Quebec’s new assisted-dying law leaves doctors struggling to adapt

Fear of legal reprisal still widespread among health professionals

CBC News

Two months after Quebec’s assisted-dying law came into effect, about 10 patients have chosen to end their lives with the help of a doctor.

Health Minister Gaétan Barrette says this is a sign that things are going well and there are no systematic obstacles.

“The information that I have from the ground and from the College of Physicians is that teams are in place and that access is there,” Barrette said.

“Problems, if there were any, were resolved quickly.”

Doctors and patient advocates tell a different story.

Jean-Pierre Ménard, a lawyer specializing in health law, says his clients have reported trouble obtaining medical assistance to die. . . [Full text]

 

 

Médecins: la « solution » du Québec est une collaboration au meurtre, pas un compromis « élégant »

 

quebec-001Les médecins rejettent le « compromis ultime » qui oblige à référer les demandes d’euthanasie 

Ne forcez personne à agir contre sa  volonté : ni les médecins, ni qui que ce soit d’autre.

Introduction (par l’Administrateur de Projet

En juin 2014, le Québec a adopté une loi autorisant l’euthanasie dans la province, en dépit de l’interdiction pénale de cette procédure encore en vigueur. La province a fait valoir que l’euthanasie administrée par un médecin est une forme de soin de santé et que, à ce titre, elle est exempte de la juridiction du gouvernement fédéral en matière criminelle. La loi du Québec est donc entrée en vigueur en décembre 2015, soit 10 mois après que la Cour suprême du Canada ait invalidé l’interdiction pénale de l’euthanasie et du suicide avec l’assistance d’un médecin dans Carter c. Canada (Procureur général).  La Cour suprême avait toutefois suspendu sa décision pour un an afin de permettre au gouvernement fédéral de développer une loi, de sorte que l’interdiction pénale contre l’euthanasie était toujours officiellement applicable lorsque la loi provinciale autorisant sa pratique est entrée en vigueur au Québec.

En réponse à une poursuite intentée par des médecins qui s’y opposaient, une injonction contre la loi a été appliquée par la Cour supérieure du Québec le 1er décembre, 2015, mais a été annulée par la Cour d’appel du Québec trois semaines plus tard. La décision de la Cour d’appel a été basée sur le fait que la loi québécoise était conforme à la décision Carter, bien qu’elle doive être soumise à une révision une fois que le gouvernement fédéral aura modifié le Code criminel.

Le Dr Yves Robert est le secrétaire du Collège des médecins du Québec, organisme gouvernemental de réglementation de la pratique médicale dans la province. Il y a trois ans, le Dr Robert a témoigné devant un comité législatif chargé d’étudier le projet de loi – qui est par la suite devenu la loi sur l’euthanasie au Québec – aux côtés du Dr Charles Bernard, président du Collège des médecins. À cette époque, le Dr Bernard avait dit:

Parce que, si on a une objection de conscience puis c’est nous qui doive faire la démarche pour trouver la personne qui va le faire, à ce moment-là , notre objection de conscience ne s’applique plus. C’est comme si on le faisait quand meme.[Consultations]

Toutefois, en novembre 2015, juste avant l’entrée en vigueur de la loi sur l’euthanasie au Québec, le Dr Robert a écrit un editorial affirmant que forcer les médecins qui s’objectent à référer les demandes d’euthanasie est un compromis qui concilie les droits et libertés des patients et des médecins.

La position du Dr Robert a été rejetée dans la réponse ci-dessous, une lettre très articulée cosignée par plus de 80 médecins du Québec, auxquels près de 350 autres médecins ont ajouté leur nom par la suite. Ce rejet est particulièrement important parce que le président de l’Association canadienne de protection médicale (ACPM) a récemment recommandé le modèle québécois comme une solution «élégante» qui concilie la liberté de conscience et de religion des médecins avec le droit des patients à accéder à l’euthanasie et au suicide assisté.

De toute évidence, les personnes les plus directement touchées par la « solution » du Québec ne partagent pas cette opinion.


Préambule :

La présente lettre a été écrite en réaction de l’éditorial du Dr. Robert paru dans LE COLLÈGE (novembre 2015) au sujet de l’objection de conscience des médecins sous la Loi concernant les soins de fin de vie dont l’entrée en vigueur était prévue le 10 décembre 2015.

Débattue en Cour supérieure du Québec suite à une demande d’injonction déposée par une coalition de médecins, le jugement rendu s’est appuyé sur la doctrine de la prépondérance fédérale sur les lois provinciales pour empêcher les articles concernant l’aide médicale à mourir d’entrer en vigueur comme prévu à cause de leur incompatibilité avec le Code criminel canadien.

La présente lettre a donc été rédigée à la lumière des conclusions du jugement de la Cour supérieure du Québec rendu le 2 décembre 2015, et elle est appuyée par 84 médecins cosignataires.

Objection scientifique à l’éditorial du Dr Yves Robert

La transmission de la demande d’un patient à une autorité du réseau de la santé qui pourra y donner suite apparaît donc comme l’ultime compromis pour respecter les droits du patient et ceux du médecin » Dr Yves Robert, LE COLLÈGE, 10 novembre 2015

Dr Robert,

Cette déclaration que vous avez faite à titre de secrétaire du Collège des Médecins du Québec est complètement fausse.

Pour commencer, retenons d’abord cet extrait, tiré du jugement de la Cour supérieure (paragraphe 97) : « L’avocate de la PGC a également manifesté son inquiétude face aux dispositions de l’article 31 de la Loi qui impose aux médecins qui ne voudraient pas accéder à une demande d’ de participer, malgré leur objection, au processus visant à trouver un autre médecin volontaire et consentant. Elle y voit par le fait même une indication que même un médecin, objecteur de conscience, sera forcément impliqué dans un processus allant mener à la commission d’un acte criminel dans l’état du droit actuel ».

Voilà qui résume sans ambiguïté le fond de la pensée de la procureure générale du Canada et de la Cour supérieure du Québec concernant votre « ultime compromis » au sujet de l’objection de conscience, opinion également partagée par le Collège des Médecins du Québec.

Cette forme de collaboration à la mise à mort de son patient, n’en déplaise au secrétaire, n’est pas l’ultime compromis. C’est une contrainte de collaboration – qui peut être vécue par un médecin comme une complicité pour un geste qu’il considère comme dommageable pour son patient et ce, peu importe que ce geste soit reconnu comme criminel ou non (la criminalité évoquée ici n’est qu’un facteur amplifiant la violence de l’obligation).

Moi, je veux continuer d’offrir des soins à mon patient, je ne romps pas la relation. Je refuse uniquement de causer sa mort. Qu’allez-vous faire contre mon jugement médical?

Si vous me suspendez, c’est vous qui brisez la relation de soin en privant le patient de son médecin alors que moi je suis disposé à continuer de le soigner. Mais je considère qu’envoyer mon patient se faire tuer n’est pas un soin parce que… se faire tuer n’est pas un soin, ni pour

moi, ni pour l’écrasante majorité des médecins et des associations médicales partout dans le monde. C’est donc d’une objection médicale qu’il est question ici, car moi j’applique la norme internationale, tandis que le Collège a décidé de façon unilatérale d’y faire dissidence.

Il s’agit donc beaucoup plus ici d’une objection scientifique que d’une objection de conscience puisque le but est de continuer à appliquer les standards et les normes internationales auxquels le Collège avait décidé de faire dissidence.

Étant donné que la plupart des médecins ne seront jamais d’accord pour cesser de prévenir le suicide de leurs patients, on ne pourra pas les contraindre à cesser cette prévention car leur jugement médical et leur expertise – qu’ils appliquent depuis des années – leur dit de ne pas le faire. Prévenir le suicide reste de la bonne médecine.

De façon analogue, un directeur d’hôpital ne peut m’obliger à pratiquer une chirurgie pour mon patient si mon opinion médicale m’indique que cette chirurgie lui sera néfaste. Ça ne veut pas dire que je brise la relation d’aide avec mon patient, seulement que j’exerce ma profession avec mon jugement et ma compétence, ce qui revient à dire que je ne suis pas un simple technicien qui ne serait que « les mains de quelqu’un d’autre ».

De la même façon, aucun patient ne peut me forcer à pratiquer une chirurgie que je considère mauvaise ou néfaste, et il va de soi que le minimum de cohérence professionnelle m’empêcherait de le référer à quelqu’un qui la pratiquerait à ma place. Je lui dirais simplement que ce n’est pas la chose à faire, et il sera libre d’aller voir ailleurs. Mais si j’organisais ce transfert vers un collègue ou une autorité du réseau de la santé sachant que le geste que je considère néfaste sera posé, ce serait comme si je le pratiquais moi-même par mains interposées.

C’est cette logique terre-à-terre que le Collège doit comprendre dans la réaction des médecins (palliativistes ou autres) qui ne veulent pas collaborer au cheminement vers la mort médicalement provoquée de leurs patients. Ces médecins, qui ne sont pas des illuminés ou des fanatiques, voient cette intention de l’État (et du Collège) de leur imposer la collaboration forcée comme un abus d’autorité. L’utilisation du terme « ultime compromis », dans ce contexte, résonne beaucoup plus comme « c’est ma dernière offre ». Et pour continuer de bien nommer les choses, on appelle plutôt ça un ultimatum – et la procureure général du Canada a bien fait de noter l’intention réelle derrière les mots.

En conclusion, si le Collège veut éviter une confrontation injuste et inutile avec des médecins qualifiés, attentionnés et intègres, qu’il trouve une façon de ne pas les contraindre à participer à la mort de leurs patients contre leur jugement médical et leur conscience professionnelle.

Même si les nouvelles mesures d’exception (ne pas lire « règle ») qui seront établies prochainement dans le Code criminel canadien en viennent à permettre l’euthanasie humaine ou le suicide assisté dans certaines conditions, il est impératif de rappeler que de forcer les médecins à référer – en les menaçant de surcroît – constituera toujours une recette assurée pour créer des batailles inutiles et dommageables pour tous, en semant la division et en générant un environnement pourri dans nos hôpitaux.

Le vrai compromis qui respecte l’autonomie de tout le monde serait plutôt celui-ci: si, un jour, il y a dépénalisation de l’euthanasie humaine ou du suicide assisté, laissez les patients faire leurs démarches eux-mêmes par l’entremise d’un système fait de volontaires, sans forcer leurs médecins traitants ni aucun autre intervenant à y participer contre leur gré.

Marc Beauchamp, MD, FRCSC, chirurgien orthopédiste, Montréal

Avec l’appui des cosignataires suivants :

1. Renata Sava, MD, médecin de famille, Montréal

2. Louis Morissette, MD, FRCPC., surspécialiste en psychiatrie légale, Montréal

3. Yousri Hanna, MD, chef de l’Unité des Soins Palliatifs de Santa Cabrini, Montréal

4. Yvan Roy, MD, médecin de famille, L’Assomption

5. Bernard H. Doray, MD, pédiatre, Montréal

6. Antonio Tongué, MD, radiologiste, Gatineau

7. Stephen Martin, MD, médecin de famille, Montréal

8. François Belzile, M.D, FRCPC, radiologiste, Sherbrooke

9. Roy Eappen, MD, endocrinologue, Montréal

10. Annik Dupras, MD, FRCPC, interniste-gériatre, Terrebonne

11. René Pouliot, MD, néphrologue, Québec

12. Francine Gaba, MD, gériatre, Montréal

13. Jacques R. Rouleau, MD, CSPQ, FRCPC, FACC (Institut universitaire de cardiologie et de pneumologie de Québec, Professeur titulaire de médecine, Université Laval)

14. Roger Roberge, MD, gériatre, Montréal

15. Elisabeth Fuvel-Girodias, MD, Kirkland

16. Louis Béland, MD, chirurgien, Québec

17. Nathalie de Grandpré, MD, médecin de famille, Montréal

18. Michelle Bergeron, MD retraitée, Québec

19. Mark Basik MDCM, FRCS(C), chirurgien oncologue, Montréal

20. Guy Bouchard, MD, médecin de famille, Québec

21. Valérie J. Brousseau, BScH, MDCM, FRCSC, oto-rhino-laryngologue, Victoriaville

22. Claude Morin, MD, médecin de famille, Québec

23. Nicholas Newman, MD, FRCSC, chirurgien orthopédiste, Montréal

24. Michel Brouillard, MD, médecin de famille, Rouyn-Noranda

25. Mance Luneau, MD, médecin de famille, Blainville

26. Suzanne Labelle, MD, médecin de famille, Laval

27. Jean-Bernard Girodias, MD, pédiatre, Montréal

28. Juan Francisco Asenjo, MD, anesthésiologiste, Montréal

29. Paul Barré, MD, nephrologue, Montréal

30. Michel Copti, MD, neurologue, Saint-Lambert

31. Liette Pilon, MD, médecin de famille, Montréal

32. André Rochon, MD, médecin de famille, Montréal

33. Douglass Dalton, MD, médecin de famille, Montréal

34. Marie-Chantal Piché, MD, médecin de famille, Vaudreuil-Dorion

35. Odile Michaud, MD, médecin de famille, Otterburn Park

36. Catherine Ferrier, MD, médecin de famille, Montréal

37. Michel de Maupeou, MD, médecin de famille, La Sarre

38. Vijayabalan Balasingam, MD, neurochirurgien, Pointe-Claire

39. Pierrette Girard, MD, chirurgienne orthopédiste, Pointe-Claire

40. Jacques Beaudoin, MD, cardiologue, Québec

41. Marc Bergeron, MD, hémato-oncologue, Québec

42. Rosaire Vaillancourt, MD, FRCPC, chirurgien thoracique, Québec

43. Louis Dionne, MD, chirurgien général, Québec

44. Juan Rivera, MD, endocrinologue, Montréal

45. Lyette St-Hilaire, MD, médecin de famille, Laval

46. Matthieu Tittley, MD, FRCPC, psychiatre, Sherbrooke

47. Luc Chaussé, MD, médecin de famille, L’Assomption

48. Gilles Gaudreau MD, médecin de famille, Sorel-Tracy

49. Evelyne Huglo, MD, médecin de famille, Montréal

50. Hong Phuc Tran-Le, MD, FCMF, médecin de famille, Val d’Or

51. Laurence Normand-Rivest, MD, médecin de famille, Châteauguay

52. Daniel Boulet, MD, FRCP(C), physiatre, Qu.bec

53. Anne-Louise Boucher, MD, responsable médical GMF du Carmel, Trois-Rivières

54. Mathieu Brouillet, MD, médecin de famille, Rimouski

55. David Bacon, MD, CM, CCFP-EM, médecin de famille, Pointe-Claire

56. Marcel D’Amours, MD, anesthésiologiste, Québec

57. Anne Marie Uhlir, MD, médecin de famille, Sainte-Croix

58. Mélanie Laberge, MD, omnipraticienne, Québec

59. Heather Coombs, MD, urgentologue, Montréal

60. Svetlana Ninkovic, MD, pédiatre, neurologue, Greenfield Park

61. Roland Leclerc, MD, pédiatre, Québec

62. Jean-Pierre Beauchef, MD, endocrinologue, Greenfield Park

63. Serge Daneault, MD, soins palliatifs, Montréal

64. Patricia Marchand, MD, médecin de famille, Trois-Rivières

65. Louis Martel, MD, médecin de famille, Trois-Rivières

66. Daniel Viens, MD, FRCPC, interniste, Drummondville

67. Roseline LeBel, MD, médecin de famille, Laval

68. Sonia Calouche, MD, psychiatre, Saint-Eustache

69. Cecile Hendrickx, MD

70. Marie-France Raynault, MD, santé publique, Montréal

71. Julie Gauthier, MD, médecin de famille, Montréal

72. Olivier Yaccarini, MD, médecin de famille, Québec

73. Caroline Girouard, MD, oncologue médicale, Hôpital Sacré-Coeur, Montréal

74. Pierre Duclos, MD, endocrinologue, Québec

75. Normand Lussier, MD, médecin de famille, Montréal

76. Paola Diadori, MD, neurologue, Montréal

77. Bruno Gagnon MD, MSc, Soins Palliatifs, Université Laval, Québec

78. Judith Trudeau, MD, rhumatologue, Hôtel-Dieu de Lévis

79. Yves Bacher, MD, gériatre, Montréal

80. Tommy Aumond-Beaupré, MD, médecin de famille, Montréal

81. Joseph Ayoub, MD, oncologie et soins palliatifs, Montréal

82. Xavier Coll, MD, cardiologue, Lachenaie

83. Léonard Langlois, MD, pédiatre, Sherbrooke

84. Anne Larkin, MD, généraliste depuis plus de 36 ans, Waterloo

Physicians: Quebec “solution” is collaboration in killing, not an “elegant” compromise

quebec-001Physicians reject claim that referral for euthanasia is “ultimate compromise”

Force no participants to act against their will, neither doctors nor anyone else.

Introduction (by Project Administrator)

In June, 2014, Quebec passed a law authorizing euthanasia in the province, despite the standing criminal prohibition of the procedure.  The province argued that physician-administered euthanasia is a form of health care, and, as such, exempt from the jurisdiction of the federal government in criminal law.  The Quebec law came into force in December, 2015, 10 months after the Supreme Court of Canada struck down the criminal prohibition of physician assisted suicide and physician administered euthanasia in Carter v. Canada (Attorney General) The Supreme Court had, however, suspended its ruling for one year to give governments a chance to develop legislation, so the criminal law against euthanasia was still officially in force when the provincial law authorizing it came into effect in Quebec.

In response to a lawsuit launched by objecting physicians, an injunction against the law was issued by the Quebec Superior Court on 1 December, 2015, but overruled by the Quebec Court of Appeal three weeks later.  The Court of Appeal ruling was based on the fact that the Quebec law was consistent with the Carter decision, though subject to review once the federal government amended the Criminal Code.

Dr. Yves Robert is the Secretary of the Collège des médecins du Québec, the state regulator of medical practice in the province.  Three years ago, he appeared before a legislative committee studying the bill that later became the province’s euthanasia law with Dr. Charles Bernard, President of the Collège des médecins.  At that time, Dr. Bernard said:

“[I]f you have a conscientious objection and it is you who must undertake to find someone who will do it, at this time, your conscientious objection is [nullified]. It is as if you did it anyway.” | “Parce que, si on a une objection de conscience puis c’est nous qui doive faire la démarche pour trouver la personne qui va le faire, à ce moment-là , notre objection de conscience ne s’applique plus. C’est comme si on le faisait quand meme.[Consultations]

However, in November, 2015, just before the Quebec euthanasia law came into force, Dr. Robert wrote an editorial claiming that forcing objecting physicians to refer for euthanasia is a compromise that reconciles the rights and freedoms of both patients and physicians.

Dr. Robert’s position was rejected in the following strongly worded response from over eighty Quebec physicians, to which others subsequently added their names.  The rejection is particularly significant because the President of the Canadian Medical Protective Association recently recommended the Quebec model as an “elegant” solution that reconciles physician freedom of conscience and religion with the legal right of patients to access euthanasia and assisted suicide. Clearly, those most directly affected by the Quebec “solution” do not share that opinion.


PREAMBLE:

The present letter was written in response to Dr. Robert’s editorial, which appeared in Le Collège (November 2015), concerning the objection of conscience of physicians under the Loi concernant les soins de fin de vie [“Law Respecting End-of-life Care”], which came into force on December 10, 2015.

Debated in the Quebec Superior Court following an injunction sought by a coalition of physicians, the decision rendered was based on the doctrine of federal preponderance over provincial law, preventing the articles concerning physician-assisted dying from taking effect as planned due to their incompatibility with the Criminal Code.

The present [French language] letter was written in light of the conclusions of the ruling given by the Quebec Superior Court on December 2, 2015, and is supported by 84 co-signed physicians.

The English version, released on January 20, 2016, is supported by a total of 344 physicians.

Scientific Objection to Dr. Yves Robert’s Editorial

[“Referring the patient’s request to a health care professional who would follow through with it would then seem the ultimate compromise, respecting patient’s and physician’s rights.” \ “La transmission de la demande d’un patient à une autorité du réseau de la santé qui pourra y donner suite apparaît donc comme l’ultime compromis pour respecter les droits du patient et ceux du médecin.” Dr Yves Robert, LE COLLÈGE, 10 novembre 2015]

The above statement that you made as Secretary of the Collège des médecins du Québec is absolutely false.

First, let’s recall this excerpt, from of the Superior Court ruling (par. 97): “The lawyer of the Attorney General of Canada also expressed her concern about article 31 of an Act respecting end-of-life care, obliging physicians who do not want to grant a request for physician-assisted dying, to participate, despite their objection, in the process of finding a willing physician. She sees in this fact itself an indication that even a physician, conscientious objector, would inevitably become involved in a process leading to the commission of a criminal act under the current state of the law”.

This summarizes without ambiguity the thoughts of the Attorney General of Canada and the Quebec Superior Court concerning your “ultimate compromise” on the subject of conscientious objection, also shared by the Collège des médecins du Québec.

This form of collaboration in killing a patient, with all due respect, is not the ultimate compromise. It is an obligation to collaborate — which can be experienced by a physician as complicity in an act he considers to be harmful to his patient, irrelevant whether the act is criminal or not (the crime evoked here only compounds the insult of the obligation).

As for me, I want to continue to offer care to my patient; not sever the relationship. I simply refuse to cause his death. What will you do against my medical judgment?

If you suspend me, you are the one severing the care relationship by depriving a patient of his physician, whereas I am willing to continue caring for him. I do not consider sending my patient to be killed as providing care because… to be killed is not a treatment, neither for me, nor for the overwhelming majority of physicians and medical associations all over the world. This then is a question of medical obligation, because I apply the international norm, while the Collège has decided unilaterally to disagree.

The issue here is much more a question of scientific objection than an objection of conscience because the purpose is to apply the international norms and standards the Collège decided to disagree with.

Given that most physicians will never agree to stop preventing suicide among their patients, we cannot compel them to stop this prevention because their medical judgement and expertise—that they have applied for years—tells them not to do it. Simply put, preventing suicide remains good medicine.

Likewise, a hospital director cannot force me to perform surgery on my patient if my medical opinion tells me the surgery would be harmful. It does not mean that I sever the professional relationship with my patient, only that I exercise my profession with my judgement and my competence, which means to say that I am not a simple technician who will only serve to be “someone else’s hands.”

In the same way, no patient can force me to perform surgery that I consider bad or harmful, and it is understood that the minimum degree of professional consistency would prevent me from referring him to someone who would perform it in my place. I would simply tell him that it is not recommended, and he would be free to go elsewhere. If however, I were to transfer him to a colleague or health care professional knowing that the procedure I consider harmful will be conducted, it would be as though I performed it through the hands of another.

The Collège needs to recognize this logical response from physicians (palliative and other) who do not want to collaborate in paving the way toward the medically assisted death of their patients. These physicians, who are neither fanatical nor arrogant, see this intention of the state (and of the Collège) to impose on them a forced collaboration like an abuse of authority. The use of the term “ultimate compromise,” in this context, sounds a lot like “this is my final offer.” That, would sooner be called an ultimatum—and the Attorney General of Canada did well to note the real intention behind the words.

In conclusion, if the Collège hopes to avoid unjust and unnecessary confrontation with qualified and attentive physicians of integrity, it should find a way not to compel them to assist in the death of their patients against their medical judgement and their professional conscience.

Even if the new exception measures (not to read “rule”) that will soon be established in the Canadian Criminal Code allows for euthanasia or assisted suicide under certain conditions, you must remember that forcing physicians to refer—moreover to threaten them—is a sure-fire way to cause unnecessary and damaging battles for all, to cause division and spoil the collegial environment in our hospitals.

If, one day, euthanasia or assisted suicide are decriminalized, a true compromise—one that would respect everyone’s autonomy—would be something like this: let patients carry out their own wishes by putting a voluntary system in place, forcing no participants to act against their will—neither their doctors nor anyone else involved.

Marc Beauchamp, MD, FRCSC, orthopedic surgeon, Montreal

With the support of the 344 undersigned:

1. Renata Sava, MD, médecin de famille, Montréal

2. Louis Morissette, MD, FRCPC., surspécialiste en psychiatrie légale, Montréal

3. Yousri Hanna, MD, chef de l’Unité des Soins Palliatifs de Santa Cabrini, Montréal

4. Yvan Roy, MD, médecin de famille, L’Assomption

5. Bernard H. Doray, MD, pédiatre, Montréal

6. Antonio Tongué, MD, radiologiste, Gatineau

7. Stephen Martin, MD, médecin de famille, Montréal

8. François Belzile, M.D, FRCPC, radiologiste, Sherbrooke

9. Roy Eappen, MD, endocrinologue, Montréal

10. Annik Dupras, MD, FRCPC, interniste-gériatre, Terrebonne

11. René Pouliot, MD, néphrologue, Québec

12. Francine Gaba, MD, gériatre, Montréal

13. Jacques R. Rouleau, MD, CSPQ, FRCPC, FACC (Institut universitaire de cardiologie et de pneumologie de Québec, Professeur titulaire de médecine, Université Laval)

14. Roger Roberge, MD, gériatre, Montréal

15. Elisabeth Fuvel-Girodias, MD, Kirkland

16. Louis Béland, MD, chirurgien, Québec

17. Nathalie de Grandpré, MD, médecin de famille, Montréal

18. Michelle Bergeron, MD retraitée, Québec

19. Mark Basik MDCM, FRCS(C), chirurgien oncologue, Montréal

20. Guy Bouchard, MD, médecin de famille, Québec

21. Valérie J. Brousseau, BScH, MDCM, FRCSC, oto-rhino-laryngologue, Victoriaville

22. Claude Morin, MD, médecin de famille, Québec

23. Nicholas Newman, MD, FRCSC, chirurgien orthopédiste, Montréal

24. Michel Brouillard, MD, médecin de famille, Rouyn-Noranda

25. Mance Luneau, MD, médecin de famille, Blainville

26. Suzanne Labelle, MD, médecin de famille, Laval

27. Jean-Bernard Girodias, MD, pédiatre, Montréal

28. Juan Francisco Asenjo, MD, anesthésiologiste, Montréal

29. Paul Barré, MD, nephrologue, Montréal

30. Michel Copti, MD, neurologue, Saint-Lambert

31. Liette Pilon, MD, médecin de famille, Montréal

32. André Rochon, MD, médecin de famille, Montréal

33. Douglass Dalton, MD, médecin de famille, Montréal

34. Marie-Chantal Piché, MD, médecin de famille, Vaudreuil-Dorion

35. Odile Michaud, MD, médecin de famille, Otterburn Park

36. Catherine Ferrier, MD, médecin de famille, Montréal

37. Michel de Maupeou, MD, médecin de famille, La Sarre

38. Vijayabalan Balasingam, MD, neurochirurgien, Pointe-Claire

39. Pierrette Girard, MD, chirurgienne orthopédiste, Pointe-Claire

40. Jacques Beaudoin, MD, cardiologue, Québec

41. Marc Bergeron, MD, hémato-oncologue, Québec

42. Rosaire Vaillancourt, MD, FRCPC, chirurgien thoracique, Québec

43. Louis Dionne, MD, chirurgien général, Québec

44. Juan Rivera, MD, endocrinologue, Montréal

45. Lyette St-Hilaire, MD, médecin de famille, Laval

46. Matthieu Tittley, MD, FRCPC, psychiatre, Sherbrooke

47. Luc Chaussé, MD, médecin de famille, L’Assomption

48. Gilles Gaudreau MD, médecin de famille, Sorel-Tracy

49. Evelyne Huglo, MD, médecin de famille, Montréal

50. Hong Phuc Tran-Le, MD, FCMF, médecin de famille, Val d’Or

51. Laurence Normand-Rivest, MD, médecin de famille, Châteauguay

52. Daniel Boulet, MD, FRCP(C), physiatre, Qu.bec

53. Anne-Louise Boucher, MD, responsable médical GMF du Carmel, Trois-Rivières

54. Mathieu Brouillet, MD, médecin de famille, Rimouski

55. David Bacon, MD, CM, CCFP-EM, médecin de famille, Pointe-Claire

56. Marcel D’Amours, MD, anesthésiologiste, Québec

57. Anne Marie Uhlir, MD, médecin de famille, Sainte-Croix

58. Mélanie Laberge, MD, omnipraticienne, Québec

59. Heather Coombs, MD, urgentologue, Montréal

60. Svetlana Ninkovic, MD, pédiatre, neurologue, Greenfield Park

61. Roland Leclerc, MD, pédiatre, Québec

62. Jean-Pierre Beauchef, MD, endocrinologue, Greenfield Park

63. Serge Daneault, MD, soins palliatifs, Montréal

64. Patricia Marchand, MD, médecin de famille, Trois-Rivières

65. Louis Martel, MD, médecin de famille, Trois-Rivières

66. Daniel Viens, MD, FRCPC, interniste, Drummondville

67. Roseline LeBel, MD, médecin de famille, Laval

68. Sonia Calouche, MD, psychiatre, Saint-Eustache

69. Cecile Hendrickx, MD

70. Marie-France Raynault, MD, santé publique, Montréal

71. Julie Gauthier, MD, médecin de famille, Montréal

72. Olivier Yaccarini, MD, médecin de famille, Québec

73. Caroline Girouard, MD, oncologue médicale, Hôpital Sacré-Coeur, Montréal

74. Pierre Duclos, MD, endocrinologue, Québec

75. Normand Lussier, MD, médecin de famille, Montréal

76. Paola Diadori, MD, neurologue, Montréal

77. Bruno Gagnon MD, MSc, Soins Palliatifs, Université Laval, Québec

78. Judith Trudeau, MD, rhumatologue, Hôtel-Dieu de Lévis

79. Yves Bacher, MD, gériatre, Montréal

80. Tommy Aumond-Beaupré, MD, médecin de famille, Montréal

81. Joseph Ayoub, MD, oncologie et soins palliatifs, Montréal

82. Xavier Coll, MD, cardiologue, Lachenaie

83. Léonard Langlois, MD, pédiatre, Sherbrooke

84. Anne Larkin, MD, généraliste depuis plus de 36 ans, Waterloo

85. David D’Souza, MD, CCFP, Global Health Fellow, University of Calgary

86. Robert Banner, MD, CCFP, FCFP, FRCP, IFMCP, Dip AAPM, Dip CAPM, ABIHM, COT, CPT, Diploma in Clinical Homeopathy, London, Ontario

87. Aletta G. Bell, MD, Family Medicine

88. Valérie Marion, MD

89. David Dawson MDCM, FRCPC

90. Rodney A. Crutcher MD MMedEd CCFP(EM) FCFP, Professor Emeritus of Family Medicine, University of Calgary

91. Robert Kidd MD,CM, Renew, Ontario

92. George B Miller, MD, Waterloo, Ontario

93. Bruce Hiller, Burnaby British Columbia

94. Karen Mason, MD, Langley, BC

95. Christopher J. Ryan, MD, BSc, Vancouver

96. Maebh Tynan, MD, Millway Medical, Mississauga, ON

97. Randall Friesen, MD, Prince Albert, SK

98. Donato Gugliotta MD, Trenton, Ontario

99. Cheryl Corkum, BN, MD, CCFP

100. Bruce Gay MD, FRCSC

101. George Abraham, MD, Welland, ON

102. Donna M. Klay, MD

103. Robert Frazer, MD

104. Timothy Ehmann, MD FRCPC

105. Jeff Kornelsen MD CCFP Inc., Abbotsford & Mission, British Columbia BC

106. Stan George, MD, FRCSC

107. Gregory S. Raymond, MD, FRCP(C), St. Albert, Alberta

108. Richard Welsh, MD, FCFP

109. John D Potts, B. Sc., M. D., D. T. M. & H., Ladysmith BC

110. Merville O. Vincent, B.A., M.D., FRCPC, DABIM

111. Warren Terry MD, MEd, FRCSC

112. Bing Guthrie, Yellowknife, MD, NT

113. R. Alan Meakes, CD, MD, FRCPC, Anaesthesia, Internal Medicine, Critical Care, Victoria, BC

114. Warren Molberg MD, CCFP(EM)

115. Owen Heisler MD, FRCSC

116. Muriel Henderson, MD

117. Marjorie D.C.Fish, M.D. (retired)

118. Regina Becker MD, FCFP

119. Mark Epp, MD, PGY-2 Pediatrics, University of Saskatchewan

120. Julia Bright, MD, Chilliwack BC

121. Peter Daley, MD, MSc FRCPC DTM+H, Assistant Professor, Disciplines of Medicine and Laboratory Medicine, Memorial University, Division Chief, Microbiology, Health Sciences Center, St. John’s, Newfoundland

122. John W McCormick MD, Toronto

123. Peter L Munk MDCM, FRCPC, FSIR, Editor in Chief, Canadian Association of Radiologists Journal, Professor of Radiology, University of British Columbia, Skeletal Imaging Section Head, Vancouver General Hospital

124. John Gordon Murray Robertson B.Sc. MD. CCFP, FRCS(C) OBGYN

125. Ronald E. Hiller M.D. – retired Family Practioner

126. John McLeod, MD, Hospitalist, Burnaby, British Columbia

127. Kimberly Elford, MD – Obs/Gyne and reproductive medicine

128. Charis Kolari, MD, Sudbury ON

129. Diane Haak, MD, CCFP, President of the Christian Medical and Dental Society of Canada

130. Frank Duerksen, M.D FRCSC, Winnipeg, MB

131. Catherine McCallum, MD, College registration #s BC- 02197, Ontario -29139

132. Rebecca Bobby, MD, emergency physician, St. John’s

133. Helena Ho, MD, CM, FRCPC

134. Dale Hoffman, MD, Delta, BC

135. Eleanor Foster, MD CCFP (PC)

136. Ricardo A. Cartagena, MD, FRCPC

137. Joyce Choi, MD, CCFP

138. Kevin Sclater, MD, CCFP (CAC-PM), Port Coquitlam, B.C.

139. W. Joseph Askin, MD, FCFP, Calgary, AB

140. James MacMillan, MD, CCFP, Rosthern, SK

141. Richard R.J. Smyth, MBBS, FRCS, FRCS(C), Adjunct Professor in Faculty of Science, Thompson Rivers University, Clinical Instructor in Otolaryngology, University of British Columbia, Director, Sleep Surgery Centre

142. Alison Froese, MD, FRCPC

143. James R. Lewis, MD, FRCSC

144. Eric Prost, MD, FRCPC, Psychiatrist, Kingston, ON

145. Thomas Geoffrey Protheroe, MD

146. Wes Reimer, MD, FCFP, Hospitalist

147. Dave S. Lounsbury, MSc MD CCFP

148. Timothy J. Kelton BSc MD CCFP(E.M.) FCFP, Assistant Professor, Department of Family and Community Medicine, University of Toronto

149. Dr. Jillian Lusina, MD, Family Physician, Vancouver, BC

150. James Yeung, MD, Rheumatologist, Richmond, BC

151. Mark B Hildebrand, MD, CPSO

152. James C. Kennedy, MD, PhD, Professor Emeritus, Department of Oncology, Queen’s University, Kingston Ontario

153. Gisela Macphail, MD, MPH, FRCPC, Specialist, Infectious Diseases

154. Richard Haber, MD, paediatrician

155. Bruce Snyder, MD, CPSO, Cambridge, Ontario

156. Tiffaney Kittmer, MD, FRCSC, General Surgeon

157. Ray Miksa, MD, CCFP, Family Medicine, Calgary, AB

158. Harwood L. Reimer, MD, Duncan, BC

159. Donald G. Street, , MD Family Physician, One Hundred Mile House, BC

160. Bryan Dias, MD, Cardiologist, University Hospital, London Ontario

161. Paul Yong, MD, FRCSC, Vancouver

162. Ray Butler, MD, Sussex, NB

163. George K. Dresser, MD, PhD, FRCP(C), Associate Professor, Clinical Pharmacology & Internal Medicine, University of Western Ontario

164. Dr. Chris Newcombe, MD, CCFP (EM)

165. Garnet Leslie Eggert Ullyot, MD, retired family doctor

166. Donald Stephens, MD

167. Thomas Choy, M.D. F.R.C.P.C.

168. Geoffrey Purdell-Lewis, MB BS, FRCPC. Dundas, Ontario.

169. Karma Murphy, MD, family physician, Yarmouth, NS

170. Mark I. Boulos, BSc MD FRCP(C) CSCN(EEG) MSc, Staff Neurologist (Stroke & Sleep), Sunnybrook Health Sciences Centre, Assistant Professor, University of Toronto

171. John Galbraith MD FRCP(C), Medical Microbiologist and Infectious Diseases Specialist, Victoria, BC

172. Robert Hauptman BMSc, MD, MCFP, Assistant Clinical Professor U of A, Pain Consultant, Family Physician

173. Dr Jack Bromley MD, CCFP

174. Ormond Uptigrove, MD, ret.

175. C. Rachelle Zimmer, MD, FRCPC

176. Joy Wong-Ting, MD, MBBS, FAAP

177. Robert Porter MD, MSc, CCFP (EM)

178. Dr Michael Bentley-Taylor, MD, Cardiologist

179. Peter Kopplin MD, Toronto

180. James Wheeler, MD, Chatham, Ontario

181. Paul R Forrest MD FRCP, Abbotsford BC

182. Sheila Rutledge Harding, MD, FRCPC, Hematologist, Saskatoon, SK

183. Jennifer Y. Tong, MD, CCFP, Family Medicine, Vancouver, BC

184. Nancy Craig MD CM CCFP Edmonton, Alberta

185. Bao Dang, MD, FRCPC Internal Medicine & Respirology

186. Wolfgang E.Schneider MD, FCFP, FCBOM

187. Nicole Allard, MD, omnipraticienne Amos

188. Lynn Kealey, MD, psychiatrist, Ottawa

189. Kami Kandola, MD, médecin de famille, T.N.O

190. Janina Zaremba, MD, médecin de famille, Ottawa

191. André Corriveau, MD, FRCPC, Yellowknife

192. Elizabeth M. Phillips MD, Family Medicine Sussex NB

193. Brian C.M. Phillips, MD FRCP Surg. Sussex NB

194. Dr Darrel Eliason, MD, General Practice, Calgary

195. Philip Fitzpatrick, MD, Emergency Physician, Saskatoon, Saskatchewan

196. Luke Savage, MD, CCFP, Three Hills, Alberta

197. Joseph Phillips, MD, PGY2, Family Medicine, Dalhousie University, Halifax

198. Anthony Kerigan, MD Hamilton ON

199. Raymond Viola, MD, MSc, CCFP, FCFP,Palliative Care, Kingston, Ontario

200. Leah V. Seaman, MD, BSR, MD, CCFP, Full-service rural physician in the NWT

201. M. Jane Pritchard MD, Toronto

202. Cameron W. Pierce, MD, FRCPC, Internal Medicine, Respirology, Vancouver

203. Maria L Zorzitto, MD, FRCP(C) Ontario

204. Lawrence F. Jardine, MD, Pediatric Hematologist, Western University, London , Ontario

205. François Primeau, MD, membre fondateur, surspecialité de gérontopsychiatrie, Lévis

206. Paul J. Ranalli, MD FRCPC Neurology, Toronto

207. Margaret Foote, MD, FAAFP, family medicine, Ontario

208. Matthew J. McQueen, MD, MB ChB, PhD., FRCPC, hon FRCPath., Professor Emeritus, McMaster University,

209. Rory Fisher, MD, O. Ont, MB, FRCP(Ed)( C)

210. Mary O’Connor, MD, General Practice, Ottawa Ontario

211. Keith Meloff, MD, FRCPC Neurologist

212. Thomas Bouchard, MD, Family Medicine Physician, Calgary, Alberta

213. Robert M. Boyko, MD, CCFP(EM), FCFP, Family Physician, MISSISSAUGA, ON

214. Michael Fielden, MD, Ophthalmologist, Calgary

215. Sephora Tang, MD, FRCPC, Psychiatrist, Ottawa

216. Howard Bright MD, Chilliwack, B.C.

217. Chantal Barry, MD Family Medicine Calgary AB

218. Natalia Pastuszewska, MD, internist Brantford Ont

219. Elizabeth Tham, MD, CCFP, FCFP, Lecturer, Department of Family and Community Medicine, University of Toronto

220. Ralph Scandiffio, MD, CCFP (Retired)

221. Sherry Chan, MD, CCFP, GP Oncologist and Family Physician, Vancouver

222. Andrew S. Johnson MD, FRCPC, Adult Infectious Diseases, Program Director, Adult Infectious Disease Residency Training Program, Clinical Assistant Professor, University of Calgary, Department of Medicine, Division of Infectious Diseases, Foothillls Medical Centre

223. William L. Orovan, MD, MBA, FRCSC, FACS, Associate Dean, Clinical Services, Faculty of Health Sciences, McMaster University

224. Andrea Loewen, MD, FRCPC, Diplomate ABIM Respiratory and Sleep Medicine, University of Calgary

225. Jacqueline Chow, MD, Family medicine, Toronto

226. Margaret Cottle, MD, CCFP (CAC-palliative care); Palliative Care, Vancouver, BC

227. Linda Baker M.D., Family Physician(retired), Rosthern, SK

228. M. Pavlovsky, MD, Regina, SK

229. Peter J. Block, MD, FRCSC

230. Daniel Cekan, MD, CCFP, ABFM

231. Jeffrey Betcher MD FRCPC MA (Bioethics), Anesthesiology and Critical Care

232. David Kopriva MDCM, FRCS(C), Vascular Surgeon, Regina, Saskatchewan

233. G. V. Walker, MD, Saskatoon (palliative care)

234. Ferretti Emanuela MD, FRCPC, neonatologist, Ottawa

235. Jonathan S. Ponesse MD FRCPC, Developmental Pediatric Neurologist, Division of Developmental Pediatrics, Ottawa Children’s Treatment Centre, Children’s Hospital of Eastern Ontario, University of Ottawa

236. Douglas Maynes MD FRCPC, Psychiatrist Halifax NS

237. Ray Deobald MD FRCSC, Surgical Oncology, Assistant Clinical Professor, Department of Surgery, College of Medicine, University of Saskatchewan

238. C. Stuart Houston, OC, SOM, DLitt, MD, FRCPC family practitioner 8 years, then radiologist 32 years, now retired 20 years at the end of January 2016, Five years editor-in-chief of the Journal of the Canadian Association of Radiologists, Five years head of Medical Imaging, University of Saskatchewan, Six years served on Council of the Royal College of Physicians and Surgeons of Canada

239. Lisa McFarlane, MD, CCFP

240. Rudy W Hamm, MD, Kelowna, B.C.

241. Ivan Jagas, MD, Kitchener Ontario

242. Edward Rzadki, M.D., FRCP(C), Etobicoke Psychiatric Consultants, Toronto

243. Martin Owen MD CCFP, President Calgary Catholic medical association, Family physician

244. Rebecca Epp, MD, Family Practice, Meadow Lake, SK

245. Ken Kontio, MD, Orthopaedic Surgeon, Ottawa, Canada

246. Mark J. Jany, Respiratory Medicine, St. Catharines, ON

247. John McWhae MD, FRCSC

248. Jean Chamberlain CM MD MEd FRCSC , Member—Order of Canada Executive Director — Save the Mothers, Associate Professor —McMaster University (Ob/Gyn)

249. John Renouf, MD Emergency Melfort Sk

250. Timothy S Darnell, MD, Lacombe, AB

251. Ewan C. Goligher MD FRCPC, Critical Care Medicine, Mount Sinai Hospital, PhD student, Department of Physiology, University of Toronto

252. Wayne Weston MD, CCFP, FCFP, Emeritus Professor of Family Medicine, Schulich School of Medicine and Dentistry, Western University

253. Amy Hendricks, MD, Médecine interne, Yellowknife

254. John Reesor, MD

255. Thomas Barry MD

256. Robert Ting, MD

257. Lizabeth Brydon, MD

258. Tanya Rodgerson, MD

259. Mark Chandra, MD

260. Kathryn Sullivan, MD

261. Shannon Rabuka, MD

262. James Lane Coquitlam ,BC

263. Michelle Korvemaker, Woodstock, Ontario, Canada

264. Chaim Goldberg, MD

265. Donald Greve, MD, SK

266. Will Johnston, MD, Vancouver

267. John Gay, MD

268. Deborah Dudgeon, MD

269. Edmond Kyrillos, MD

270. Mark Leakos, MD

271. Rene Leiva, MD

272. Tim Cuddy, MD, Burlington ON

273. Carlos Miura, MD

274. Lauren Mai, MD

275. Donna Shaddick, MD

276. Terence Da Silva, MD

277. Barbara Powell, MD

278. Alice Westlake, MD

279. Jake Raguz, MD

280. Nisha Fernandes, MD

281. Ellis Scott, MD

282. Sze Wan Sit, MD

283. Andrew Taylor, MD

284. Timothy Heerema, MD

285. Garvin Pierce, MD

286. Lester Liao, MD

287. Chris Ekong, MD

288. Dr Paul Galassiere, MD

289. Valerie Hindle, MD

290. Karen Macdonald, MD

291. Joel Emery, MD

292. Muriel Beatty, MD

293. David Hook, MD

294. James Holmlund, MD

295. Eileen Cochien, MD

296. Garnet Leslie Eggert Ullyot, MD, retired family doctor

297. Juliette Eberhard, MD

298. Christy Reich, MD

299. Steve Russell , MD

300. Lew Valliant, MD

301. Sherri Renwick, MD

302. G. Ivan Stewart, MD

303. Ilo De Porres, MD

304. Lydia Cheung, MD

305. John Kraulis, MD

306. Myra Butler, MD

307. Shawn Verity, MD

308. Venetia S.J. Mah, MD

309. Althea Burrell, MD, Respirology, Markham Ontario

310. Cornelia Mielke, MD

311. Benjamin Love, MD

312. Betty-Anne Story, MD

313. Helen Montgomery, MD

314. John Alexander Watt, MD, Psychiatry

315. Don Munnings

316. Len Prins, MD

317. Steven Bredenoord, MD

318. Raymond Penner, MD

319. Andrea Milne-Epp, MD

320. Paul McArthur, MD, Walkerton, ON

321. Susan McArthur, MD, Walkerton, ON

322. Duncan Etches, MD

323. David Neima, MD

324. Philip Hui, MD

325. Piotr Koziarz, MD

326. Catherine Elizabeth McNally, MD

327. Larry Taranger, MD

328. Paul Galessiere, MD, FRCSC, General, laparoscopic, and gynecological surgeon

329. Alana Cormier, MD

330. Cindy Lou, MD

331. Larry Ness, MD

332. Brent Lanting, MD

333. Isabel Sarides, MD

334. Costa Sarides, MD

335. RJ Buhr, MD

336. Emily Pranger

337. Dauna Cutforth, MD

338. Peter Hong, MD

339. Marie Dale, MD

340. Kristy Green, MD

341. Maria MacDonald, MD, FRCPC, Neurologist in Oncology, London, Ontario

342. AJ Donauer, MD, candidate, class of 2018

343. Caleb De Putter, MD, candidate, May 2016

344. Naomi Kasteel, third year medical student, UBC

A bureaucracy of medical deception

 Quebec physicians told to falsify euthanasia death certificates

Regulators support coverup of euthanasia 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.1 In fact, the Collège des médecins du Québec and pharmacy and nursing regulators in the province had already made the decision. In August, the three regulators issued a Practice Guide directing Quebec physicians to falsify death certificates in euthanasia cases.

The physician must write as the immediate cause of death the disease or morbid condition which justified [the medical aid in dying] and caused the death. It is not a question of the manner of death (cardiac arrest), but of the disease, accident or complication that led to the death. The term medical aid in dying should not appear on this document.2

Lawyer Jean Pierre Ménard correctly observed that Quebec’s euthanasia law does not require physicians to report euthanasia on death certificates.1  M. Ménard is an expert on euthanasia law consulted by the Quebec government and the CMA,3  but he seems unaware of guidelines relevant to the classification of deaths and medico-legal death investigations. . . [Full text]

Quebec Euthanasia Guidelines

Practice guide issued by Quebec health care profession regulators

Introduction

Sean Murphy*

Quebec’s Act Respecting End of Life Care (ARELC) was passed in June, 2014 and comes into effect in December, 2015.  When enacted, the  law purported to legalize euthanasia in the province, but its actual legal effect was questionable because Canadian provinces do not have jurisdiction over criminal law.  Only the Canadian federal government can make laws governing homicide and suicide.

However, in February, 2015, the Supreme Court of Canada released its decision in the case of Carter vs. Canada. The Court struck down the criminal prohibition of homicide and assisted suicide to the extent that it prevents the provision of physician assisted suicide and physician administered euthanasia for a certain class of patients.  The Court specified that the law cannot prevent the procedures for competent adults who are suffering intolerably as a result of a grievous and irremediable medical condition, which cannot be relieved by other means acceptable to the patient.  The declaration of invalidity was suspended for one year to allow the government time to revise the law.

The federal government under Conservative Prime Minister Stephen Harper took no action until mid-July, when it appointed a panel to study the issue and offer advice about legislative options.  The government was defeated in the federal election in October, and it remains unclear what direction the new Liberal government will take.

ARELC thus comes into force about two months before the Supreme Court ruling in Carter takes effect, while the criminal prohibition of euthanasia and assisted suicide is still in place.  However, the guidelines for euthanasia in ARELC are actually more restrictive than those proposed by the Supreme Court of Canada in Carter, so it seems doubtful that the federal government will challenge the Quebec law.

In August, 2015, the state regulators of the professions of medicine, pharmacy and nursing jointly issued an 88 page Medical Aid in Dying Practice Guide to direct the provision of euthanasia in Quebec.  The Guide appears to be available only in French, and is currently accessible only through a password protected portal on the Collège des médecins du Québec website, or by making an access to information request.  However, the Guide also states that it can be reproduced as long as the source is acknowledged.

What follows is a partial machine assisted English translation of the Guide set opposite the original French text.  For ease of reference, each translated segment is identified by a translation number (T#).  Only those parts of the Guide that appear to have some relevance to freedom of conscience are reproduced here.

Go to translation

Beware of assisted-suicide zealots

National Post

Will Johnston

For at least a few more months, the Canadian medical system will continue to be a safe space, free of assisted suicide and euthanasia. But all that is about to change. In order to ensure our hospitals and palliative care centres remain places where patients feel safe and secure, we must respect doctors’ conscience rights, rather than listen to activists who seek to impose their one-size-fits-all policy on the rest of us.

For instance, the palliative care centres in Quebec that refuse to have anything to do with euthanasia, for reasons of medical judgment and ethics, have apparently angered Jean-Pierre Menard, the lawyer who helped write Quebec’s euthanasia law, Bill 52. The act specifically states that palliative care centres are not required to provide euthanasia service — but maybe to Menard, those were just soothing words to get the bill passed. Now Menard says money should be taken away from palliative services that won’t provide euthanasia on their premises. And the minister of health, Gaetan Barrette, has threatened to revoke the hospital privileges of doctors who won’t comply. . . . [Full text]

Canadian doctors want freedom to choose whether to help terminal patients die

CMA to revisit issue of doctor-assisted death after delegates pass motion supporting physician’s right to ‘follow their conscience’

canada.com

Sharon Kirkey

Canada’s doctors say they should be free to choose whether to help terminally ill patients kill themselves if the federal ban outlawing euthanasia is overturned.

Delegates at the Canadian Medical Association‘s annual general meeting in Ottawa overwhelmingly passed a motion Tuesday supporting the “right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying.”

The CMA is formally opposed to euthanasia  –  a stance its leaders indicated would now be revisited as the emotionally charged issue takes on new urgency in Canada.

The Supreme Court of Canada is set to hear a constitutional challenge of the criminal ban on doctor-assisted death in October, while Quebec has introduced Bill 52, legislation allowing doctors help end the lives of terminal patients suffering “unbearable physical or psychological pain.”

The CMA defines “medical aid in dying” as euthanasia or physician-assisted death.[Full text]

Redefining the Practice of Medicine- Euthanasia in Quebec, Part 9: Codes of Ethics and Killing

Abstract

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.

A principal contributor to this lack of awareness – if not actually the source of it – is the Code of Ethics of the Collège des médecins, because it requires that physicians who are unwilling to provide a service for reasons of conscience help the patient obtain the service elsehere. The President of the Collège was pleased that law will allow physicians to shift responsibilty for finding someone willing to kill a patient to a health system administrator, avoiding an anticipated problem caused by the requirement for referral in the Code of Ethics.  However, the law does not displace the demand for referral in the Code, and can be interpreted to support it.

The Collège des médecins Code of Ethics demand for referral conflicts with the generally accepted view of culpable indirect participation.  Despite this, it continues to be used as a paradigm by other  professions, notably pharmacy.  It is thus not surprising that the College of Pharmacists also anticipates difficulty over the issue of referral.  Like the Collège des médecins, the College of Pharmacists would like to avoid these problems by allowing an objecting pharmacist to shift responsibility for obtaining lethal drugs to a health systems administrator.

Nurses cannot be delegated the task of killing a patient, it is not unreasonable to believe that nurses may be asked to participate in euthanasia in other ways. Thus, there remain concerns about indirect but morally significant participation in killing.  Their Code of Ethics imposes a duty to ensure both continuity of care and “treatment,” which is to include euthanasia.  However, under ARELC, an objecting nurse is required to ensure only continuity of care.  This should not be interpreted to require nurses to participate in euthanasia, though they may be pressured to do so.

As a general rule, it fundamentally unjust and offensive to human dignity to require people to support, facilitate or participate in what they perceive to be wrongful acts; the more serious the wrongdoing, the graver the injustice and offence.  It was a serious error to include this a requirement in code of ethics for Quebec physicians and pharmacists. The error became intuitively obvious to the Collège des médecins and College of Pharmacists when the subject shifted from facilitating access to birth control to facilitating the killing of patients.

A policy of mandatory referral of the kind found in the Code of Ethics of the Collège des médecins  is not only erroneous, but dangerous.  It establishes the priniciple that people can be compelled to do what they believe to be wrong – even gravely wrong – and punish them if they refuse.  It purports to entrench  a ‘duty to do what is wrong’ in medical practice, including a duty to kill or facilitate the killing of patients. To hold that the state or a profession can compel someone to commit or even to facilitate what he sees as murder is extraordinary.

Quebec’s medical establishment can correct the error by removing the mandatory referral provisions of their codes of ethics that nullify freedom of conscience.  This would prevent objecting physicians and pharmacists from being cited for professional misconduct for refusing to facilitate euthanasia or disciplined for refusing to facilitate other procedures to which they object for reasons of conscience, including contraception and abortion.  This would almost certainly antagonize consumers who have been conditioned to expect health care workers to set aside moral convictions.

It remains to be seen whether the Quebec medical establishment will maintain the erroneous provisions, preferring to force objecting health care workers to become parties to homicide rather than risk occasionally inconveniencing people, such as the young Ontario woman and her supporters who were outraged because she had to drive around the block to obtain The Pill. [Full Text]

Redefining the Practice of Medicine- Euthanasia in Quebec, Part 8: Hospitality and Lethal Injection

Abstract

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.

The exemptions have been challenged by organizations that want hospices forced to kill patients who ask for MAD, or at least to allow physicians to come in to provide the service.  Hospice representatives rejected the first demand and gave mixed responses to the second.  A spokesman for the Alliance of Quebec Hospices confirmed that palliative care hospices that provide euthanasia will not be excluded from the Alliance.

A prominent hospice spokesman predicted that the pressures would increase after the passage of ARELC, and that hospices refusing to provide euthanasia would operate in an increasingly hostile climate.

A former minister of health rejected the challenges to the exemptions and insisted that the policy of hospices be respected, appealing to the principles of autonomy and freedom of choice.  Consideration of freedom of conscience is irrelevant to this approach, and the description of the problem as a conflict of autonomy actually precludes a successful resolution by an appeal to the principle giving rise to it.

While the former minister of health wanted the autonomy of hospices explicitly set out in law, the only requirement in ARELC is that regional health authorities consult with institutions and palliative care hospices in their territories before making rules.  Mere consultation may be insufficient to protect the integrity of hospices in the long term. [Full Text]

Redefining the Practice of Medicine- Euthanasia in Quebec, Part 7: Refusing to Kill

Abstract

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.  The goal here is to ensure that conscientious objectors to euthanasia will be able to continue to work in health care without becoming complicit in what they consider to be wrongdoing.

Physicians may refuse to provide euthanasia if the patient is legally ineligible, and for other reasons, including conscientious objection.  ARELC requires physicians who refuse to provide euthanasia for any reason other than non-eligibility to notify a designated adminstrator, who then becomes responsible for finding a MAD physician.  The idea is to have the institution or health care system completely relieve the physician of responsibility for facilitating the procedure.

It would be preferable to end the involvement of the objecting physician with refusal, accompanied by a suggestion that the patient will have to look for assistance from other sources.  This might be achieved if objecting physicians were to notify both executive directors and patients in advance that they will not provide or facilitate euthanasia.

A more sensitive problem attends the requirement that an objecting physician forward  a euthanasia request form to the designated administrator, since that is more clearly connected to the ulitmate killing of a patient.  Since the requirement to forward the request applies only if it has been given to the physician, this might be avoided if the objecting physician made his position clear in advance, and/or refused to accept such a request.  Such complications could avoided if administrators were to adopt a policy to the effect that a health care professional who witnesses and countersigns a euthanasia request to arrange for MAD services is responsible for arranging them.

The protection of conscience provision in ARELC distinguishes physicians from other health professionals, providing less protection for physicians than for others.  Other health care professionals may refuse to “take part” (participate) in killing a patient for reasons of conscience.  Physicians may refuse only “to administer” euthanasia – a very specific action –  which seems to suggest that they are expected to participate in other ways.

Some Quebec physicians may be unwilling to provide euthanasia while the criminal law stands, even if they do not object to the procedure. Quebec’s Attorney General may be unwilling to provide the extraordinary kind of immunity sought by physicians, which exceeds what was recommended by the Select Committee on Dying with Dignity, and some physicians may be unwilling to provide euthanasia without it.

Finally, as long as euthanasia remains a criminal offence, physicians or other entities responsible for issuing or administering MAD guidelines may respond to requests for euthanasia precisely as they would respond to requests to become involved in first degree murder: with total refusal to co-operate.  Even a partial  and scattered response of this kind would likely be administratively troublesome.

Patients may lodge complaints against physicians who refuse to provide or facilitate euthanasia with institutions and the regulatory authority, regardless of the reasons for refusal. [Full Text]