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Testimony from a practicing palliative care physician:

I have been practicing Palliative Care medicine for the past 6 years, having worked with teams in two other cities before coming to Montreal, where I currently practice.

Palliative Care providers are a passionate group of people, dedicated to caring for terminally ill patients, helping them in life’s final journey.

Today I wish to express my concerns with regards to the Parliamentary Committee’s recommendations. I have two main concerns that lead me to worry about the future of Palliative Care in this great country.

Firstly, the Quebec law on assisted dying has already had a drastic impact on the practice of Palliative Care. Palliative Care aims to maintain or improve quality of life despite a life-limiting illness. As a team, approaching medical care in a patient-centered way, we are exceedingly successful in bringing comfort, meaning and dignity to people’s dying days. This includes the majority of patients who have asked for hastened death prior to the introduction of medically assisted dying. Patients and their families are truly grateful for the care that we are able to offer.

The introduction of the assisted dying laws has poisoned our interactions with patients who bring up a desire for hastened death. It used to be a way to open up communication, see how the patient was suffering and explore options to ease their pain. Now, patients often categorically refuse any further discussion about the reasons for their request, affirming that it is their right and shutting out the Palliative Care services we have to offer. This has led to a harmful environment of low morale and ethical anxiety for my colleagues and me.

Many of my colleagues are on the verge of leaving the work they love. Some have retired early. One has gone on extended leave. Many nurses have expressed to me their readiness to leave Palliative Care.

If we want to maintain Palliative Care services in this country, where are the Palliative Care voices in this Parliamentary discussion? Have we decided to replace Palliative Care with medically hastened death?

My second concern centres around the fact that the Parliamentary Committee has ignored the Canadian Medical Association’s recommendations regarding Conscientious Objection. The CMA ’s position is “Physicians are not obligated to fulfill requests for assisted dying. This means that physicians who choose not to provide or participate in assisted dying are not required to provide it or to participate in it or to refer the patient to a physician or a medical administrator who will provide assisted dying to the patient. There should be no discrimination against a physician who chooses not to provide or participate in assisted dying.”

There is no question that if Conscientious Objectors are forced to provide an effective referral, thus sending patients to their death, there will be many physicians who will quit their practice, many of whom will be Palliative Care doctors. Instead, I suggest we follow the CMA’s recommendation that “Physicians are expected to provide the patient with complete information on all options available, including assisted dying, and advise the patient on how to access any separate central information, counselling and referral service.”

The convergence of a law that is harmful to Palliative Care and a requirement for those physicians to be complicit in an act that violates their conscience provides a perfect storm for a dangerous degradation of Palliative Care services in this country. This is not what the majority of the population wants. The protection of Palliative Care services needs to be a priority of this government, and I believe that the existing recommendations have not shown an appreciation of these risks.

R. G. (Montreal, QC)