Quebec Commission on Dying with Dignity Releases Death with Dignity Report

 Improvements to hospice palliative care recommended


Canadian Hospice Palliative Care Association

April 2, 2012 (Ottawa, ON) – The Canadian Hospice Palliative Care Association (CHPCA) is optimistic about many of the recommendations put forth in the Special Commission on Dying with Dignity’s (Commission spéciale sur la question de mourir dans la dignité) report, Dying with Dignity. On March 22, the Committee made 24 recommendations to the Minister of Health and Social Services as to how end-of-life care should be improved in Quebec. Among the recommendations, the CHPCA applauds those focused on the further development of hospice palliative care in Quebec; these include improved training for hospice palliative care professionals, earlier access to hospice palliative care for patients, and the implementation of end-of-life care policy in Quebec.

The CHPCA commends the Committee for their efforts and inclusion of recommendations around improving the quality and delivery of hospice palliative care in Quebec. The Commission conducted extensive hearings with hospice palliative care professionals across Quebec to ensure that all viewpoints were equally represented. The resulting report is a strong first step towards implementing standardized hospice palliative care in Quebec so that all patients may have the highest quality of life and quality of dying

Among the recommendations however, were several advocating for the legalization of physician assisted death**, should the patient request. “Many of the Committee’s recommendations show a positive future for hospice palliative care in Quebec,” stated Sharon Baxter, Executive Director of the CHPCA, “however we need to have a clear distinction between hospice palliative care and physician assisted death. Physician assisted death should not be considered a part of or linked to hospice palliative care ideology or practice.”

“. . .Physician assisted death should not be considered a part of or linked to hospice palliative care ideology or practice.”  . . . Should a legislation allowing physician assisted death be passed by the Quebec government in the future, the dedicated and committed personnel who work in hospice palliative care should not be expected to participate in this practice.

The CHPCA believes that hospice palliative care is about ensuring a good death for all Canadians through an interdisciplinary approach that includes pain and symptom management, psychological support, spiritual care, bereavement care, and much more to address the suffering of patients and their families.

Should a legislation allowing physician assisted death be passed by the Quebec government in the future, the dedicated and committed personnel who work in hospice palliative care should not be expected to participate in this practice.

Right now, only 16% of Canadians who die have access to or receive hospice palliative, and quality end-of-life care services. The CHPCA wants to ensure that all Canadians have the highest quality of life as they live with a life limiting or terminal illness. Too many Canadians die with suffering that could be addressed in a more effective manner. The CHPCA believes that we need to have a greater focus on quality end of life care and the right to high quality hospice palliative care at the end of life for all Canadians as we enter into the debate around the contentious issue of physician assisted death.

**incorporates both terms “euthanasia” and “assisted suicide”


For further information, please contact:

Vanessa Sherry Communications Officer Canadian Hospice Palliative Care Association E-mail: Phone: 613-241-3663 ext: 229

The Canadian Hospice Palliative Care Association — the national voice for hospice palliative care in Canada – is dedicated to the pursuit of excellence in care for persons approaching death so that the burdens of suffering, loneliness and grief are lessened. The CHPCA operates in close partnership with other national organizations and continues to work to ensure that all Canadians, regardless of where they may live, have equal access to quality hospice palliative care services for themselves and their family.

Quebec euthanasia proposal challenged as unbalanced

Margaret Somerville, founding Director of McGill University’s Centre for Medicine, Ethics and Law, criticizes the report of Quebec’s Select Committee on Dying with Dignity on the ground that it is unbalanced “and reads rather like a pro-euthanasia manifesto.”  She notes that two thirds of the submissions received by the Committee opposed euthansia. [The Gazette]


Compulsory referral for euthanasia recommended in Quebec

The Select Committee on Dying with Dignity has tabled a report unanimously recommending “relevant legislation be amended” to allow euthanasia in the province of Quebec.  The Committee also recommends that objecting physicians be forced to refer for the procedure.  According to the recommendations, conscientious objections by nurses will be allowed, but it does not indicate whether or not they should be compelled to participate in or facilitate the procedure by referral or other means. The Committee recommends that codes of ethics for physicians and nurses be amended accordingly.  The recommendations are available in English, but the report will not be available in English until May [Quebec National Assembly].


Withdrawal of nutrition and hydration should be normative

Catherine Constable of the New York University School of Medicine has published a journal article advocating that patients diagnosed as being in a permanent vegetative state (PVS) should be killed by starvation and dehydration unless their families insist that they receive assisted nutrition and hydration.

Constable, C. (2012), Withdrawal of Artificial Nutrition and Hydration for Patiens in a Permanent Vegetative State: Changing Tack. Bioethics, 26: 157–163


Council of Europe asserts that euthanasia “must always be prohibited”

In a document addressing the issue of advance directives, the Parliamentary Assembly of the Council of Europe included the statement, “Euthanasia, in the sense of the intentional killing by act or omission of a dependent human being for his or her alleged benefit, must always be prohibited.”  While the document is not legally binding on member states of the European Union, it has persuasive weight.  It thus seems less likely that health care workers who object to euthanasia will be pressured to participate in the procedure.  However, the document makes no reference to assisted suicide. [Resolution 1859 (2012)]

Warning that protection of conscience laws may enable euthanasia

Burke J. Balch, J.D., director of National Right to Life Committee’s Robert Powell Center for Medical Ethics in the USA, has warned that protection of conscience laws like the  Illinois Health Care Right of Conscience Act and Mississippi’s Health Care Rights of Conscience Act are dangerous because they may permit health care workers to commit euthanasia by withdrawing or refusing to provide medical treatment for reasons of conscience. [NRTL News]


Conscientious commitment

The Lancet, Volume 371, Issue 9620, Pages 1240 – 1241, 12 April 2008

Bernard M. Dickens

In some regions of the world, hospital policy, negotiated with the health ministry and police, requires that a doctor who finds evidence of an unskilled abortion or abortion attempt should immediately inform police authorities and preserve the evidence. Elsewhere, religious leaders forbid male doctors from examining any part of a female patient’s body other than that being directly complained about. Can a doctor invoke a conscientious commitment to medically appropriate and timely diagnosis or care and refuse to comply with such directives? [Full Text]

Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands

N Engl J Med 2000; 342:551-556 February 24, 2000 DOI:10.1056/NEJM200002243420805

Johanna H. Groenewoud, M.D., Agnes van der Heide, M.D., Ph.D., Bregje D. Onwuteaka-Philipsen, Ph.D., Dick L. Willems, M.D., Ph.D., Paul J. van der Maas, M.D., Ph.D., and Gerrit van der Wal, M.D., Ph.D.

Background and Methods

The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in the Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death.


In 114 cases, the physician’s intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5).


There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In the Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient’s inability to take the medication or because of problems with the completion of physician-assisted suicide. [Full text]

Canada Safeway orders pharmacists to dispense abortifacients

In a policy statement that included reference to dispensing euthanasia drugs, RU486 and the ‘morning after pill’, Canada Safeway advised pharmacists who have conscientious objections to dispensing certain drugs that they would be required to do so if a non-objecting pharmacist was not available.