Committee on Physician Assisted Dying. He refers to the proceedings as "shock TV."  He perhaps has a point. The name of the committee does not indicate that the hearings are actually about euthanasia and physician-assisted suicide, so someone watching the proceedings for the first time, might be shocked. . .
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Special Joint Committee on Physician Assisted Dying
Parliament of Canada (January-February, 2016)

  • Framework and Proceedings of Special Joint Senate and House of Commons Committee formed to prepare federal statutory framework for implementation of physician assisted suicide and physician administered euthanasia in Canada
    Special Joint Committee
 

A bureaucracy of medical deception

Quebec physicians told to falsify euthanasia death certificates
Regulators support coverup of euthanasia of from families

  • Sean Murphy* | In the first week of September, the Canadian Medical Association (CMA) was reported to be "seeking 'clarity'"about whether or not physicians who perform euthanasia should misrepresent the medical cause of death, classifying death by lethal injection or infusion as death by natural causes. The question arose because the Quebec College of Physicians was said to be "considering recommending" that Quebec physicians who provide euthanasia should declare the immediate cause of death to be an underlying medical condition, not the administration of the drugs that actually kill the patient.  . . .
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Quebec Euthanasia Guidelines

 

Canadian Medical Association plans for physician assisted suicide, euthanasia
Commentary on draft framework (June/July, 2015)

  • Sean Murphy* | On 6 February, 2015, the Supreme Court of Canada ordered the legalization of physician-assisted suicide and euthanasia in Canada, effective in February, 2016. . . The Canadian Medical Association (CMA) had been preparing for legalization of physician assisted suicide and euthanasia since 2014.  In the months following the ruling, CMA officials and the Board of Directors finalized draft guidelines ("draft framework") on the subject and published them in June.  An internal CMA on-line consulation concerning the draft framework ran from 8 June to 20 July, 2015. . .
    Full Text [Ethics]

2010-2014

When is a problem not a problem?
Refusing to dispense drugs to kill patients with psychiatric illness
Levenseinde Kliniek complains about uncooperative Dutch pharmacists

  • Sean Murphy* | In April, 2014, a complaint was made in the Netherlands that some Dutch pharmacists were refusing to provide euthanasia drugs.  The complaint led members of the Dutch Parliament from the green party, GroenLinks, to ask for a debate with health minister, and members of other Dutch political parties let it be known that they were also concerned. . .
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Promises, promises
Canadian law reformers promise tolerance, freedom of conscience

  • Sean Murphy* |  With the passage of the Quebec euthanasia law and the pending case of Carter v. Canada in the Supreme Court of Canada, physicians, medical students, nurses and other health care workers opposed to euthanasia and assisted suicide for reasons of conscience are confronted by the prospect that laws against the procedures will be struck down or changed.  They may wonder what the future holds for them if that happens.  
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The Mary Dilemma - A Case Study on Moral Distress:
Newborn infant starved to death in Toronto hospital
(Toronto, Ontario, Canada.  2012 or earlier)

  • Fr. Michael Della Penna, ofm,* Francisca Burg-Feret* | This paper begins with a case study describing the perspective of a Catholic nurse who experienced moral distress while observing the tragic death of a newborn infant named Baby Mary. The purpose of this paper is to raise awareness and educate readers about the concept of moral distress and promote a greater understanding of the lived experience of Catholic health care providers who undergo this trauma. It also provides an analysis and some recommendations for practice that can help health care professionals make good ethical choices in difficult situations based on their faith.
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Therapeutic homicide in a neonatal unit?
The Mary Dilemma: Case Study on Moral Distress
(Toronto, Ontario, Canada.  2012 or earlier)

  • Sean Murphy* |  . . .if Baby Mary was being starved to death as reported by the Journal article, it was irrelevant that she was being starved to death by health care professionals wearing white coats in a neonatal intensive care unit. On the contrary: if she was a "child in need of protection" - which, according to the Journal article, she was - then every one of those professionals was obliged to immediately report what was happening to the Children’s Aid Society, and their failure to do so was an offence. . .
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Re:  Redefining the Practice of Medicine

Euthanasia in Quebec
An Act Respecting End of Life Care (June, 2014)

  • Sean Murphy* | Part 1: Overview - An Act Respecting End-of-Life Care ("ARELC") is intended to legalize euthanasia by physicians in the province of Quebec.  It replaces the original Bill 52, the subject of a previous commentary by the Project.  The original text of the Bill 52 did not define medical aid in dying (MAD), but ARELC now makes it clear that Quebec physicians may provide euthanasia under the MAD protocol.  . .
    Part 1
  • Part 2: ARELC in detail - An Act Respecting End-of-Life Care ("ARELC") is intended to legalize euthanasia by physicians in the province of Quebec.  It replaces the original Bill 52, the subject of a previous commentary by the Project. ARELC purports to establish a right to euthanasia for a certain class of patients by including it under the umbrella of "end-of-life care." . . .
    Part 2
  • Part 3: Evolution or Slippery Slope? - Euthanasia laws frequently include guidelines and safeguards intended to prevent abuse.  Eligibility criteria are the most basic guidelines or safeguards.  In considering their stability, it is important to consider not only the elasticity of existing statutory provisions, but recommendations for expansion that might ultimately result in changes to the law. . .
    Part 3
  • Part 4: The Problem of Killing - The original text of Bill 52 did not define "medical aid dying" (MAD), but it was understood that, whatever the law actually said, it was meant to authorize physicians to kill patients who met MAD guidelines.  The Minister of Health admitted that it qualifed as homicide, while others acknowledged that MAD meant intentionally causing the death of a person, and that its purpose was death. . .
    Part 4
  • Part 5: An Obligation to Kill - Statistics from jurisdictions where euthanasia and/or assisted suicide are legal suggest that the majority of physicians do not participate directly in the procedures.  Statistics in Oregon and Washington state indicate that the proportion of licensed physicians directly involved in assisted suicide is extremely small. . .
    Part 5
  • Part 6: Participation in Killing - It appears that, even where euthanasia or assisted suicide is legal, the majority of physicians do not actually provide the services.  However, by establishing a purported legal "right" to euthanasia, ARELC generates a demand that physicians kill their patients, despite the high probability that a majority of physicians will not do so. . .
    Part 6
  • Part 7: Refusing to Kill - It is important identify problems that the Act poses for those who object to euthanasia for reasons of conscience, and to consider how objecting health care workers might avoid or respond to coercion by the government and the state medical and legal establishments . . .
    Part 7
  • Part 8: Hospitality and Lethal Injection - Under the Act Respecting End of Life Care (ARELC) palliative care hospices may permit euthanasia under the MAD protocol on their premises, but they do not have to do so.  Patients must be advised of their policy before admission.  The government included another section of ARELC to provide the same exemption for La Michel Sarrazin, a private hospital.  The exemptions were provided for purely pragmatic and political reasons. . .
    Part 8
  • Part 9: Codes of Ethics and Killing - Refusing to participate, even indirectly, in conduct believed to involve serious ethical violations or wrongdoing is the response expected of physicians by professional bodies and regulators.  It is not clear that Quebec legislators or professional regulators understand this. . .
    Part 9

Consultations & hearings on Quebec Bill 52
September-October, 2013

2005-2009

The Case of the Disappearing Plaintiffs:
Robert Baxter et al vs. State of Montana
(Montana, USA: 2008-2009)

  • Sean Murphy* | . . . Janet Murdock lived in Missoula with the four physicians, who, citing their "professional obligation to relieve suffering," convinced a judge to legalize assisted suicide in Montana.  Where were they in Janet Murdock's 'hour of need'? . . .
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Conscience Situation OK - For Now
(Oregon, USA: September, 2005)

  • Ed Langlois | . . .now that more than 200 Oregonians have used the assisted-suicide law to die, doctors and pharmacists have worked out a system on their own. Physicians writing lethal prescriptions call ahead to pharmacies to make sure the pharmacist is willing to comply.
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2000-2004

Belgium: mandatory referral for euthanasia
(December, 2003)

  • Sean Murphy* |. . .The Flemish Palliative Care Federation is silent on the issue of referral, but the joint statement asserts that an objecting physician must not only give patients timely notice of his position, but must "organise a smooth referral." At another point the joint statement insists that an objecting physician work together with the patient to find a willing colleague. . .
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Edmonton Hospitals Suspected of Euthanasia
(Edmonton, Alberta, Canada: 2001)

  • Candis McLean | . . .The Elder Advocate of Alberta . . . says that if the case does prove to be euthanasia, it will not be the first she has seen documented. . . Far more common, however, she says, is euthanasia by failure to feed or hydrate. . .
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Assisted Suicide: What Role for Nurses?
(USA: May, 2000)

  • Carrie Farella* | Initially, when [Oregon's assisted suicide law] was designed, the assumption was that physicians would be the first ones to explore PAS with patients," . . . "but in reality, nurses are usually the ones in the line of fire. Patients often feel nurses understand their wishes for good quality of life and good quality of death, too."
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1995-1999

British Medical Association proposes death by dehydration
(United Kingdom: 1999)

  • Letter | . . .Withdrawal of fluids will cause the patient to die from dehydration, which is distressing to the patient, to the carers and to relatives. It is disingenuous and inhumane to suggest the contrary. . .
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1990-1994

Chief Justice favours assisted suicide, willing to order assistance
(Canada: 1993)

  • When ruling on the case of Sue Rodriguez, who was seeking legalized assisted suicide, Chief Justice Antonio Lamer of the Supreme Court of Canada expressed the opinion that assisted suicide should be available to everyone.  Those who object to euthanasia or assisted suicide have cause for concern that the also implied that some unspecified actor had a duty to assist Rodriguez to commit suicide.
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From Abortion to Euthanasia: Nurses on the Spot
(British Columbia, Canada: November, 1991)

  • Transcript | ". . .  nurses are employed by the government. . . I could be weeded out if I don't go along with euthanasia. I have a contract. I have my nurse's, my RNABC contract as well. If it becomes a policy under the RNABC, if it becomes a policy under the hospital hiring policy, I am in contract to kill. It's as simple as that. . ."
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