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Dear Dr Couillard,

We congratulate you on your victory in the April 7 election. Nonetheless we feel compelled to express our deep disappointment, and that of many medical colleagues and other Quebec citizens, at your announcement the day after the election that you intend to reintroduce Bill 52, including medical aid in dying.

Knowing that in October 2013 you expressed serious reservations about the “medical aid in dying” component of Bill 52, we are mystified by your about-face on this very grave question. It is impossible to legalize euthanasia without putting vulnerable patients at risk, as the experience in Belgium and other countries shows clearly. Bill 52, with or without the amendments, goes even farther than the Belgian law; it defines medical homicide as health care and requires that it be available to all patients who meet the exceedingly broad criteria set out in the bill. As a physician you are conscious of the power imbalance between us and our patients, and how patients can be manipulated to consent even by well-meaning health professionals.

The promoters of Bill 52 have not been honest with other politicians or with the Quebec population. The so-called consensus around this issue is a fabrication based on misinformation and manipulation of facts. The majority of the citizens and health professionals who made submissions to the Select Committee on Dying with Dignity in 2010-11 opposed legalization of euthanasia but the report recommended it. The fact that the vast majority of palliative care physicians oppose euthanasia was systematically ignored by the Commission and the preceding government. The public, who seems to be clamouring for so-called death with dignity, is largely unaware that what is being proposed to them is a homicidal act and that skilled palliative care and wise management of end-of-life decisions are sufficient to address the fears leading to their request.

From the legal and political point of view it is clear that the Quebec government lacks jurisdiction to legalize euthanasia, which is contrary to the Criminal Code of Canada, and that this component of the bill will be challenged in court, cause a confrontation with the Federal Government and ultimately be found illegal. We urge you to examine the legal opinions of your ministry of Justice on this aspect and to publish them as you have promised to do with those regarding the validity of the Secularity Charter (Bill 60).

We request a meeting with you at your earliest convenience to discuss these questions. We realize that at this beginning of your mandate you have many pressing issues to address, but your plan to adopt Bill 52 soon has made this an urgent priority.

Sincerely,

Balfour Mount MD, OC, OQ, FRCSC Emeritus Eric M. Flanders Professor of Medicine, McGill University

Serge Daneault MD, M.Sc., Ph.D., C.S.P.Q., Chief, Palliative Care Service, Centre hospitalier de l’Université de Montréal (CHUM)

Physicians’ Alliance against Euthanasia http://www.totalrefusal.blogspot.ca/ 625 physicians; 12,334 citizen supporters

Ipsos survey, September 2013: Only 33% of Quebecers surveyed understood medical aid in dying as a lethal injection given by a physician at the patient’s request. 29% thought it was symptom control through palliative care, and 38% identified it as withdrawal of overzealous care or as assisted suicide.