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]

Right-to-die already weighing on Quebec’s conscience

 New law has hospitals, doctors grappling with old fears, new moral burdens

Toronto Star

Allan Woods

MONTREAL—Quebec passed a landmark euthanasia law earlier this month meant to end the agony in the final days of a terminal patient’s life. But the legislation has lumped the province’s medical community with an existential burden it is only now confronting.

Doctors are weighing their consciences against their looming legal responsibilities to dying patients. It’s not entirely clear which one will win the day.

“I’ve been working in clinical ethics as a physician for 24 years and this is going to be one of our biggest challenges,” says Dr. Eugene Bereza, director of the centre for applied ethics at Montreal’s McGill University Health Centre.

The process that led to Bill 52, the so-called Medical Aid in Dying legislation, was wrenching enough in a society where the government, school and hospitals were a proxy for the Catholic Church not two generations ago. . . . [Full text]

Hearings on Quebec Bill 52: Quebec Association of Clinical Ethicists

Delphine Roigt, Emilia Guévin, Michel Lorange

Wednesday, 9 October 2013 – Vol. 43 N° 45

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.  Translation block numbers (T#) have been assigned by the Project as references to facilitate analysis and discussion.

Original Text

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Caution: raw machine translation

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Le Président (M. Bergman) : À l’ordre, s’il vous plaît! Alors, Me Roigt, bienvenue. Vous avez 15 minutes pour faire votre présentation, suivie d’un échange avec les membres de la commission. S’il vous plaît, donnez-nous votre nom, votre titre, ainsi que ceux qui vous accompagnent. Et le prochain 15 minutes, c’est à vous. 001 The Chairman (Mr. Bergman): Order, please! So Me Roigt, welcome. You have 15 minutes to make your presentation, followed by a discussion with the members of the commission. Please give us your name, title, and those who accompany you. And the next 15 minutes, it’s up to you.
Mme Roigt (Delphine): Parfait. Merci. Alors, je suis Delphine Roigt, éthicienne clinique et avocate, présidente de l’Association québécoise en éthique clinique. Je suis accompagnée d’Émilie Guévin qui a participé à la recherche et à la rédaction sur le mémoire, donc Me Émilie Guévin, et Michel Lorange qui est vice-président de l’Association québécoise en éthique clinique. Merci. 002 Ms. Roigt (Delphine): Perfect. Thank you. So I’m Delphine Roigt, clinical ethicist and lawyer, president of the Quebec Association of Clinical Ethicists. I am accompanied by Emilia Guévin who participated in the research and writing on the memory, so Emilia Guévin Me and Michel Lorange who is vice-president of the Quebec Association Clinical Ethics. Thank you.
Alors, M. le Président, Mme la ministre, membres de la commission, je tiens d’abord à vous remercier de l’invitation qui m’a été faite de venir partager mes réflexions sur cet important projet de loi. D’entrée de jeu, puisque j’avais l’opportunité de m’adresser à vous en tant qu’éthicienne clinique et avocate, j’ai décidé, avec mes collègues éthiciens cliniques, de le faire aussi à tire de présidente de l’Association québécoise en éthique clinique. 003 So, Mr. President, Madam Minister, members of the committee, I want to thank you for the invitation that was made to me to come and share my thoughts on this important bill. From the outset, since I had the opportunity to speak to you as a clinical ethicist and lawyer, I decided with my colleagues clinical ethicists, do also draws President of the Quebec Association for clinical Ethics.

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