Newsletter, May 2017

Dear colleagues,

Welcome to our newsletter. We hope it will be a helpful tool to communicate with you, our members and supporters; to share information; to highlight emerging research; to analyse and influence social and political developments. But above all, we hope to provide a meeting point, where those who believe in a truly human, life-respecting and Hippocratic medical practice, might explore together the experiences and methods which will enable us to effectively pursue that goal in our own work, even in the new and challenging environment created by recent legislative changes.

Understandably, in the first flush of their victory, our recent adversaries have adopted an uncompromising triumphalistic tone which assumes all dissent is at an end. The other day I attended a session on the Quebec euthanasia law at the hospital where I work: Bill 52, one year later. Apparently, it is now abundantly clear that euthanasia is Pure Altruism and every patient’s right, and so that any document whose authors hesitate about facilitating access to it is considered biased and unworthy of trust. Such, for instance, was the criticism we heard of the – very substantial— Discussion paper of the Association des médecins psychiatres du Québec.

It is reasonable to assume however that, among physicians, psychiatrists have the greatest expertise in notions such as voluntariness, informed consent and competency… and they are far from being unanimously in favour of this new trend. Should we not listen to them?

Coincidentally, the next day I met with a fascinating group of people who work in suicide prevention. Not a milieu I’d been in touch with before. I’ve been accustomed, when talking about the dangers of legal euthanasia, to reactions of polite silence followed by “but people should be allowed to choose”, as if it settled everything. With this group I kept wondering when that familiar dogmatism was going to come out. One spoke after the other, from the front-line worker to the researcher to the psychologist… it never came. I finally realized: these people get it! They see death. They know what the risks are. They’ve seen the deadly vulnerability of people who contemplate suicide. They understand the ambivalence behind desires to die, and the fact that, with the skill that comes from empathy and experience, it can be turned around, turned into hope for a better life.

The psychiatrists, the suicide prevention groups… and so it goes, also, with experts in palliative care, in pain management, and in the rehabilitation and maintenance of the disabled. The closer we approach those fields most directly concerned with the target clientele, the more resistance we find to the practice; the more ambivalence; the less certainty. Food for thought.

In coming editions of this newsletter, we hope to provide profiles and interviews with doctors who have personal experience with these issues, with their patients, in their practice. With your participation and support, we hope to share ideas, discuss events and improve practice, to the benefit of all.

Please send any comments or suggestions you might have.

I’m looking forward to hearing from you.

Sincerely,

Catherine Ferrier MD
President

Can we stop this freight train before it crushes our patients, ourselves, our health care environments?

Are you a psychiatrist? A geriatrician? A pediatrician? A doctor in any field caring for the patient populations who are up next for medical homicide? Is your own freedom to practise according to your principles threatened by coercive laws and College policies?

Can you advocate through your professional association? In a letter? An article in a medical journal? Give talks to your peers? To the public? Contact your federal or provincial member of parliament?

Would you consider being part of a work group of doctors in your field to promote patient protection? If so write to us at info@collectifmedecins.org.

We are over 800 doctors in the Alliance. That makes for a powerful voice if we all speak out. Let’s have the fortitude and creativity to fully exploit that extraordinary potential which invariably accompanies such unsettled times.

• The Quebec Health Ministry and bureaucrats across the province are seeking ways to make death more and more accessible. Meanwhile, what about access to health care to keep you alive and well? Doctors will come in on Saturday or Sunday to kill you, but try getting into a pain clinic to have your symptoms relieved while remaining alive. You might wait a year.
• After the murder of Jocelyne Lizotte by her husband in February, and the public statements of MNA François Bonnardel about his mother who has Alzheimer’s disease, the Quebec government is talking about having a commission to study euthanizing people with Alzheimer’s disease. We can guess what the conclusion will be: an update of the very troubling CMQ working group document published in 2013.
• As promised in Bill C-14, the federal government is also studying extending euthanasia and assisted suicide to this population, as well as children and those with mental illness. The outcome to this one won’t be a surprise either. Please make sure your MP knows what you think.
• On April 12 Ontario adopted its provincial euthanasia law, rejecting proposed amendments to protect the conscience of doctors who consider referring a patient for euthanasia to be contrary to their ethical and professional principles. This despite the cogent arguments of many of our colleagues, for example Dr. Christine Cserti-Gazdewich, a self-described secular humanist and vegan environmentalist.
• 27-year-old Adam Maier-Clayton of Windsor committed suicide on April 13 after many years campaigning for euthanasia for mental illness. The pro-death camp is gloating. Read this thoughtful commentary by a suicide survivor.

Other troubling notions heard at our Hospital information meeting:

1. The Principle of Autonomy must be adhered to at all cost regardless of its effect on the life and health of the patient and his/her family. The old adage “Thou shalt not kill” is dépassé and has been replaced by “Thou must obey the autonomous patient”.

2. Capacity to consent to death is easily assessed by interviewing a patient in a vacuum and there is no need to consult the family if the patient doesn’t want you to.

Ask Belgian chemist Tom Mortier what he thinks about euthanasia without consulting the family. It happened to his mother after a lifetime of battling depression, sometimes successfully. An oncologist decided after a couple of visits that she was competent to choose death. Tom found out the next day. He’s since become a fierce opponent of the Belgian euthanasia law.

Notice should be taken of the irresponsible fashion in which acts of suicide and euthanasia are glowingly portrayed in media. WHO experts on suicide prevention are adamant on how such deaths should be reported: Avoid language which sensationalizes or normalizes suicide, or presents it as a solution to problems. Avoid explicit description of the method used in a completed or attempted suicide. Provide information about where to seek help. Don’t romanticize death.

CMAJ January 23, 2017: Cost analysis of medical assistance in dying in Canada

Is anyone surprised that euthanasia saves money? I was wondering when someone was going to do this study. It’s been the elephant in the room all along, and any references to cost as a motive was met with ardent hand-wringing: “Doctor, how could you say such a thing?”

Canadian Family Physician, March 2017: Can medical assistance in dying harm rural and remote palliative care in Canada?

Journal of Bioethical Inquiry, March 2017: Four Reasons Why Assisted Dying Should Not Be Offered for Depression

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

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