Redefining the Practice of Medicine- Euthanasia in Quebec, 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.  At most, 2.31% of all Belgian physicians were directly involved in reported euthanasia cases, and the actual number could be much lower.  A maximum of 9% to 12% of all Dutch physicians have been directly involved, most of them general practitioners.  The current situation in Belgium and the Netherlands suggests that, for some time to come, a substantial majority of Quebec physicians will probably not lethally inject patients or provide second opinions supporting the practice.

It is anticipated that between 150 and 600 patients will be killed annually in Quebec by lethal injection or otherwise under the MAD protocol authorized by ARELC.  While these estimates amount to only a small percentage of the deaths in the province each year, and while Quebec has about 8,000 physicians in general practice, there is concern that only a minority of physicians will be willing to provide euthanasia, and it may be difficult to implement ARELC.

The reason for the concern appears to be that ARELC purports to establish MAD as a legal “right” that can be exercised and enforced anywhere in the province, but physicians willing to provide the service are unlikely to be found everywhere.  As a result, in some areas, if no physicians are willing to provide MAD services, patients wanting euthanasia may be unable to exercise the “right” guaranteed by the statute.

Rather than deny either patients’ access to euthanasia or physicians’ freedom of conscience, several mechanisms have been proposed to accommodate both.  Delegation is not permitted by law, and transfer of patients will not normally be feasible.  However, workable alternatives include the advance identification of willing physicians in each region, the use of electronic communcation services to permit remote consultation and the establishment of mobile “flying squads” of euthanatists to provide services not otherwise available in some parts of the province.

Euthanasia proponents deny that they intend to force physicians to personally kill patients, but the exercise of freedom of conscience by objecting physicians who refuse to kill patients can lead to unjust discrimination against them.  Discriminatory screening of physicians unwilling to kill patients can be effected by denying them employment in their specialties and denying them hospital privileges.  By such strategies one can truthfully affirm that physicians are not actually being forced to kill, although those unwilling to do so may be forced to change specialties, leave the profession or emigrate. [Full Text]

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