Quebec Doctors Forced Into Homicide?

 Human Exceptionalism

Wesley J. Smith

No one should be forced to kill or participate in killing. But if a recommendation of a Quebec euthanasia commission to legalize doctor-administered death are followed (discussed in more detail here) every Quebec physician will be conscripted to participate in homicide as a condition of practicing medicine.  Read more . . .

 

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.

 

Quebec to consider allowing euthanasia and assisted suicide

Quebec Minister of Health Yves Bolduc and Minister of Justice and Attorney General of Quebec, Jean-Marc Fournier have announed that a committee of legal experts will be formed to determine how to allow assisted suicide and euthanasia in the province, though the procedures are criminal offences in Canada. [LifeSite News]

Canadian Society of Palliative Care Physicians rejects euthanasia

The Canadian Society of Palliative Care Physicians has rejected a recommendation from a Quebec legislative committee that euthanasia and physician assisted suicide be legalized.  The Society stated that the procedures contradict “a fundamental tenet” of the Society and most palliative care physicians.  The president of the Society said “We are concerned that, despite the fact that our members are unwilling to provide these services, this may be mandated if it becomes law in Quebec.” [CSPCP statement]

Canadian hospice association rejects participation in euthanasia

The Canadian Hospice Palliative Care Association has lauded recommendations for the improvement of palliative care contained in a report from the Quebec Comission on Dying with Dignity.  However, it states that euthanasia and assisted suicide should not be part of palliative or hospice care, and that hospice and palliative care workers should not be expected to participate in such practices if they are legalized. [News Release]

Quebec Commission on Dying with Dignity Releases Death with Dignity Report

 Improvements to hospice palliative care recommended

NEWS RELEASE

Canadian Hospice Palliative Care Association

April 2, 2012 (Ottawa, ON) – The Canadian Hospice Palliative Care Association (CHPCA) is optimistic about many of the recommendations put forth in the Special Commission on Dying with Dignity’s (Commission spéciale sur la question de mourir dans la dignité) report, Dying with Dignity. On March 22, the Committee made 24 recommendations to the Minister of Health and Social Services as to how end-of-life care should be improved in Quebec. Among the recommendations, the CHPCA applauds those focused on the further development of hospice palliative care in Quebec; these include improved training for hospice palliative care professionals, earlier access to hospice palliative care for patients, and the implementation of end-of-life care policy in Quebec.

The CHPCA commends the Committee for their efforts and inclusion of recommendations around improving the quality and delivery of hospice palliative care in Quebec. The Commission conducted extensive hearings with hospice palliative care professionals across Quebec to ensure that all viewpoints were equally represented. The resulting report is a strong first step towards implementing standardized hospice palliative care in Quebec so that all patients may have the highest quality of life and quality of dying

Among the recommendations however, were several advocating for the legalization of physician assisted death**, should the patient request. “Many of the Committee’s recommendations show a positive future for hospice palliative care in Quebec,” stated Sharon Baxter, Executive Director of the CHPCA, “however we need to have a clear distinction between hospice palliative care and physician assisted death. Physician assisted death should not be considered a part of or linked to hospice palliative care ideology or practice.”

“. . .Physician assisted death should not be considered a part of or linked to hospice palliative care ideology or practice.”  . . . Should a legislation allowing physician assisted death be passed by the Quebec government in the future, the dedicated and committed personnel who work in hospice palliative care should not be expected to participate in this practice.

The CHPCA believes that hospice palliative care is about ensuring a good death for all Canadians through an interdisciplinary approach that includes pain and symptom management, psychological support, spiritual care, bereavement care, and much more to address the suffering of patients and their families.

Should a legislation allowing physician assisted death be passed by the Quebec government in the future, the dedicated and committed personnel who work in hospice palliative care should not be expected to participate in this practice.

Right now, only 16% of Canadians who die have access to or receive hospice palliative, and quality end-of-life care services. The CHPCA wants to ensure that all Canadians have the highest quality of life as they live with a life limiting or terminal illness. Too many Canadians die with suffering that could be addressed in a more effective manner. The CHPCA believes that we need to have a greater focus on quality end of life care and the right to high quality hospice palliative care at the end of life for all Canadians as we enter into the debate around the contentious issue of physician assisted death.

**incorporates both terms “euthanasia” and “assisted suicide”

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For further information, please contact:

Vanessa Sherry Communications Officer Canadian Hospice Palliative Care Association E-mail: vsherry@bruyere.org Phone: 613-241-3663 ext: 229


The Canadian Hospice Palliative Care Association — the national voice for hospice palliative care in Canada – is dedicated to the pursuit of excellence in care for persons approaching death so that the burdens of suffering, loneliness and grief are lessened. The CHPCA operates in close partnership with other national organizations and continues to work to ensure that all Canadians, regardless of where they may live, have equal access to quality hospice palliative care services for themselves and their family.

Quebec euthanasia proposal challenged as unbalanced

Margaret Somerville, founding Director of McGill University’s Centre for Medicine, Ethics and Law, criticizes the report of Quebec’s Select Committee on Dying with Dignity on the ground that it is unbalanced “and reads rather like a pro-euthanasia manifesto.”  She notes that two thirds of the submissions received by the Committee opposed euthansia. [The Gazette]

 

Compulsory referral for euthanasia recommended in Quebec

The Select Committee on Dying with Dignity has tabled a report unanimously recommending “relevant legislation be amended” to allow euthanasia in the province of Quebec.  The Committee also recommends that objecting physicians be forced to refer for the procedure.  According to the recommendations, conscientious objections by nurses will be allowed, but it does not indicate whether or not they should be compelled to participate in or facilitate the procedure by referral or other means. The Committee recommends that codes of ethics for physicians and nurses be amended accordingly.  The recommendations are available in English, but the report will not be available in English until May [Quebec National Assembly].