The caricature of the conscientiously objecting physician

Objecting doctors are the bad guys, obstructing care.

How will disciplining conscientious doctors or driving them from the profession improve health care?

Physicians’ Alliance Against Euthanasia

Catherine Ferrier

Weary physicianCanadian doctors who object to directly causing the death of their patients, once the near-totality of the profession, have since the enactment of laws permitting “medical assistance in dying” suddenly become outliers. Polling data is unclear, polls are often biased, and there is no doubt that the euthanasia lobby had the ear of media, opinion leaders and politicians long before we knew what they were up to. Be that as it may, we are now told that euthanasia/MAiD is an accepted ‘medical treatment’ that must be provided to those who request it. Many provincial medical colleges, though not requiring doctors to euthanize patients themselves, do expect, to different degrees, that we facilitate their being euthanized by someone else. . . [Full text]

L’euthanasie au Canada: une mise en garde

Rene Leiva, Margaret M. Cottle, Catherine Ferrier, Sheila Rutledge Harding, Timothy Lau, Terence McQuiston, John F. Scott*

Nous sommes des médecins canadiens consternés et concernés par les impacts – sur les patients, sur les médecins, sur la pratique médicale – de l’implantation universelle de l’euthanasie dans notre pays, définie comme un « soin de santé » auquel tous les citoyens ont droit (conditionnellement à des critères ambigus et arbitraires). Beaucoup d’entre nous sont si touchés par la difficulté de pratiquer sous ces nouvelles contraintes prescrites que nous pourrions être forcés, pour des raisons d’intégrité et de conscience professionnelle, d’émigrer ou de se retirer complètement de notre pratique. Nous sommes tous profondément inquiets du futur de la médecine au Canada. Nous croyons que ce changement sera non seulement nuisible à la sécurité des patients, mais également à la perception essentielle par le public – et par les médecins eux-mêmes – que nous sommes réellement une profession dédiée seulement à la guérison et au mieux-être. Nous sommes donc très inquiets des tentatives visant à convaincre l’Association Médicale Mondiale (AMM) de modifier sa position qui s’oppose à la participation des médecins à l’euthanasie et au suicide assist . . . . Continuer la lecture dans le World Medical Journal en anglais | Français

Euthanasia in Canada: a Cautionary Tale

Rene Leiva, Margaret M. Cottle, Catherine Ferrier, Sheila Rutledge Harding, Timothy Lau, Terence McQuiston, John F. Scott*

We are Canadian physicians who are dismayed and concerned by the impact  – on patients, on doctors, on medical practice – of the universal implementation, in our country, of euthanasia defined as medical “care” to which all citizens are entitled (subject to the satisfaction of ambiguous and arbitrary qualifying criteria). Many of us feel so strongly about the difficulty of practicing under newly prescribed constraints that we may be forced, for reasons of personal integrity and professional conscience, to emigrate or to withdraw from practice altogether. All of us are deeply worried about the future of medicine in Canada. We believe this transformation will not only be detrimental to patient safety, but also damaging to that all-important perception by the public  – and by physicians themselves – that we are truly a profession dedicated to healing alone. Thus, we are alarmed by attempts to convince the World Medical Association (WMA) to change its policies against physician participation in euthanasia and assisted suicide. . . Continue reading in the World Medical Journal | Français

Ontario hospitals allowed to opt out of assisted dying, raising conscientious accommodation concerns

National Post

Sharon Kirkey

Ontario will allow hospitals to opt out of providing assisted death within their walls, provoking charges from ethicists that conscientious accommodation has gone too far.

Elsewhere in the country, a divide is already shaping up, with half of voluntary euthanasia cases in Quebec reportedly occurring in Quebec City hospitals — and few in Montreal.

The situation highlights the messy state of the emotionally charged debate as the provinces wrestle with the new reality of doctor-assisted death, and as the Senate takes a proposed new law further than the governing Liberals are prepared to go. . . [Full Text]


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


Redefining the Practice of Medicine- Euthanasia in Quebec, Part 4: The Problem of Killing


Impartiality, complicity and perversityThe original text of Bill 52 did not define “medical aid dying” (MAD), but it was understood that, whatever the law actually said, it was meant to authorize physicians to kill patients who met MAD guidelines.  The Minister of Health admitted that it qualifed as homicide, while others acknowledged that MAD meant intentionally causing the death of a person, and that its purpose was death.  Various witnesses in favour of the bill referred explicitly to lethal injection and the speed of the expected death of a patient.

Given the moral or ethical gravity involved in killing, it is not surprising to find serious disagreement about MAD among health care workers.  Conflicting claims made about the extent of opposition to or support for euthanasia within health care professions are difficult to evaluate, but a review of the transcripts of the legislative committee hearings into Bill 52 is instructive.

One physician member of the committee was shocked by the assertion that there is no  moral, ethical, or legal difference betwen withdrawing life support and lethally injecting a patient.  Hospices and palliative care physicians rejected participation in euthanasia.  Sharp differences of opinion among other health care workers were reported.  Support for killing patients by lethal injection was likened to support for the death penalty; that is, many more agreed with the act in principle than were willing to do the actual killing.  So marked was the evidence of opposition to euthanasia that doubts were raised about the possiblity of implementing the law.

Since the law was passed as a result of assurances from the Quebec medical establishment that it could be implemented, a committee member who is now a minister of the Quebec government warned that they would be called to account if it is found that few physicians are willing to participate.  This political pressure is likely to provide an additional incentive for the medical establishment to secure the compliance of Quebec physicians.

The introduction of euthanasia into Quebec’s health care system is to be accomplished using the structures and powers established by other Quebec statutes that govern the delivery of health care in the province, which have established a multi-layered and overlapping bureaucracy of committees, councils, commissions, boards, directors, examiners, coordinators, syndics and commissioners.  Physicians and other health care providers who object to euthanasia will find their working environments increasingly controlled by a MAD matrix functioning within this system, a prominent feature of which is an emphasis on patient rights.

Everyone authorized to enact or supervise adherence to policies or standards can become a MAD functionary, using codes of ethics, protocols, guidelines, directives, etc. to normalize euthanasia. Similarly, every disciplinary and complaints procedure can be used to force participation in MAD services.  Those who openly advocate refusal to provide or facilitate euthanasia can be fined from $1,500.00 to $40,000.00 per day under Quebec’s  Professional Code if they are deemed to have helped, encouraged, advised or consented to a member of a profession violating the profession’s code of ethics. [Full Text]

Hearings on Quebec Bill 52: Physicians’ Alliance for Total Refusal of Euthanasia

Dr. Catherine Ferrier, Dr Serge Daneault, Dr François Primeau

Tuesday 24 September 2013 – Vol. 43 N° 37

Note: The following translation is the  product of a first run through “Google translate.”  In most cases it is  sufficient to identify statements of interest, but more careful translation is  required to properly understand the text.

Original Text

Caution: machine assisted translation

(version non révisée)
Unrevised version
 (Reprise à 10 h 57)
Le Président (M. Bergman) : À l’ordre, s’il vous plaît! Alors, on souhaite la bienvenue au Collectif de médecins du refus médical de l’euthanasie. Dre Ferrier, Dr Daneault et Dr Primeau, bienvenue. Vous avez 15 minutes pour faire votre présentation suivie d’un échange avec les membres de la commission. Alors, s’il vous plaît, donnez-nous vos noms et vos titres, et vous avez le prochain 15 minutes pour votre présentation. The Chairman (Mr. Bergman): Order, please! So, welcome you wish to Physicians’ Alliance for Total Refusal of Euthanasia. Dr. Ferrier, Dr. Daneault and Dr. Primeau, welcome. You have 15 minutes to make your presentation followed by a discussion with the members of the commission. So please, give us your name and your title, and you have the next 15 minutes for your presentation. .
Mme Ferrier (Catherine) : Vous m’entendez bien? Parce que ma voix ne porte pas beaucoup, je pense que… Alors, je vous remercie de nous avoir invités. Je m’appelle Catherine Ferrier, je suis médecin de famille et professeure adjointe de médecine familiale à l’Université McGill. Je travaille depuis 30 ans dans une clinique de gériatrie. Alors, je vois des gens qui commencent à perdre l’autonomie à cause d’une démence ou à cause d’une atteinte physique, c’est un moment très angoissant de la vie d’une personne. Et j’ai été témoin plusieurs fois devant les tribunaux pour des cas d’abus, des cas de chicane de famille autour du parent âgé, souvent motivé par l’argent, et je constate toujours la grande vulnérabilité de ces personnes. Mrs. Ferrier (Catherine): Can you hear me? Because my voice does not carry a lot, I think … So, thank you for inviting us. My name is Catherine Ferrier, I am a family physician and assistant professor of family medicine at McGill University. I worked for 30 years in a geriatric clinic. So I see people start to lose autonomy because of dementia or because of physical harm, it is a very scary time in a person’s life. And I have witnessed several times in court for abuse, cases of family feud around the aged, often motivated by money, and I still see the vulnerability of these people.

Full Translation

Over 500 physicians have signed up against Quebec euthanasia bill

The Physicians’ Alliance for the Total Refusal of Euthanasia, a Quebec organization, is comprised mainly of physicians whose focus of practice is on dying patients.  The group is adamantly opposed to euthanasia.  Over 500 physicians have identified themselves as supporting its Total Refusal of Euthanasia Declaration.  The Alliance has issued a news release denouncing the Quebec government’s new euthanasia bill.

Dr. Catherine Ferrier of the Montreal General Hospital is concerned that virtually all of her patients in the geriatric clinic would be eligible for euthanasia, and that the spectre of euthanasia would haunt “every interaction” with her patients were it to be legalized.  While she is doubtful about whether or not the euthanasia bill can be stopped, she said ” I am certainly never going to kill a patient.” [CJAD]

Dr. Gerald van Gurp, whose opposition to euthanasia is informed by developments in his homeland, the Netherlands, is a palliative care and emergency physician at Montreal’s Hotel Dieu Hospital.  He argues that most Quebeckers do not have access to quality palliative care, and that the solution to that problem is to provide access to high-quality palliative care, not euthanasia. [Montreal Gazette]

Dr. van Gurp said that he would not continue to provide home palliative care for terminally ill patients if the euthanasia bill passes.  “I’m not going there,” he said.

Speaking for the Alliance, Dr. Marc Beauchamp described the bill as “an enormous revolution in ethics and law.” [CBC News]