Re: Interim Guidance on Physician Assisted Death
Virtually all of what is proposed in Interim Guidance on Physician-Assisted Death (IGPAD) is satisfactory, requiring only clarifications to avoid misunderstanding and appropriate warnings concerning the continuing effects of criminal law.
The College has no basis to proceed against physicians who refuse to do anything that would entail complicity in homicide or suicide, including “effective referral,” because they believe that a patient does not fit the criteria specified by Carter. College policies and expectations are of no force and effect to the extent that they are inconsistent with criminal prohibitions.
Proposals about respect for patients, access to services, and providing information are acceptable, subject to some clarifications and limitations with respect to offering the option of suicide. Simple and uncontroversial recommendations are offered to avoid problems associated with failed assisted suicide and euthanasia attempts, and in urgent situations.
However, the requirement for “effective referral “is completely unacceptable. It is ludicrous to assert that the reasoning that underpins the law on criminal complicity and culpability, civil liability and the College policy that prohibits referral for Female Genital Cutting can be dismissed as legally irrelevant to the exercise and protection of fundamental freedoms of conscience and religion.
The College cannot justify a demand for “effective referral” on the grounds that it cannot be understood to involve morally significant complicity in killing patients or helping them to commit suicide, nor can it be justified as a reasonable limitation on fundamental freedom.
The only apparent basis for the College’s demand for effective referral is that it has decided what the Supreme Court of Canada did not decide: that euthanasia and assisted suicide in circumstances defined by Carter are morally/ethically acceptable. College officials seem to consider the College justified in using force – the force of law – to compel dissenting physicians to conform to their moral/ethical views.
This is not a reasonable limitation of freedom but a reprehensible attack on them. It is a paradigmatic example of the authoritarian suppression of freedom of conscience and religion and a serious violation of human dignity. Examples of alternative acceptable policies demonstrate that access to assisted suicide and euthanasia can be ensured without suppressing freedom of conscience and religion.
B1. A note of caution
B2. The questions addressed in Part VII
B3. Plaintiffs’ claim shapes and limits the analysis
B4. Ethics: which one?
B5. Medical ethics
B5.1 Ethics and the willingness of physicians
B5.2 Ethics and the positions of medical associations
B5.3 Ethics and the opinions of ethicists
B5.4 Ethics and current end-of-life practices
B6. Ethics of society
B6.2 Ethics and public opinion
B6.3 Ethics and public committees
B6.4 Ethics and prosecution policies
B7. Summary of the ethical debate
B8. Conclusions about the ethical debate
B8.2 Would Canadian physicians provide the services?
B8.3 Current medical practice with respect to end-of-life care?
B8.4 Does the law attempt to uphold a conception of morality?
B9. Carter Part VII: in brief
B9.1 Unanswered questions
B9.2 Meaningless findings
B9.4 Neglected evidence
B9.5 Deficient review of end-of-life decision-making
B10. On appeal to the Supreme Court of Canada