La conscience et les médecins canadiens

English

Collectif des médecins contre l’euthanasie

Depuis la légalisation de l’euthanasie, il y a un an, nous voyons qu’il y a une forte pression politique pour normaliser sa pratique au Canada. Pourtant, beaucoup de médecins s’opposent toujours à cette pratique. Nombre d’entre eux désireraient qu’elle soit rigoureusement restreinte. Et plusieurs, pour des raisons de conscience, personnelle ou professionnelle, refusent catégoriquement d’y collaborer.

Malheureusement, nos politicien(ne)s ne nous permettent aucun doute quant à leur intention d’ignorer le jugement des médecins dissidents, et d’étouffer leur opposition. Or, les pires de ces politiciens semblent se trouver parmi les rangs de notre propre profession.

Considérons, à titre d’exemple, la nouvelle politique (2015), du College of Physicians and Surgeons of Ontario, au sujet du « Droit de Conscience » de ses membres.

Cette politique est identifiée comme étant une simple mis à jour révisée, mais en réalité elle s’apparent peu à la version précédente (2008).

Et la raison en est évidente : sans jamais parler franchement de l’euthanasie, du suicide assisté, ou même de l’aide médicale à mourir, cette nouvelle politique fut, dès le départ, façonnée pour faciliter une redéfinition radicale, à la manière Orwellienne, de « l’euthanasie », de l’homicide en soin médical. Cela oblige, effectivement, tous les médecins ontariens à participer au programme d’euthanasie.

De manière pratique :

« Dans le cas où des médecins ne voudraient pas fournir certains soins pour des raisons de conscience ou de religion, ces derniers sont tenus de référer le patient à un autre fournisseur de soins. »

Bien-sûr, on voit, ici, l’obstacle principal à la collaboration de nombreux docteurs qui considèrent le fait d’orienter leurs patients vers d’autres agences de mort  comme étant aussi horrible que de pratiquer eux-mêmes l’acte d’euthanasier.

Cependant, le problème éthique ne s’arrête pas à  l’obligation de référer le patient à d’autres ressources. Il y a également le « devoir d’informer » :

« Les médecins doivent fournir de l’information à propos de toutes les options cliniques qui peuvent être disponibles ou appropriés pour répondre aux besoins cliniques du patient ou à ses préoccupations ».

« Les médecins ne doivent pas retenir de l’information au sujet d’une procédure ou d’un traitement pour des raisons de conflit avec leur conscience ou leur croyance religieuse ».

Prenez bien note des italiques ajoutés : apparemment, le médecin se trouverait dans l’obligation d’informer ses patients de toutes les options légalement disponibles, même si elles s’avèrent inappropriées ! Et cette obligation aurait préséance sur toute conviction morale ou professionnelle du médecin.

L’aspect impératif de ce “devoir d’informer” dépasse même celui du « devoir de référer”. Dans chaque cas où les critères associés à l’euthanasie seraient satisfaits, il y aurait obligation de soumettre le patient aux terribles stress et doutes soulevés par le constat, ainsi imposé, qu’il fait partie du groupe select de personnes pour lesquelles l’euthanasie est devenue praticable. Aucune objection de jugement, aucune objection de conscience, ne pourrait excuser le médecin du devoir de livrer ce message effroyable, avec la suggestion implicite qu’il véhicule.

En Ontario, donc, par proclamation du CPSO, le rôle du médecin serait réduit à celui d’une machine distributrice automatique qui afficherait les options d’euthanasie mandatés par l’état, et qui offrirait passivement de boutons correspondants que le patient puisse actionner.

Évidemment, la force et l’étendu d’un telle politique sont extraordinaires. Le jugement professionnel est la fondation de la pratique médicale. Le « Droit de Conscience » est à la base de tout notre système de démocratie séculaire. Tous les deux sont écartés. Nous devons réellement nous trouver devant une situation de crise colossale pour justifier de telles mesures draconiennes !

Mais voilà. Il n’existe aucune urgence semblable.

Rappelons-nous que le programme original d’euthanasie nous fut vendu comme la réponse impérative au sort de ce patient hypothétique, au seuil de la mort et affligé de souffrances, à la fois, insoutenables et intraitables. Rappelons aussi, comment ce cas extrême, que dis-je, ce cas virtuellement mythique, fut exploité pour nous acheminer doucement vers tous ces morts, sans rapport, que nous devons craindre actuellement. Encore, de nouveau, une stratégie similaire se poursuit. Cette fois, le besoin absolu, pour tous les médecins, de faire la promotion de l’euthanasie (en tout temps et auprès de leurs patients les plus vulnérables), nous est présenté comme le prix nécessaire pour pallier à la possibilité hypothétique qu’un seul patient puisse être frustré dans son désir de mourir.

On nous demande de croire que n’importe quel fardeau réel, qu’il soit financier, professionnel ou moral, serait justifié quand il est question de faciliter une seule mort volontaire et idéalisée. Ce serait un genre d’inversion grotesque de la proposition voulant que « aucun prix n’est trop élevé, pourvu qu’un seul enfant puisse vivre… », qui devient dans la discussion actuelle : « pourvu qu’une seule personne puisse mourir… »

D’autres juridictions, pas moins respectables que l’Ontario, ont épousé des principes tout à fait opposés. Et il n’existe aucune évidence que quiconque aurait souffert, ou souffrira ultérieurement.

Le Manitoba élabore actuellement une loi qui reconnaitrait explicitement le droit de non-participation et de non-orientation des patients vers l’euthanasie pour les médecins, ainsi que pour les autres professionnels de la santé. Deux des principaux hôpitaux de Winnipeg ont signalé leur refus de permettre l’euthanasie dans leur établissement.

Dans l’État de Vermont, une bataille judiciaire autour des mêmes principes s’est soldée, dernièrement, par une victoire complète des droits des médecins.

Et en Ontario, un groupe de médecins, dévoués et courageux, a récemment engagé une action à ce sujet contre le CPSO; les arguments furent écoutés Juin 13-15, 2017.

Ce jugement sera rendu plus tard dans l’année. Nous espérons que la cour tranchera, cette fois, du bon côté !

Mais nonobstant la nature de ce jugement, le temps qu’il faudra, la dépense; nonobstant les efforts législatifs qui peuvent être éventuellement exigés : Cette politique autoritaire du College of Physicians and Surgeons of Ontario n’est ni nécessaire, ni justifiée. Elle n’est pas désirable. Elle n’est même pas raisonnablement défendable. Elle est extrême. Elle est irrationnelle. Surtout, elle serait profondément préjudiciable pour les médecins,  leurs patients, et tout le système médical. Elle représente une injustice et une honte qui ne peuvent être acceptées.

 

Conscience and Canadian doctors

Francais

Physicians’ Alliance Against Euthanasia

In the year since euthanasia became legal, we have witnessed a powerful political push to normalize it as part of medicine in Canada. Yet many doctors remain opposed to the practice. Most would like to see it rigorously limited. And some, for reasons of personal and/or professional conscience, refuse categorically to be part of it.

Unfortunately, our politicians have made it perfectly clear that they intend to ignore the judgement of opposing doctors and to stifle their dissent. In fact, the worst of these politicians are to be found within our own profession.

Consider, as a case in point, the new (2015) College of Physicians and Surgeons of Ontario policy on doctors’ conscience rights.

This CPSO policy is identified as a mere “revised update”, but it actually bears little resemblance to the earlier version (2008).

And it is obvious why this is so: Without ever honestly mentioning euthanasia, assisted suicide, or even MAID, the new policy was designed from the start to facilitate a radical new Orwellian redefinition of “euthanasia”, from homicide to medical treatment. It effectively obliges all Ontario physicians and surgeons to participate in the euthanasia program.

In practical terms:

“Where physicians are unwilling to provide certain elements of care for reasons of conscience or religion, an effective referral to another health-care provider must be provided to the patient.”

This, of course, is the main sticking point for many doctors, who consider referring their patient to any agency of death to be an act just as abhorrent as performing the euthanasia themselves.

But “effective referral” is by no means all. There is also the “duty to inform”:

“Physicians must provide information about all clinical options that may be available or appropriate to meet patients’ clinical needs or concerns.”

“Physicians must not withhold information about the existence of any procedure or treatment because it conflicts with their conscience or religious beliefs.”

Please note the italics: The physician apparently has a duty to inform his patients of all options legally available even if they are inappropriate! And this obligation shall override any moral or professional convictions that physician might hold.

The violence of the obligation to “inform” goes even beyond that of “effective referral” itself. Every patient who fits the criteria for euthanasia must be subjected to the terrible stress and doubt of learning that he or she belongs to that select group of people for whom medically-inflicted death has become an option. And no objection of judgement or of conscience can free the doctor from delivering that terrible message and its implicit suggestion.

In Ontario, then, by proclamation of the CPSO, the doctor’s role is reduced to that of an automatic vending machine which simply displays state-mandated euthanasia options and passively offers corresponding buttons for the patient to push.

Obviously, the scope and impact of such a policy is astounding. Professional judgement is the bedrock of medical practice. Freedom of conscience is the underpinning for our entire system of secular democracy. Both are set aside.  The scale of the emergency must be colossal to require such draconian measures!

But, of course, there is no such urgency.

Let us remember that the original euthanasia program was sold to us as an imperative response to a hypothetical terminally ill patient in unbearable and untreatable pain.  Let us recall how that extreme, no, that virtually mythical case, was leveraged into all of the totally unrelated deaths that we now apprehend. Once again, a similar strategy is at work. This time, the absolute need for all doctors to promote euthanasia (all the time and to all of their most vulnerable patients), is presented as a required response to the hypothetical possibility of even one patient, desirous to die, but who is frustrated in her wish.

We are asked to believe that any real burden whatsoever, financial, professional, or moral, can be justified in the interest of allowing that one sacred voluntary death. It is a sort of grotesque inversion of the proposition that “no price is too high” provided that “only one child be saved…”.  Which becomes in this case: “if only one person might die…”.

Other jurisdictions, no less respectable than Ontario have taken an opposite stance, and there is no evidence that anybody has suffered or will suffer.

Manitoba is in the process of explicitly recognizing the right of non-participation and non-referral of all health professionals and others working in health care. Major hospitals in Winnipeg have announced their refusal to euthanize patients.

In the State of Vermont a judicial battle over similar issues has resulted in an unambiguous victory for doctors’ rights.

And in Ontario, a group of dedicated and courageous doctors launched a court challenge in defense of doctors’ conscience, which was heard June 13-15, 2017.

That judgement will be rendered later this year.  Let’s hope our courts get it right this time!

But regardless of that outcome, regardless of the timeframe, and regardless of expense; regardless of the legislative efforts that may ultimately be required: This authoritarian policy of the College of Physicians and Surgeons of Ontario is neither necessary nor justified. It is not desirable. It is not even reasonably defensible. It is extreme. And it is irrational. Above all, it is profoundly harmful to individual doctors and patients and to the whole medical profession. It constitutes both an injustice and an embarrassment which cannot be allowed to stand.

 

“Now you want to crush every tiny focus of opposition”

Physicians’ Alliance Against Euthanasia Open letter to Mme Véronique Hivon

Note: Véronique Hivon, now a member of the Quebec National Assembly, was Minister of Health in the previous government and was responsible for bringing forward Quebec’s euthanasia law.

Mme Hivon:

You label as « ideology » the decision made by the McGill University Health Centre to not euthanize patients on the palliative care ward.

“The patients at the end of life are the ones who should have their rights respected and be at the centre of the organization of care”, you say. If that is what you really believe,

  • where were you when the number of palliative care beds at the MUHC was reduced for budgetary reasons?
  • When the specialized geriatrics unit was closed completely?
  • Why do you not speak out when patients are transferred all over the hospital and the city for trivial reasons, as is regularly done in Quebec?

What other than ideology could make you want to force hospitals, not only to kill patients, but to kill them in the one place where they most need to be protected?

Palliative care professionals are experts in easing the pain and suffering of terminally ill patients, accompanying them to the very end of their lives, with no need to kill them in order to do so. Now they are struggling, all over Quebec, to continue providing the same peace at the end of life in a situation where death is being promoted. Yes, promoted. This law was passed against the better judgment of those who know best how to care for the dying. Now you want to eliminate even the little safe space that is left for patients and professionals. All they ask for is one place in the hospital where there is no risk of being killed.

You got what you wanted when this law passed. Now you want to crush every tiny focus of opposition to your favourite project.

That is more than ideology. It’s intolerance, pure and simple.

We support the freedom of the palliative care professionals at the MUHC (and at every hospital) to ensure there are safe spaces for patients.

Yours truly,

[Original text and over sixty signatories]

 

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

 

Medical aid in dying: Court challenge

News Release

Living with Dignity, Physicians’ Alliance

MONTREAL, July 17, 2014 /CNW Telbec/ – As announced when Bill 52, An Act Respecting End-of-Life Care, was adopted, the citizen movement Living with Dignity (LWD) and the Physicians’ Alliance against Euthanasia (the Alliance), representing together over 650 physicians and 17,000 citizens, have today filed a lawsuit before the Superior Court of Quebec in the District of Montreal.

The lawsuit requests that the Court declare invalid all the provisions of An Act Respecting End-of-Life Care that deal with “medical aid in dying”, a euphemism used to describe euthanasia. This Act not only allows certain patients to demand that a physician provoke their death, but also grants physicians the right to cause the death of these patients by the administration of a lethal substance.

The Alliance and LWD are challenging the constitutionality of those provisions in the Act which are aimed at decriminalizing euthanasia under the euphemism “medical aid in dying”. Euthanasia constitutes a culpable homicide under the Criminal Code. It is a subject-matter which is at the core of the exclusive federal legislative power in relation to criminal law and Quebec therefore does not have the power to adopt these provisions.

In addition, the impugned provisions unjustifiably infringe the rights to life and to security of patients guaranteed by the Canadian Charter of Rights and Freedoms and the Quebec Charter of Human Rights and Freedoms. They further infringe the right to the safeguard of the dignity of the person, which is also protected by the Quebec Charter.

In view of the gravity of the situation and the urgent need to protect all vulnerable persons in Quebec, the Alliance and LWD request an accelerated management of the case in order to obtain a judgement before the expected coming into force of the Act on December 10, 2015.

Sources: The citizen network Living with Dignity and the Physicians’ Alliance against euthanasia .

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]

Physicians’ Alliance for Total Refusal of Euthanasia

Although euthansia and assisted suicide are criminal offences in Canada, and criminal law is under the jurisdiction of the federal government, the government of Quebec has announced that it will legalize assisted suicide and euthanasia provided by health care workers.  [National Post] The commission that recommended this step also recommended that objecting physicians be forced to facilitate the procedures by referral.

It appears that the provincial government will claim that assisted suicide and euthanasia are forms of medical treatment.  Since health care is under provincial and not federal jurisdiction, the province will likely argue that the prohibition of these services within the context of health care trespasses on provincial jurisdiction.  This was one of the claims of the BC Civil Liberties Association in Carter v. Canada, which it won.

The third legal argument advanced by the BC Civil Liberties Association in Carter was that “treatment and management of the physical and emotional suffering of a grievously and irremediably ill patient” are matters that fall within the “exclusive jurisdiction” of the provinicial government, which is constitutionally mandated to manage health care. Since (according to the plaintiff physician) physician-assisted suicide and voluntary euthanasia are “important component[s] of the provision of health care to grievously and irremediably ill patients,”the lawsuit asked that sections of the Criminal Code (a federal statute) that prevent the provision of this “health care” should be struck down as an unconstitutional interference in provincial jurisdiction, “to the extent that [they] prohibit physician-assisted dying.” See Legalizing therapeutic homicide and assisted suicide:A tour of Carter v. Canada

However, the claim was not adjudicated in Carter because it was not actually argued during the trial.

The province also has the constitutional authority to enforce and administer criminal law, so that it could, in theory, instruct prosecutors not to pursue charges against health care workers  who provide the procedures in accordance with government guidelines.  It could do this pending the outcome of litigation, and even if the criminal prohibition stands. This is the approach taken in England with respect to  assisted suicide, though the English guidelines indicate that health care workers must not be involved.

Should the provincial government refuse to prosecute health care workers who provide the services, it would be possible for the federal government to order the federal police force, the Royal Canadian Mounted Police, to investigate allegations, and to appoint and pay lawyers to act as prosecutors.  However, this would be especially contentious in Quebec, since the current government is ideologically committed to the separation of Quebec from Canada and the establishment of the province as an independent nation state.  Nationalist elements in Quebec would see that kind of federal intervention as not only a constitutional violation of provincial jurisdiction, but as violation of sovereignty.

Thus, divisions among health care workers on this issue may involve complexities and nuances not encountered elsewhere, and those who resolutely refuse to provide or facilitate assisted suicide and euthanasia may find their circumstances unusually challenging.  Nonetheless,  prominent Quebec physicians have formed The Physicians’ Alliance for Total Refusal of Euthanasia.  The Alliance is directly challenging the medical regulatory authority:

The Quebec College of Physicians does not have the legal or the moral authority to change one of the basic pillars of medicine, or to amend the code of medical ethics, without first conducting an extensive study and consultation with members of the profession. The mere passing of a resolution by the board of directors does not make physician-inflicted death an acceptable form of care.