Physicians’ Alliance Newsletter, September 2018

Advance directives authorizing death. We can do better…

Even before the adoption of the laws permitting euthanasia in Quebec and Canada, which require that it be requested by a capable adult, the pressure to extend it to incapable persons was looming. This possibility is now being considered by an advisory panel to the Canadian government (Council of Canadian Academies), and the recently elected political party in Quebec (Coalition Avenir Québec; CAQ) made it part of their platform in the recent provincial election. A group of researchers (Bravo, G. et al.) has surveyed family caregivers, nurses and doctors about it and concluded that most favour extending the law to permit MAID by advance request for persons incapable of decision-making. The pressure is on. If administering death is a good, why refuse it to anyone? Continue reading editorial…

Make euthanasia unimaginable.

Sincerely,

Catherine Ferrier
President

Doctor’s voices

Euthanasia in Canada: A Cautionary Tale, (World Medical Journal; Vol. 64, Nr. 3, page 17, September 2018)
Commentary by Dr. Roger Roberge on the article: Time to clarify Canada’s medical assistance in dying law (Canadian Family Physician, September 2018).
Suicide by Media
Dr. Fernandes and Dr. Lau identify a grave media ‘malfeasance’ due to the ‘romanticized reporting of euthanasia’ propagating the contagion of suicide. The article explores the detrimental effects of media on the rates of suicide and euthanasia within our society due to their approach in reporting on these themes.

Call to action

The September 2018 issue of Canadian Family Physician contains a few research articles with a strong pro-euthanasia bias. If you or any of your colleagues have publications or ongoing research that demonstrate the harms from euthanasia or physician-assisted suicide, please let us know at info@collectifmedecins.org so that we may share them with other members of the Physicians’ Alliance.
The Association des médecins omnipraticiens de Montréal is holding elections for its Board of Directors. Members will have received the information by mail, and candidates must submit their nomination papers by October 9, 2018. Please consider running for a position on the Board, in order to defend doctors’ rights to not euthanize our patients.
If you have not received the information, you can contact us at info@collectifmedecins.org and we will send it to you.

In the news

Earlier in September, the Coalition Avenir Québec (ACQ) relaunched their debate on medical aid in dying by promising to consult on its eventual extension to individuals with Alzheimer’s disease or other types of severe dementia. This was deemed to be “irresponsible and outrageous” by the organization Vivre dans la Dignité, who proposed that instead, efforts should be directed towards addressing the important issue of access to quality palliative care. For more details: Aide médicale à mourir: l’engagement de la CAQ décrié.
In a follow-up radio interview on September 18, 2018 with Radio X Saguenay, Aubert Martin, the Executive Director of Vivre dans la Dignité explains their opposition to euthanasia and medical aid in dying for individuals with Dementia: Alzheimer: opposition à l’aide médicale à mourir.
In a pre-emptive strike, the Federal government has taken a stance against the extension of euthanasia and medical aid in dying, by warning Quebec political parties that it will thwart any efforts by the National Assembly to broaden access to medical aid to dying. In an exchange with Le Devoir, federal department of Justice spokesman Ian McLeod stated that the criminal law falls within the exclusive legislative jurisdiction of the Parliament of Canada. One wonders why the previous (Conservative) federal government did not do the same when Quebec was first debating the introduction of euthanasia, between 2010 and 2014: Une bataille à venir autour de l’aide médicale à mourir?
A new study from the Canadian Institute for Health Information says only 15 per cent of Canadians have early access to palliative care at home.
While survey results show that most Canadians prefer to die at home, a report by the Canadian Institute for Health Information (CIHI) shows that few Canadians (15%) receive palliative home care in their last month of life (based on available data). This is the case even though more than 80 per cent would benefit from the service. September 19, 2018. CIHI’s report Access to Palliative Care in Canada has confirmed that two of the major limitations in producing this report are: Information gaps on access to palliative care (since little comparable information currently exists on how this type of care is delivered across the country) and the lack of a single shared definition of palliative care in Canada and common standards for delivering it in practice.

If you have an article, letter or interview relevant to our work published in any media, please let us know at info@collectifmedecins.org.

Resources

Dying Healed Program offered this Fall by Life Canada, in communities all across Canada.
This comprehensive training program provides formation to those who want to understand the issues and participate in healing our society of the ills of legalized euthanasia.

Events

The World Medical Association General Assembly which began yesterday in Reykjavik, Iceland will end on October 6th, 2018.
Ne Gaspillez votre mort: Soins palliatifs ou euthanasie (Don’t waste your death: Palliative care or euthanasia). The Conference will be held on October 17th, 2018 (at 7:30p.m.) at Mary Queen of the World Cathedral, Montreal, Quebec.

In the literature

New England Journal of Medicine (September 2018): Voluntary Euthanasia — Implications for Organ Donation
By this practice, the donation would kill the patient. Currently in Canada, death by euthanasia must be caused by the administration of a ‘ substance ‘ and not by the recovery of an organ”. It is likely that most patients asking for euthanasia would accept death by a donation. Here is another attack on the freedom of patient consent for euthanasia.
JAMA (September 2018): Use of Palliative Care Earlier in the Disease Course in the Context of the Opioid Epidemic: Educational, Research, and Policy Issues
This article discusses the trend in some settings, towards implementing palliative care for patients with serious chronic illness, earlier in the disease course. It highlights challenges around the use of opioids for pain control in this broader population of patients due to longer periods of use and greater likelihood of mood and substance-use disorders.
Age and Ageing (September 2018), “What Matters to You”: Setting the Compass of Care in the Right Direction for Older People in Ireland
What Matters To You (WMTY) is an approach that supports caring conversations and compassionate relational care.
JAMA Internal Medicine (September 2018): Ambiguity in End-of-Life Care Terminology—What Do We Mean by “Comfort Care?”
This Perspective uses an end-of-life care vignette to illustrate the need to clarify the meaning of the term comfort care.
AMA Journal of Ethics (2018) How Do Medicalization and Rescue Fantasy Prevent Healthy Dying?
“It is far easier for physicians to help patients “jump” to their deaths than it is to sit with them, listen, and coordinate the help of ancillary staff like social workers and chaplains to address patients’ concerns—existential, spiritual, familial, personal—at the end of life.”
Canadian Journal of Public Health(2018): Quebec physicians’ perspectives on medical aid in dying for incompetent patients with dementia.
The study concluded that ‘Many Quebec physicians support extending medical aid in dying to incompetent patients with dementia to relieve suffering at the terminal stage. This finding will inform current deliberations as to whether medical aid in dying should be extended to these patients.’However, given that the results indicate that only ‘A total of 136 physicians out of 653 returned the questionnaire’, we need to question the ‘representative-ness’ of the sample with respect to the population of interest. In this study, there is a 79% non-responsiveness bias, which is known to have significant implications on both the reliability and validity of survey study findings.The Canadian Medical Association journal’s editorial policy requires a survey response rate of at least 60% for a study to be published (Huston, 1996). Fowler, a well-known authority on survey research methods states that, “…one occasionally will see reports of mail surveys in which 5% to 20% of the selected sample responded…It is very unlikely that such procedures will provide any credible statistics about the characteristics of the population, as a whole (Fowler, 2002).”
- Huston P. Reporting on surveys: information for authors and peer reviewers. Can Med Assoc J. 1996;154:1695–8.
- Fowler FJ. Survey Research Methods. 3rd ed. Thousand Oaks, CA: Sage Publications; 2002.
If you come across articles that could be of interest to colleagues in the Alliance please send the reference to info@collectifmedecins.org.