Canadian/Royal Dutch Medical Association Proposed Change to WMA Policies
Euthanasia and Physician Assisted Suicide
Full Text
III. REGIONAL WMA CONFERENCES
III.1.1 National associations gathered regionally to
discuss end-of-life issues in 2017 and 2018. Conferences in three of
the four WMA world regions (Latin America, Asia-Oceania and Africa)
unanimously opposed euthanasia and physician assisted suicide, and the
majority of participants in the European conference held in the Vatican were
also opposed to the practices.
III.1.2 It is obvious that a general appetite for
euthanasia and assisted suicide is confined to North America, western
Europe, Australia and New Zealand, and that the overwhelming majority of
national associations favour retaining the WMA prohibition of physician
participation in the practices.
III.1.3 WMA public documentation of the conferences is
notably weighted in favour of the European gathering, and many speakers used
slides in English during their presentations. In addition,
live-tweeting by Dr. Jeff Blackmer of the Canadian Medical Association
supplemented the official record. For these reasons, the Vatican
conference is described here in much greater detail than the other regional
conferences. However, the reader should note that only
the papal message and opening address by the President of the Pontifical
Academy for Life were made available as full-text documents. Thus,
individual presentations can only be described in outline, and some
inferences are necessary to make sense of some of them.
III.2 Latin America: Rio De Janeiro (March, 2017)
III.2.1 The Brazilian Medical Association hosted the
Latin American Meeting on End-of-Life Ethical dilemmas and provided a report
summarizing participant conclusions. In brief, the participants
emphasized the need for access to palliative care and rejected euthanasia
and assisted suicide. Their view was that those at the end of life
need do not need help to "precipitate death," nor to prolong suffering by
"therapeutic obstinacy", but should be relieved by palliative care until
death arrives.1
III.2.2 The summary made the important point that the
participants understood the social debate about legalizing euthanasia to
concern "exceptional" cases that cannot be managed adequately by "quality
medical care." It is doubtful that some prominent cases of
legal euthanasia in Canada,2 Belgium3 or the Netherlands4 would have met
this criterion, though they were obviously acceptable to the national
medical associations in those countries.
III.2.3 The summary stated that human life always has dignity,
although people live in conditions contrary to human dignity, caused by
decisions and behaviours that fail to respect it. Since death occurs
at a certain moment in life, it can neither be dignified nor undignified in
itself, though the conditions of life preceding it may be either.5
III.2.4 The participants did not believe that respect for
patient autonomy was sufficient to guarantee the freedom and dignity of the
person, who may be unable to manifest his will freely in certain situations.
Thus, they said, patient dignity must be defended against the interventions
of third parties, and sometimes even against patients' own decisions.6
III.2.5 Euthanasia and assisted suicide would, in their
view, adversely affect medical ethics and undermine the trust in the
physician-patient relationship. They were concerned that legalizing
euthanasia would send a "social message" to severely disabled patients and
other vulnerable patients that they should request euthanasia so as not to
burden their families and society.6
III.2.6 The Latin American Associations stated that
requests for euthanasia would be reduced by improving professional training
in pain relief and palliative care. They expressed concern that
legalizing euthanasia would discourage health professionals and researchers
from responding in non-lethal ways to patients with incurable conditions,
which requires considerable dedication of time and human resources.
They also referred to the risk of the "slippery slope," exemplified by the
Netherlands, where euthanasia has been provided to people who have not
requested it or have not met legal requirements.6
III.2.7 The participants emphasized that those who choose
to practise medicine dedicate themselves to saving the lives of their
patients and eliminating as much suffering as possible, and cannot
simultaneously dedicate themselve to ending a patient's life. Hence,
they said, euthanasia should never be a medical activity ("La eutanasia en
ningún caso debe ser una actividad médica."). On this
point, the English translation of the document is not just erroneous, but
states the opposite.6
III.3 Oceania and Asia: Tokyo (September, 2017)
III.3.1 The General Assembly of the Confederation of
Medical Associations in Asia and Oceania (CMAAO) met in Tokyo in September,
2017.7
WMA Secretary General Otmar Kloiber, German Medical Association President
Prof. Dr. Frank Ulrich Montgomery, International Manager Dr. Ramin
Parsa-Parsi and the immediate past American Medical Association President
Dr. Andrew Gurman were present for the symposium on end-of-life questions.8
III.3.2 Preceding the conference, a survey was sent to
all 21 national associations with five groups of questions centred on the
following topics: (1) euthanasia and
physician-assisted suicide, (2) advance directives, (3) withholding or
withdrawing life-sustaining treatment, (4) palliative care and end-of-life
care and (5) substitute decision making for incompetent adults.9
III.3.3 19 associations replied. During the
conference, 17 associations presented reports elaborating or modifying their
survey answers. Only Macau and Sri Lanka did not respond. New Zealand
and Cambodia did not attend the conference, but submitted detailed answers.10
III.3.4 The summary states that all participants
opposed euthanasia and physician assisted suicide, and, except in New
Zealand and Australia, there is no appetite for discussion of the procedures
in civil society. On the other hand, all participants supported advance
directives and advance care planning for terminally ill patients.11
Taiwan, which was one of only three associations to recommend a change in
WMA policy (a major revision of the euthanasia policy:
II.1.2) was a
participant in the symposium, so it appears that either the major revision
it had in mind was consistent with the conclusions of the symposium, or that
the discussion caused it to change its position.
III.3.5 Japanese Medical Association's legal advisor, Professor Tatsuo Kuroyanagi,
was responsible for the report of the symposium.12
He erroneously implied that both euthanasia and physician assisted suicide
are legal in Switzerland and the United States, and also erroneously stated
that Canadian legislation approves only physician assisted suicide.10
III.3.6 In personal comments included in the report, he
noted the wide variety and strong influence of religious beliefs throughout
the region. He also observed that "family and community bonds are
extremely firm in the island regions in Oceania such as Indonesia,
Philippines, Malaysia and the countries/jurisdictions in the Southeast Asian
region such as Pakistan, India, Bangladesh, Myanmar, Thailand, and Cambodia,"
and that these areas have not assimilated the western concept of
self-determination.13
III.3.7 Prof. Kuroyanagi also drew attention to
confusion caused by terms like "active" and "passive" euthanasia, as well as
difficulty that could arise from failing to distinguish between physician
assisted suicide and "a criminal type of murder at the victim's request,"
which he suggested might be called "physician-assisted dying." He did
not explain why consensual homicide should be called "physician-assisted
dying" rather than euthanasia.12
III.3.8 In October, the Secretary General provided the
WMA Medical Ethics Committee with an oral report of the symposium.
According to the Ethics Committee minutes, he said that none of the national
associations attending the meeting had a policy supporting euthanasia and
assisted suicide.14
While correct, this did not reflect the stronger position later reported by Prof.
Kuroyanagi: that all associations opposed the procedures (III.3.4).
III.4 Europe: Vatican City (November, 2017)
III.4.1 A two-day WMA European Region Conference on End-of-Life Questions
organized by the WMA, the German Medical Association and the Pontifical
Academy for Life was held in Vatican City on 16 and 17 November 2017.15 According
to the report on the conference, about
150 participants attended.
The author of the report of the conference is not identified; it is said to
have been based on an article by Nigel Duncan in the World Medical
Association Journal.16
III.4.2 During a plenary panel discussion at the conclusion of the conference,
six speakers debated whether
or not WMA policies on euthanasia and assisted suicide should be changed.
Five of the six panelists had made presentations at the conference; one (Dr. Matilde Leonardi)
had chaired the morning sessions on the first day.17
Based on their earlier presentations, it appears that Professor Dr. Urban
Wiesing (Germany),
Dr.
René Héman (Netherlands) and Dr. Yvonne Gilli (Switzerland) advocated
for change. Presentations of Prof. Dr. Stephan Sahm (Germany) and
Prof. Dr Frank Ulrich Montgomery (Germany) indicate that they
represented the "no change" position during the panel discussion. They
were likley supported by panelist Dr. Leonardi (Italy), a corresponding
member of the Pontifical Academy for Life.
III.4.3 Throughout the conference, advocates for change
emphasized "patient self-determination, dignity and compassion," insisting
that their intention "was to protect physicians in their own countries who
are acting within the law, not to change or influence policies in other
countries."17
III.4.4 Those opposed rejected both
procedures "as being diametrically opposed to the ethical principles of
medicine." Opponents voiced concerns that legalization "could lead to misuse
or abuse," generate social pressures on the elderly and those with chronic
illness to end their lives, and undermine the trust essential to the
physician-patient relationship.17
III.4.5 The majority of participants rejected any change to existing WMA policies
against euthanasia and physician assisted suicide, but
all supported "high-quality, accessible palliative care" and
rejected the use of the procedures as cost-saving
measures.17
III.4.6 The CMA's Dr. Jeff
Blackmer, attending the conference, tweeted the reason for his presence:
Dr. Blackmer: At a meeting on #EOL care and #euthanasia at
#TheVatican organized by @medwma. @CMA_Docs pleased to represent
Canadian physicians here. Current WMA policy states physicians who
participate are unethical. We are working with others to try and change
this.18
III.4.7 While he acknowledged that Vatican
officials as "very gracious hosts,"19
he commented, "It's like having a human-rights discussion in North Korea.
It's not a neutral environment."20
III.4.8 Dr. Blackmer was not a speaker, he participated in
discussions and defended the participation of Canadian physicians in
euthanasia and assisted suicide.21
He tweeted his comments on the presentations and some of his exchanges
with speakers and conference participants.
III.4.9 Some Twitter respondents applauded the CMA's presence. Dr. Blackmer
retweeted praise from Meredith Vanstone: "Changing and shifting values-
@CMA_Docs are responding to Canadian patient needs and requests, doing
important work for those who express this wish."22
He also retweeted "Kudos" from Jocelyn Downie,23
with whom he shared his personal experience of the proceedings:
Dr. Blackmer: Would love for you to be able to observe the dialogue
@jgdownie. It is a terrific exercise in attempting to exert control
over your own inner dialogue.24
III.4.10 Professor Jocelyn Downie of Dalhousie University25
is perhaps the foremost advocate for euthanasia and assisted suicide in
Canada. She contributed substantially to the legal strategy that
resulted in the Supreme Court decision ordering legalization of the
procedures.26 She favours coercion of objecting health care workers
and institutions to compel them to collaborate in euthanasia and assisted
suicide by referral,27,28
as well as forcing both private and public institutions to permit the
procedures on their premises.29
She has been awarded the Order of Canada for her work in this field.30
It appears that Dr. Blackmer has since deleted this reply to her from his
Twitter feed.
III.4.11 The reaction to the CMA presence by Canadian
physician Dr. Martin Owen, Vice-President of the Canadian Federation of
Catholic Physicians' Societies, was markedly different.
Dr. Martin Owen: How can the CMA go
from "officially opposed" to euthanasia to "international advocate" in such
a short time?31
Dr. Blackmer: Please don't become one
of those mis-stating facts. We are not advocating for euthanasia. We are
asking the WMA to stop condemning our CMA members who participate - or
physicians anywhere where it is a legal act - as acting unethically.32
Dr. Owen: Legality does not
change ethics. The WMA is within their rights to maintain their position.33
Dr. Blackmer: BTW - please add
the following disclaimer to all my future tweets: When I say I am
representing Canadian physicians, I mean as an official representative of
the CMA, based on CMA policy. Clearly I don't represent the actual views of
ALL Canadian docs. That would be #impossible.34
Dr. Owen: Despite the
disclaimer that he doesn't represent the opinions of all Canadian doctors
the official presence of the @CMA_Docs with the intention of changing WMA
policy speaks volumes.35
Dr. Blackmer: Let me make
something crystal clear. The CMA supports the right of all its members to
decide whether or not to participate in #euthanasia. We have spent 1000’s of
hours protecting conscience rights. And we will advocate for our members who
elect to participate in a legal act.36
III.4.12 Dr.
Frank Montgomery (President, German Medical Association) spoke out strongly
against euthanasia,37
eliciting a protest tweet from Dr. Blackmer.
Dr. Blackmer: Dr. Montgomery from Germany says "In countries with
#euthanasia, families apply pressure to pt's to end their lives" and
"Assisted dying has nothing to do with #compassion. It is a misguided
interpretation of compassion." This is not our experience in Canada.38
III.4.13
WMA President Elect Dr. Leonid Eidelman of Israel also opposed euthanasia,39
and, in Dr. Blackmer's view, also made claims uninformed by experience.
Dr. Blackmer's tweets resulted in a short Twitter conversation with some
Canadian physicians.
Dr. Blackmer: Dr. Eidelman from
Israel argues strenuously against #euthanasia. Says doctors who participate
do so with no more serious thought than prescribing antibiotics. This has
not been my experience in #Canada where physicians really struggle with the
decision making process.40
Dr. Lesley Barron: The idea
that drs providing #MAID don't take the decision seriously is quite
offensive really.41
Dr. Blackmer: I agree. I told
him that. I asked him for his evidence - or whether he had ever spoken to
anyone who had assisted in a death. He had no evidence and had not done so.
He declined to retract his statement though. He is President Elect of the
WMA.42
Dr. Barron: Not a good
approach for a medical leader.43
Dr. Ron George: Disparaging comment
to MDs everywhere struggling with difficult decisions with the persons they
provide care.44
III.4.14 Dr. Barron, a surgeon, has publicly and forcefully argued that
physicians who object to euthanasia and assisted suicide should be compelled
to facilitate the procedures by referral.45
Dr. George is an award winning member of the Faculty of Medicine, Dalhousie University in Halifax.46
III.4.15 Dr. Stephan Sahm of Germany denounced
euthanasia and assisted suicide as morally unjustifiable and a danger to
patients.47 He,
too, made allegations concerning Canadian physicians for which he had no
evidence.
Dr. Blackmer: Dr. Sahm, referencing
Canadian physicians, says they might struggle with #euthanasia initially,
but then they get used to it and it doesn't trouble them anymore. He hasn't
spoken to any Canadian physicians.48 When I challenged him to produce any evidence to
support his claims he could not.
Then he decided that maybe physicians do
continue to struggle and that this is also an argument against euthanasia.
Sigh.49
Joel Kirsh: With a sample size of
n=0, every outcome is in the confidence limits. Could re-title slide "Flaws
and fallacies in the evaluation of #assisteddying"50
Dr. Blackmer: There were a
number of slides that might be seen to fall into that category.51
III.4.16 Dr. Gunnar Eckerdal
(Sweden) spoke largely from the perspective of palliative medicine about
medication, feeding and terminal sedation. He rejected euthanasia and
assisted suicide because, he said, they were unsafe and unresponsive to the
actual needs of patients. His concluding slide, which concerned
mistaken patient assessments,52
appears to have been challenged by Dr. Blackmer.
Dr. Blackmer: A speaker said that 1% of pt's at his hospital are
misdiagnosed but (he guessed) 20% of #euthanasia pt's are misdiagnosed. When
I challenged him on his math, an Italian doctor yelled at me and accused me
of saying it's ok that some euthanasia pt's are misdiagnosed.53
III.4.17 Finland's Dr. Heikki Pälve explained that a bill to
legalize euthanasia was before the Finnish parliament, but
polls showed that it was supported by only 17 percent of specialists in
end-of-life care. Dr. Pälve said that the Finnish medical association supports physician
participation in public debates on the subject, but opposes physician
participation in the procedures. He also asserted "that the
slippery slope argument was a fact, and a very undesirable one."54
Professor Ilora Baroness Finlay discussed the portrayal of euthanasia and
physician assisted suicide in public discourse, challenging the purported
need for legalization and involvement of physicians in light of the actual
health needs of most of the world's population.55
III.4.18 In her presentation on assisted suicide in Switzerland, Dr. Yvonne Gilli
presumed but did not argue for the acceptability of assisted suicide.56 Only one speaker explicitly argued for the
acceptability euthanasia and assisted suicide. Dr. René Héman, Chairman of the Royal Dutch Medical Association
(RDMA) defended the practice of euthanasia in the Netherlands, basing his
position on "principles of respect for a patient's autonomy and on
compassion." He claimed that, while it is never good to deliberately
end someone's life, it is sometimes worse not to do so.57
Dr. Blackmer: Dr. Heman from #Holland says that “Euthanasia can be
accepted as an expression of #compassion and #mercy”. This is consistent
with our experience in #Canada. Also references importance of #autonomy and
respect for the views of others.58
III.4.19 Representatives of the Catholic Church
or Catholic perspectives,59,60,61,62 Islam,63
Judaism,64 and Orthodox
Christianity65 all opposed euthanasia and physician assisted suicide.
However, Professor Urban
Wiesing (Institute for Ethics and History of Medicine,
University of Tuebingen,Germany) countered that there is no ethical or
Christian
consensus on end-of-life issues, noting support for assisted suicide and
"killing on demand" (euthanasia) by the majority of Christians in
industrialized countries.66
III.4.20 Professor Wiesing cited former Archbishop of
Canterbury Lord Carey and Desmond Tutu as euthanasia/assisted suicide
supporters from the Anglican tradition, and tendentiously identified Hans
Kung as a supportive Catholic theologian.67
A slide referring to criticism of Pope Francis by former European Union
President Herman Van Rompuy indicates that Professor Wiesing drew attention
to the provision of euthanasia for mental illness by the Belgian province of
the Brothers of Charity, a Catholic religious order.68
In short, he held that ethical or moral pluralism is the norm, and that it
is necessary to preserve that pluralism by means of political solutions that
do not forbid euthanasia or assisted suicide on the basis of one of many
different convictions. On the other hand, he asserted that there is a
consensus that no one should choose assisted suicide prematurely, as a
result of pressure, or because of the lack of medical treatment or
palliative care.66 Dr. Blackmer
took note:
Dr. Blackmer: Dr. Wiesing from Germany uses a human rights based approach to
#euthanasia. Even in Christian Ethics there is no consensus. Empirical
evidence shows no #slipperyslope or decrease in #palliativecare. Personal
#EOL decisions not in scope of state responsibility.69
III.4.21 Professor Wiesing, though he referred to "killing on demand"
and occasionally to euthanasia, referred exclusively to physician assisted
suicide when he offered the findings of what he called "empirical ethics."
These demonstrated, he said, that where the procedure is legal, there is no
"slippery slope," no decrease in palliative care, no social discrimination
(against vulnerable patient groups) and no loss of trust in physicians. Perhaps it was Professor Wiesing's reference
to empirical evidence that led to a memorable question from one of the
participants, tweeted by Dr. Blackmer.
Dr. Blackmer: My favorite question so far from the meeting on #EOL and #euthanasia at
#TheVatican, from a physician representing Catholic doctors: “What
evidence do you have that death ends suffering?” Can't wait to see THAT
clinical trial application.70
III.4.22 Dr. Héman, defending Dutch euthanasia
practices, explained that Dutch law still prohibits euthanasia as a general
rule, allowing exemption from prosecution if certain criteria are met.
Hence, the law does not recognize a right to be assisted by others in
suicide, nor a right to euthanasia, nor does it oblige physicians to perform
euthanasia.57
III.4.23 Speaking of Swiss practice, Dr. Gilli stated,
"No physician can be ordered to assist suicide," adding that it is important
to "resist any pressure on physicians to assist or perform assisted suicide"
and to resist interpreting human rights to include a right to "unlimited
self-determination" concerning one's time of death within the context of
end-of-life-care.56
III.4.24 Dr. Eidelman appears to have adopted an
unusual position, opposing physician participation in euthanasia and
assisted suicide, but also (apparently) opposing conscientious objection by
physicians.39 Referring to a New
England Journal of Medicine article, he appears to have asserted that
"Health care professionals are not conscripts, and in a freely chosen
profession, conscientious objection cannot override patient care," and that
physicians are obliged to "provide, perform or refer."71
He appears to believe that physicians are protected against involvement in
euthanasia and assisted suicide by "the standards of the profession,"
which preclude such practices. This is clearly erroneous and
unrealistic, as demonstrated by the CMA's acceptance of euthanasia and
assisted suicide as legitimate treatments.
III.4.25 Professor Chris Gastmans from KU Leuven in Belgium was
the only speaker who addressed freedom of conscience for health care
workers, though exclusively within the context of conscientious objection.72
His presentation was purely descriptive, identifying three categories of
responses to conscientious objection: non-conventional compatibilism (the
Project position), conventional compatibilism (arguably the CMA's position)
and conventional incompatibilism (Julian Savulescu et al). He
identified three points of agreement among those holding these disparate
views:
- the patient should have adequate notice of the objection;
- disclosure should occur when a patient is taken on;
- objecting physicians should cooperate in a transfer of care.
Gastmans suggested that those opposed to conscientious objection were
primarily concerned about its negative effect on patient autonomy, while
those supporting it were concerned that making it illegal would cause some
people not to enter health care, and that one cannot provide good care while
acting against one's conscience.
III.4.26 Other speakers addressed a variety of topics:
the medical decision-making
process,73 assisted nutrition and hydration and terminal sedation,74 equitable access to health care
and patient centred practice,75 suffering,61,62,65 burdensome or disproportionate treatments,76 public discourse in bioethics77
and the meaning of the
term "euthanasia."78,79
III.4.27 A particular controversy about the meaning and
significance of the term "euthanasia" was noted by Pofessor Druml,76 summed up
in a reference in one of her slides to a paper by Andrej Michalsen and
Konrad Reinhart: "Euthanasia": a confusing term, abused under the Nazi regime
and misused in present end-of-life debate. The thesis of the authors
is that "[t]he term 'euthanasia' was so abused during the Nazi regime as
a camouflage word for murder of selected subpopulations with the willing
participation of physicians, we believe that, regardless of the benevolent
goals of current euthanasia practices, for historical reasons the term
'euthanasia' must not be used with regards to current end-of-life care.80
III.4.28 It does not appear that the subject was
pursued in depth by Professor Druml or addressed by other speakers, but it
became the focus of a sharp quarrel precipitated by an exchange at lunch
between Dr. Blackmer and another physician.
Dr. Blackmer: At lunch break today a physician who shall remain
unnamed struck up a conversation with me by telling me why the situation
with #euthanasia in #Canada today is so similar to what happened in Nazi
Germany. With great self control I managed not to euthanize him on the
spot.81
III.4.29 A Twitter respondent congratulated Dr.
Blackmer on his response.
Joel Kirsh: Admirable restraint. Godwin's Law meets (?willfully?) misapplied
definitions/comparison. What happened in the #Shoah was not
#assisteddying. Sad that such is the level of discourse, even at a
meeting of the presumably informed.82
Dr. Blackmer: Incredibly, the German
and Israeli Medical Associations made the very same comparison about two
years ago. The GMA has since clearly stated that the two are completely
unrelated.83
III.4.30 Dr.
Martin Owen took exception to Dr. Blackmer's jocular reference to
euthanizing a colleague, and a series of sharp exchanges followed.
Dr. Martin Owen: It appears that
@CMA_Docs has become unable to tolerate differences of opinion.84
Dr. Blackmer: That is profoundly
disappointing @mdmartinowen. Different opinions are one thing. Comparing
voluntary, patient-requested euthanasia to Nazi Germany is quite another.
All are entitled to views - but some cross a line and need to be called on
it.85
Dr. Owen: Agreed. Your comments about
euthanizing your colleague for their opinion crossed the line.86
Dr. Blackmer: You and your colleagues
were so pleased when the CMA advocated strongly for the right to
conscientious objection. It is profoundly unfortunate that you will not
allow us to advocate for other Canadian physicians whose views differ from
yours without comparing them to Nazis.87
Dr. Owen: Please do not
mischaracterize my comment. It was a strategy of the Nazi regime to promote
euthanasia. Please provide evidence to the contrary. You were the one
desiring to euthanize your colleague for their opinion...that's not
supportive of #freedomofconscience.88
Dr. Owen: Actually, euthanasia of
"undesirables" was a key strategy of Nazi Germany, and its acceptance by the
medical profession paved the way for future atrocities. Ironically, it was
physicians in the Netherlands who opposed euthanasia.89
Dr. Blackmer: Really, @mdmartinowen?
You really want to make any sort of comparison between the current situation
in Canada and what happened in #Nazi #Germany? There are not enough
characters in the whole world to tell you why this is so wrong and
disappointing.90
Dr. Blackmer: I’ve decided, as a
general principle, to block anyone on Twitter who in any way compares
Canadian physicians who participate in #euthanasia to #Nazis. Just so there
are no surprises, misunderstandings or hurt feelings.91
III.5 Africa: Abuja (February, 2018)
III.5.1 National Medical Associations from Nigeria,
Zambia, Kenya, South Africa, Cote D'Ivoire and Botswana met in Abuja,
Nigeria for two days in February, 2018. WMA Secretary General Dr.
Otmar Kloiber and some invited dignitaries attended the meeting.
III.5.2 The national associations observed that
most African countries suffer from a high poverty rate and "poor access to
affordable, equitable and quality health care." They advocated the general
strengthening of African health care systems: universal health care and
increased state financing of health care and insurance, including coverage
for chronic medical conditions and palliative care.
III.5.3 They noted that palliative care is generally
accepted, but there there is poor access to it and little awareness of
end-of-life issues among African populations and medical/health
professionals. On the other hand, "[i]n African culture, tradition and
religion, life is held sacred and families never abandon their loved ones at
the end of life."
III.5.4 Finally, the African national associations
stated that they were "unanimously opposed to euthanasia and physician assisted suicide in any
form."92
Notes
Latin America
1. World Medical Association. MEC 209/End of
Life Brazil/Apr2018: Report of the WMA South American region meeting
on End-of-Life Questions in Brazil 2017 (April, 2018) ["Latin
America"].
2. Grant K.
Medically assisted death allows couple married almost 73 years to die
together. The Globe and Mail, 1 April, 2018 (Accessed 2018-04-04).
3. Waterfield B.
Euthanasia twins 'had nothing to live for.' The Telegraph, 14
January, 2013 (Accessed 2018-06-05).
4. Cook M.
Dutch couple choose euthanasia together. BioEdge, 19 August, 2017
(Accessed 2017-08-22).
5. Latin America, p. 1.
6.
Latin America, p. 2.
Oceania and Asia
7.
World Medical Association. MEC 209/End of Life Japan/Apr2018: Report
of the Symposium on End-of-Life Questions in Japan 2017 (April,
2018) [Asia-Oceania].
8.
Asia-Oceania, p. 3.
9. Asia-Oceania, p. 2-3.
10. Asia-Oceania, p. 2.
11.
Asia-Oceania, p. 4.
12. Asia-Oceania, p. 5.
13. Asia-Oceania, p. 4-5.
14. World Medical Association. MEC
207/Report/Oct2017: Report of the Medical Ethics Committee (11
October, 2017) p. 5.
Europe
15.
WMA European Region Meeting on End-of-Life Questions
(16-17 November, 2017) Aula Vecchia del Sinodo, Vatican [Internet].
World Medical Association [Cited 2018 Sep 28] [WMA Vatican Programme].
16. World Medical Association. MEC 209/End
of Life Europe (Rev/Apr2018): Report on the WMA European Region
Conference on End-of-Life Questions 2017 [Europe] p. 3.
17. WMA Vatican Programme, p. 7.
18. Blackmer J. Tweet Jeff Blackmer@jblackmerMD
[Internet]. Twitter;
2017 Nov 15 at 11:29 pm [Cited 2018 Sep 28].
19. Blackmer J. Tweet Jeff Blackmer@jblackmerMD
[Internet]. Twitter;
2017 Nov 16 at 12:45 pm [Cited 2018 Sep 28].
20. Wojazer P.
'Like having a human rights discussion in N. Korea': WMA debates
euthanasia in Vatican City. Reuters [Internet]. 2017 Nov 18
[Cited 2018 Sep 28].
21. Europe, p. 2.
22. Meredith Vanstone @MGVanstone [Internet].
Twitter;
2017 Nov 17
at 7:05 am [Cited 2018 Sep 28].
23.
Jocelyn Downie @jgdownie [Internet]. Twitter;
2017 Nov 17 at 05:33 am [Cited 2018 Sep 28].
24. Blackmer J. TweetJeff
Blackmer@jblackmerMD [Internet]. Twitter; 2017 Nov 17 [Cited 2017
Nov 26]. Since deleted.
25. Dalhousie
University: Schulich School of Law: Faculty and Staff: Jocelyn Downie
[Internet]. [Cited 2018 Sep 28].
26. In 2007 and 2008 she developed a legal
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or assisted suicide on their premises, or arrange for it to be done
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