Ensuring access to euthanasia by encouraging physician participation: it’s complicated

Sean Murphy*

In July, 2017, Canadian euthanasia/assisted suicide (EAS) practitioners and advocates alleged that patient access to euthanasia and assisted suicide was in danger because of “barriers” and “disincentives” to physician participation. Dr. Stefanie Green, president of their professional association, described the situation as “a crisis.”1 There was, in fact, no crisis — only a false perception of crisis fuelled by unrealistic expectations about levels of physician participation in euthanasia and assisted suicide.2

Nonetheless, it is reasonable for policy makers to respond to their concerns that physicians are discouraged from participating in euthanasia and assisted suicide. Indeed, objecting physicians are less likely to experience disadvantage and coercion if policy-makers seriously consider suggestions by EAS practitioners and advocates about how to encourage physician participation in euthanasia.

Removing barriers and disincentives to physician participation

Minimizing procedural and administrative requirements
Returning to the complaints and concerns of Canadian euthanasia practitioners (see Canada’s Summer of Discontent2), reducing or streamlining procedural requirements and minimizing burdensome paperwork might encourage more physicians to participate. However, this raises a question that may prove difficult to answer. Is a procedural requirement a “barrier” — or a necessary safeguard? A “disincentive” — or an essential ethical prerequisite? The difficulty is illustrated by developments in Belgium. . . .[Full text]

When is a problem not a problem?

Refusing to dispense drugs to kill patients with psychiatric illness

Levenseinde Kliniek complains about uncooperative Dutch pharmacists

Sean Murphy*

In April, 2014, a complaint was made in the Netherlands that some Dutch pharmacists were refusing to provide euthanasia drugs.  The complaint led members of the Dutch Parliament from the green party, GroenLinks, to ask for a debate with health minister, and members of other Dutch political parties let it be known that they were also concerned.

 According to the news reports, over half the physicians at “the independent euthanasia clinic” had been refused lethal drugs, and 23 percent of 53 pharmacists surveyed reported that they sometimes refused to fill euthanasia prescriptions.  It was argued that pharmacists should not be able to refuse drugs needed to kill patients if two physicians had approved the euthanasia request.  However, while the law in the Netherlands permits physicians to provide euthanasia, it does not mention pharmacists. [Full Text]

Canadian Medical Association softens stand on assisted suicide

Globe and Mail

André Picard

The Canadian Medical Association, which has a long-standing policy saying doctors should not participate in euthanasia or assisted suicide, is substantially softening its stance.

Delegates to the organization’s general council decided Tuesday that the CMA now “supports 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 carefully crafted position is an acknowledgment that, while assisting death is still a crime in Canada, the attitudes of Canadians, including those of physicians, are changing quickly, and so is the law.

While the group’s official policy has not changed, “it’s only a matter of time,” said Louis Francescutti, outgoing president of the CMA. Dr. Francescutti said the “conscience” resolution, which was adopted by an overwhelming 91 per cent of delegates, means that the CMA supports a doctor’s right to refuse to hasten the death of a terminally ill patient, but it will also support a doctor’s right to hasten death if the law allows.[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]