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Dear friends,

A surprising article entitled Vers la mort à la carte? (Towards death à la carte?) appeared recently on the Collège des médecins du Québec website. College Secretary Dr. Yves Robert, who was one of the principal actors in the push for legal euthanasia in Quebec as of 2009, is now expressing concern at the rapid evolution in public opinion, from support for euthanasia in cases of extreme suffering at the end of life, to an expectation of death on demand with no limits.

I encourage Quebec doctors and citizens to call or write to Dr. Robert, tell him you share his concerns, and urge the College to take a firm stand against broadening the criteria for euthanasia. The College contact information is here and Dr. Robert’s local and e-mail here.

Please find our reflections on this startling reversal here: Dr Robert’s regrets…

As we finally begin to have some warm weather, I wish you all a pleasant summer and an opportunity to take a well-earned break from your hard work in favour of patients.

Sincerely,

Catherine Ferrier
President

One of our opponents in this battle is the newly-formed Canadian Association of MAID Assessors and Providers (CAMAP). Note the absence of the D-word in the acronym for their association: as if this were not about Death. At their first national conference last week they expressed their opposition the federal law’s safeguard requiring that the patient’s death be reasonably foreseeable for euthanasia to be permitted. They have published clinical practice guidelines that could be challenged on medical and probably on legal grounds as well. Please read them and make your views known in medical or lay media.

We hope to organize our own conference for physicians in the fall, with the purpose of addressing clinical issues of concern to you in the care of patients who are at the end of life and at risk of requesting euthanasia. A possible time would be before or after the CFPC’s Family Medicine Forum, which will be held in Montreal November 8-11, 2017. We will be sending you very shortly a survey, to gauge members’ interest, as well as to obtain your opinion on dates, topics etc. Please take a moment to answer it promptly when you receive it.

• Our Ontario colleagues continue to fight for the freedom to not participate in euthanasia in any way, including referral. The following article contains an excellent overview of the arguments advanced by refusing doctors: Link to article >>
• Unfortunately, despite the excellent work of many testifying before the Ontario legislature, the law regulating euthanasia was adopted with no conscience protections incorporated in it. A private member’s bill for conscience protection was likewise defeated, provoking great disappointment among doctors and many musings about leaving the province: Link to article >>
• Moreover, as many critics have pointed out, of all jurisdictions allowing some form of euthanasia or assisted suicide, Ontario alone has espoused such an extreme policy. There was once a particularly pointed parody of authoritarian policy in the old Soviet Union: “Anything that is not forbidden is compulsory!” Now that may sound impossibly silly, but in the current instance, that which was literally criminal homicide a day or two ago, has now become mandatory in Ontario, at least through “effective referral”.
• Several doctors have publicly speculated on how or why such incredibly extreme, divisive and pragmatically harmful policies could possibly be imagined. What, they ask, can be the motivation behind this heavy-handed short-sightedness?
• The next step is the legal challenge of the College of Physicians and Surgeons of Ontario policy that mandates “effective referral” to a consenting doctor whenever a patient requests a procedure contrary to the doctor’s professional or moral judgment. The court hearing is scheduled for June 13 to 15. We heard recently from one of the organizations behind the challenge that the $120,000 that was needed urgently for legal costs has been collected. Thanks to all who contributed!
• Doctors thinking about leaving Ontario won’t have far to go. The neighbouring province of Manitoba has introduced legislation prohibiting all coercion of health professionals to participate in euthanasia: Link to article >>

In Quebec, the government pressure to implement MAID within the Palliative Care community continues to excite criticism and push-back. Access to quality Palliative Care must be expanded to include all Quebecers before the “choice” of MAID can be seen otherwise than as a cynical budget ploy: Link to article >>

The illusion of overwhelming public support for broad-based euthanasia is finally beginning to show some cracks. The following opinion piece, motivated by the Robert-CMQ article, appeared in the Journal de Montreal. It shows a clearly perceptible dawning of reality upon the popular consciousness (French link only): Link to article >>

An inspiring and thoughtful description of one man’s reasons for rejecting euthanasia (French link only): Link to article >>

And finally, a reminder that pro-euthanasia forces around the world are not really having things all their own way. Although it may appear, in Canada, that the writing is already (indelibly) on the wall, a dispassionate review of the larger debate reveals no such fatality. In fact, there is reason for some real embarrassment over the fact that, so early on, our Canadian policy makers should have associated themselves with such a radical, extreme, and objectively marginal agenda. Link to article >>

If you have experiences related to our work that you would like to share with your colleagues, please send it to info@collectifmedecins.org.

International Psychogeriatrics, published online May 2, 2017: Suicide and assisted dying in dementia: what we know and what we need to know. A narrative literature review. Literature review by an international group including several Quebec researchers.

BMJ, May 9, 2017: Assisted dying for healthy older people: a step too far?  Opinion piece arguing that a recent Dutch proposal to extend euthanasia to older people who are healthy but believe their life is complete could increase social pressure on older people and reinforce negative ideas surrounding old age.

New England Journal of Medicine, May 25, 2017: Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada. A group from the University Health Network in Toronto describes their experience implementing the euthanasia law. Of particular note is the fact that 95% of the patients euthanized cited loss of autonomy as the reason for their request. Other common reasons included the wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life. Few patients cited inadequate control of pain or other symptoms. See this thoughtful commentary by the Living with Dignity network.

Critical Care Medicine, June 2017: Physician-Assisted Suicide and Euthanasia Is Incompatible With Medicine: A Response from Medical Students. Seven U.S. medical students remind us that they did not enter medical school to learn to kill patients.

If you come across articles that could be of interest to colleagues in the Alliance please send the reference to info@collectifmedecins.org.