Project Submission to the Canadian Provincial/Territorial Expert Advisory Group on Physician-Assisted Dying

Re:  Implementation of Supreme Court of Canada ruling in Carter v. Canada

I.    Introduction

I.1    The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience among health care workers. It does not take a position on the acceptability of morally contested procedures. For this reason, almost half of the questions in the Written Stakeholder Submission Form are outside the scope of the Project’s interests.

I.2    The completed Written Stakeholder Submission Form is in Appendix “A” of this submission. The responses are numbered for reference purposes.

II.    Scope of this submission

II.1    The responses in the Written Stakeholder Submission Form (Appendix “A”) are supplemented, in some cases, by additional comments in Part III. A protection of conscience policy is suggested in Appendix “B.”

III.    Additional comments on numbered responses

III.1    Role of Physicians (Response 11)

III.1.1    While the Quebec euthanasia kits are to include two courses of medication in case the first does not work,1 insufficient attention has been paid to the fact that euthanasia and assisted suicide drugs do not always cause death as expected.2

III.1.2    Physicians willing to perform euthanasia as well as to assist in suicide should disclose and discuss options available in the event that a lethal injection or prescribed drug does not kill the patient.

III.1.3    Physicians willing to prescribe lethal drugs but unwilling to provide euthanasia by lethal injection should consider what they may be expected to do if a prescribed drug incapacitates but does not kill a patient.

III.1.4    The possibility of this complication provides another reason for insisting that the physician who approves assisted suicide or euthanasia should be the one to administer the lethal medication or to be present when it is ingested. Expecting other health care workers to deal with this complication is likely to increase the likelihood of conflict in what will be an already emotionally charged situation. . . . [Full Text]

A bureaucracy of medical deception?

Falsifying death certificates in euthanasia/assisted suicide cases

Quebec’s new euthanasia law raises questions

Sean Murphy*

lethal-injection-002The Canadian Medical Association is reported to be “seeking ‘clarity'”about whether or not Quebec physicians who perform euthanasia should misrepresent the medical cause of death, classifying death by lethal injection as death by natural causes.

The uncertainty of CMA officials is understandable. They take the position that physicians can have a professional obligation to kill patients in circumstances defined by the Supreme Court of Canada. Since killing is far more serious than mere deception, they may now be at a loss to explain why physicians do not also have a professional obligation to lie.1

Lawyer Jean Pierre Ménard has correctly observed that Quebec’s euthanasia law does not require physicians to report euthanasia on death certificates.1 M. Ménard, an expert on euthanasia law consulted by the Quebec government and the CMA,2 seems unaware of other statutes and guidelines relevant to medico-legal death investigations. . . .[Full Text]

Ontario physicians unwilling to kill patients must help find someone who will

 College of Physicians and Surgeons demands “effective referral” for euthanasia, assisted suicide

For immediate release

Protection of Conscience Project

The College of Physicians and Surgeons of Ontario has quietly issued a directive that physicians who, for reasons of conscience or religion, are unwilling to kill patients or help them commit suicide, must help them find someone willing to do so.

The requirement appears in the policy Planning for and Providing Quality End-of-Life Care, approved in September by College Council:

8.3 Conscientious Objection

Physicians who limit their practice on the basis of moral and/or religious grounds must comply with the College’s Professional Obligations and Human Rights policy.

A note explains that limiting practice includes refusals to “provide care” (i.e., kill patients or assist with suicide.)

The College’s policy, Professional Obligations and Human Rights , demands that physicians who are unwilling to provide procedures for reasons of conscience or religion must make “an effective referral to another health-care provider,” which is defined as “a referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency.”

As a result of the demand for “effective referral,” Professional Obligations and Human Rights is the subject of a legal challenge filed by the Christian Medical and Dental Society and the Canadian Federation of Catholic Physicians’ Societies.  Among other things, the suit alleges actual bias or a reasonable apprehension of bias on the part of the working group that developed the policy.

Professional Obligations and Human Rights was approved by College Council in March, 2015, despite overwhelming opposition to the demand for “effective referral” that was evident in the returns during the public consultation.  The College issued a statement with the policy to the effect that it did not apply to euthanasia or assisted suicide.  It promised to revisit the issue after Parliament or the provincial legislature enacted laws in response to the Supreme Court of Canada decision in Carter v. Canada.

“It was obvious at the time that this was an ingenuous tactic that they hoped would defuse opposition to the policy, at least among Council members” said  Protection of Conscience Project Administrator, Sean Murphy.  “This development simply confirms the obvious.”

Intimidation in Quebec to force physician participation in euthanasia

Letter pleads for support for palliative care physicians

Urgent: we must support our palliative care colleagues

Last week, Dr. Barrette raised the spectre of suspension for physician members of (palliative care) services not wishing to offer euthanasia in hospital. Mr. Ménard, architect of Bill 52, even presses the government to cut subsidies to all palliative care centres in Quebec because they have all decided not to offer euthanasia within their walls, a decision clearly permitted by Bill 52!

Who will bear the brunt of such abuses of power? Terminally ill patients, of course, whose doctor will be suspended or whose palliative care centre will have decreased its services for lack of money. A big mess in perspective.

The population must be aware that these ideologues are about to severely damage, if not ruin, our palliative care network.

We ask all our members to come to the defense of palliative care providers who are currently the target of a true campaign of intimidation that will only increase in the coming months if we do not speak out.

Write massively to the opinion pages of Quebec newspapers and to medical magazines: you will find a list of email addresses to forums and other opinion pages at the bottom of this email.

Speak to politicians and health care administrators in your area.

Show your support for palliative care centres and for your colleagues who give themselves everyday to our weakest and most vulnerable citizens.

Take part in the efforts of the Physicians’ Alliance against Euthanasia to affirm your support for palliative care physicians and end of life patients. This essential and sorely needed service must not disappear.

Catherine Ferrier, MD

President, Physicians’ Alliance against Euthanasia

Physician Alliance Against Euthanasia

1650 avenue Cedar, bureau D17-173 Montréal, QC H3G 1A4 Canada


Pope Francis must defend religious liberty in America

New York Post

Armando Valladares

Thirty years ago, I slid a piece of paper across a table at a secret meeting with the fabled French maritime explorer Jacques Cousteau. In it were dozens of names, all political prisoners in Fidel Castro’s gulags where I spent 22 years of my life. Months later, when Cousteau visited Cuba for research and Castro wanted to scuba dive with him, Cousteau leveraged the release of 80 of those prisoners in exchange. Cousteau used the gift of his fame to change the lives of Cubans for generations to come.

When Pope Francis arrives in the United States this month, he will not barter pictures and backslaps for political prisoners. America is still a nation where its citizens can publicly oppose their political leaders without fear of incarceration. At least for now. But in his unprecedented address to a joint session of Congress, he should protest against the ongoing creation of a new class of prisoners in our society: religious conscientious objectors. [Full Text]

Quebec’s split over euthanasia a warning for Canada

Palliative care specialists’ reluctance to administer life-ending drugs indicates it may be easier to change laws than attitudes.

Toronto Star

Allan Woods

MONTREAL―Quebec”s euthanasia law is the template and test case for the rest of the country, but problems emerging just months before the terminally ill can start demanding their deaths show that laws are easier to change than attitudes.

Since legislation was adopted in the summer of 2014 that would allow dying patients access to a life-ending drug cocktail under strict conditions, politicians here have celebrated the perception of Quebecers being the vanguards of social change.

But with time running out before Dec. 10 — the date that patients can begin requesting the procedure — hospitals and health-care providers are scrambling to draw up policies and find the staff who will carry out those patients” wishes.

If that wasn”t tough enough, some of those who might be expected to lead the change — palliative care physicians and hospice administrators — have let it be known that they are instead digging trenches for the battle.

“The vocation of a palliative care hospice is to provide care, and that doesn”t include medical aid in dying,” said Élise Rheault, director of Maison Albatros Trois-Rivières. . . [Full Text]

Medical leaders grapple with new euthanasia dilemma: What to write on the death certificate

National Post

Sharon Kirkey

As Canada inches closer to granting doctors the power to end the lives of consenting patients, medical leaders are grappling with a new dilemma: should deaths by lethal injection be classified “death by natural causes” on death certificates?

Quebec’s College of Physicians is considering recommending doctors list the underlying terminal disease as the cause of death in cases of “medical aid in dying” on public death records – and not euthanasia.

The college says it wants to ensure life insurance is paid to families in cases of euthanasia and says the province’s assisted-death law will require any doctor who administers euthanasia to report the death to a special oversight body. That information will be kept confidential or shared with the college and/or the doctor’s hospital.

Euthanasia opponents are denouncing the proposal as an attempt to conceal the truth. It is also creating unease among some doctors who worry misstating death certificates could make it difficult to track how often assisted death is occurring once the practice becomes legal in Canada in February, and whether it is being performed legally. . . [Full Text]

Any objections? Doctors still pressured against following conscience

Catholic News Service

Carol Glatz

ROME (CNS) — When St. John Paul II called for conscientious objection against laws legitimizing abortion and euthanasia 20 years ago, one Catholic doctor never imagined the struggle and sacrifice to carry out that duty would last for so long.

Dr. Robert Walley, a British obstetrician and gynecologist who founded and heads MaterCare International, organized the group’s very first world conference in Rome in 2001 on the question of conscience in maternal healthcare. And now, 14 years later, “the problem hasn’t gone away, it’s still here.”

To address the ongoing dilemma, MaterCare held its 10th international conference in Rome Aug. 31-Sept. 4 to look at the problem of discrimination against Catholic obstetricians, gynecologists, midwives, medical students and health care staff when they object to training and procedures that go against their beliefs. Part of the World Federation of Catholic Medical Associations, MaterCare was founded in 1995 to serve mothers and their children.

“In 1973, I had three choices” when he practiced under Britain’s state-run National Health System: do the abortions, change his specialization or leave the country, Walley said. “So we left and went to Canada” to start life over with his wife and seven children to support.

While he was “prepared to accept that cross,” he said he felt he did not receive enough support or encouragement from the church and feels medical professionals who become conscientious objectors are still “basically on our own.” . . . [Full text]

Gaétan Barrette insists dying patients must get help to ease suffering

Quebec’s right-to-die law comes into effect on Dec. 10

The Canadian Press

Terminally ill patients in Quebec who seek medical aid in dying must be provided with the service even if some doctors are against it, Quebec’s health minister said Wednesday.

Gaétan Barrette called out unco-operative doctors and directors of institutions in the province’s health care network Wednesday after a palliative care unit in Montreal announced it wouldn’t offer the service.

Quebec’s right-to-die law comes into effect on Dec. 10 and Barrette says the patient will be the priority.

“The role of (medical) institutions is to offer the service,” he said. “And it will be offered.” . . . [Full Text]

Palliative care centres say no to medically assisted death

West Island Palliative Care Residence won’t obey Quebec’s ‘dying with dignity’ law

CBC News

The director of the West Island Palliative Care Residence says patients seeking assistance with dying will have to go elsewhere.

“We are absolutely one of the 29 [palliative care programs in Quebec] that are opting out of providing this service,” says the residence’s executive director, Theresa Dellar.

“The basic philosophy of palliative care is we do nothing to hasten death, and obviously euthanasia does hasten death. Our philosophy to provide comfort, care and dignity at the end of life and to allow for the natural process of death to take place,” she said. . . . [Full text]