Psychiatry and Euthanasia: November-December newsletter of the Physicians’ Alliance against Euthanasia

There is something ironic and horrible in the notion that the first clear breach in the voluntariness of legal euthanasia – that all euthanasia be the result of a competent, capable choice – should be made in psychiatry. For we are accustomed to trust psychiatry with the defense and arbitration of choice itself. It is psychiatrists who have specific expertise in studying the voluntary operation of the will: capable, competent and unconstrained.

One of the traditional cornerstones of the determination of decision-making capacity in clinical settings is the observation of a patient’s attitude towards self-preservation. For although we praise self-sacrifice in the protection of others, the will for self-destruction in suicidal thinking has hitherto been understood as a sign of incapacity and incompetence. How then can psychiatrists now be asked to evaluate a “rational” desire for suicide? To assert that any form of self-destruction, in the context of medical care, can be a rational, normal and competent act, rather than the obvious manifestation of some putative pathology, is to stab at the heart of psychiatric science, practice and ethics. Continue reading editorial…

Make euthanasia unimaginable.

*********************************************************************

With special thanks for the collaboration of Dr. Mark Komrad.

*********************************************************************

We take this opportunity to wish you all a merry Christmas, happy Hannukah, joy in all your celebrations this holiday season, and a happy and peaceful new year 2019.

Catherine Ferrier
President

Alliance news 

The Physicians’ Alliance against Euthanasia is pleased to announce our 2nd medical conference, Improving Care 2019, which will take place in Montreal on Saturday, April 6th, 2019.

Topics include:

  • Consent and capacity at the end of life (Dr. Louis Morissette)
  • Medical-legal issues regarding MAiD (Dr. Richard Mimeault, CMPA)
  • Advanced pain management (Dr. Patrick Vinay)
  • Palliative care at home (Dr. Golda Tradounsky and Joan Foster N.; in French with Judith Marchessault N.)
  • General public talk: The future of Palliative care

More details to follow soon.

Doctor’s voices 

In a recently published opinion piece in La Tribune, “Les règles nous empêchent d’offrir les soins palliatifs”, Dr. Christiane Martel addresses the issue of access to palliative care in Quebec.

A letter to the editor in the November issue of the CMAJ addresses the need to protect the conscience rights of Canadian physicians.

Dying with dignity: a palliative care comparison: A thought-provoking CMAJ blog post by Stephanie Hinton, a medical student in the Class of 2019 at Queen’s University.

In recent news, faith-based hospitals in Alberta have been receiving considerable backlash for transferring patients out of the hospital to receive medical assistance in dying, based on conscience objection of physicians. Karol Boschung offers rational arguments for why ‘faith-based hospitals should not be bullied’ into providing MAID’: Opinion: Church out of medicine will worsen palliative care.

Call to action 

Our ally, Canadian Physicians for Life, is launching a mentoring program for physicians and medical students. For information on how to become or find a mentor, visit: https://learn.physiciansforlife.ca/.

In the news 

As per our recent mailing, the report on euthanasia extension to vulnerable groups was released by the Council of Canadian Academies (CCA) on December 12, 2018. Here is a Summary of the report.

Revised Canadian Medical Association Code of Ethics and Professionalism.

Of note:

  • A.: Commitment to professional integrity and competence. Practise medicine competently, safely, and with integrity; avoid any influence that could undermine your professional integrity.
  • C. 3. Act according to your conscience and respect differences of conscience among your colleagues; however, meet your duty of non-abandonment to the patient by always acknowledging and responding to the patient’s medical concerns and requests whatever your moral commitments may be.
  • C. 4. Inform the patient when your moral commitments may influence your recommendation concerning provision of, or practice of any medical procedure or intervention as it pertains to the patient’s needs or requests.

The Commission on End-of-Life care published their annual report (for the period from July 1st, 2017 – March 31st, 2018): Original report available in French only, on the website of the National Assembly: Le rapport annuel d’activités de la Commission sur les soins de fin de vie, pour la période du 1er juillet 2017 au 31 mars 2018.

Covenant Health recently released their updated policy on medical assistance in dying. The policy states that “Covenant Health will not provide nor explicitly refer for MAID given the incompatibility of MAID with the organization’s mission and ethical tradition. At the same time, Covenant Health is committed to the principles of justice and non-abandonment, and thus must ensure persons in our care seeking further information, assessment, and potentially, provision of MAID are able to access navigation resources within the health system which can facilitate these processes independently of Covenant Health.”

In a similar vein, Delta Hospice reaffirms position on MAiD, still at odds with Fraser Health.

The medically assisted death of a Nova Scotia woman, Audrey Parker has been receiving significant press coverage as lobbyists for MAID are fighting for the legalization of advanced directives for MAID. Coincidentally, on the same day of her planned death, there was a leak to the Globe and Mail of a draft of the report by the Council of Canadian Academies (CCA) addressing Advance Requests for MAID. In a recent update, the CCA reported that “the document obtained by the Globe and Mail is not the final version of the report and does not reflect the final deliberations of the Working Group.”

In her article, “The Canadian euthanasia express rolls on: The right to life can be flipped into a right to die” bioethicist Margaret Somerville reflects on the Audrey Parker case and highlights what Australians can learn from Canada: “Audrey’s case is a good example showing that once we step over the line that we must not intentionally kill there’s no logical stopping point… Australia can avoid all such problems by persuading the Victorians to repeal the Voluntary Assisted Dying Act and not legalizing PAS-E.”

Euthanasia for children: It’s interesting to note the state of affairs in Canada today. Recent headlines included court approval for a class action against McDonald’s over Happy Meal toy marketing. The main argument being that it is illegal under the Quebec Consumer Protection Act, which prohibits commercial advertising to children under 13 years old. Yet, there are some fighting to allow our children to have the right to be killed precisely when they need special care. Author Wesley Smith clearly summarizes our journey in his article: Canadian Doctors Get Ready for Child Euthanasia

Advertising for MAiD in a Canadian hospital waiting room: A deeply disturbing advertisement for MAiD was recently seen in a William Osler Health System hospital waiting room.
Even after the legalization of MAID, it was understood that health care institutions that choose to do so would provide access to MAID for those patients who sought it, but never promote it as a recommendation! Many physicians have been appalled by the insensitivity of targeting vulnerable patients (especially in a state of acute illness, fatigue and discouragement). Wesley J. Smith offers his views on the matter: Canadian Hospital Waiting Room Promotes Euthanasia

Saskatchewan Conservative MP David Anderson tables bill to protect conscience rights of health care professionals: “I believe it’s time to stand up for doctors and health care providers who aren’t willing to leave their core ethics behind when they’re at a patient’s bedside,” said Anderson.

Information from the Quebec College of Physicians (CMQ): Members of the Quebec College of Physicians (CMQ) recently received updated requirements for reporting “medical aid in dying”, which result from the implementation on November 1, 2018 of the federal reporting guidelines. The CMQ initially called on its members to refuse to complete the federal form, invoking double documentation requirements and confidentiality issues. Quebec and Ottawa rapidly agreed on a common online reporting system. The main change that is relevant to our members is that any physician receiving a written request for “medical aid in dying” must report the request, regardless of the outcome:

Le médecin du Québec qui reçoit une demande au moyen du Formulaire de demande d’aide médicale à mourir prescrit par le ministre doit en faire rapport, s’il ne l’administre pas lui-même et si, dans les 90 jours qui suivent la date de la demande, l’un ou l’autre des événements suivants se produit : 

  • il transmet la demande à un confrère; 
  • il détermine que la personne n’est pas admissible; 
  • il apprend que la personne a retiré sa demande; 
  • il apprend que la personne est décédée.

You will note that no option of withdrawing from the case without getting involved is mentioned. However, according to our reading of the federal guidelines they are more open in this regard (Federal regulations : see page 4)

At the 2018 American Medical Association (AMA) Interim Meeting, held in November,the American Medical Association continues to debate assisted suicide.

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

From the trenches

An interesting opinion piece in the Prince George Citizen: Consent doesn’t justify assisted suicide

An update on the Legal and regulatory proceedings provided by the CMPA: Medical assistance in dying: Where do we stand two years later? Originally published June 2018 / Revised November 2018

Soins palliatifs: signaux d’alarme (Sounding the alarm in palliative care): An editorial in Le Soleil, reflecting on the law surrounding end-of-life care in Quebec. Original article in French.

Une direction nationale en soins palliatifs réclamée (Reclaiming Federal leadership of Palliative Care): Original article in French.

Resources

Authors : Luce Des Aulniers and Bernard J. Lapointe

Editor : Jean Pichette (Éditions Somme Toute)

This essay takes the form of a dialogue between a palliative care physician and a trail-blazing anthropologist in the study of human relationships in the face of death. From 40 keywords, it offers facets often unnoticed, even taboo, of the realities of the disease, the care and the social bond present when death looms on the horizon. It seeks to discern the psychological and socio-cultural needs that are at the source of the demand for an advanced death.

 

In the literature 

Journal of Medical Ethics, (Online: 30 October 2018) Of dilemmas and tensions: a qualitative study of palliative care physicians’ positions regarding voluntary active euthanasia in Quebec, Canada by Emmanuelle Bélanger, Anna Towers, David Kenneth et al. This study provides insight into nuanced positions of experienced palliative care physicians in Quebec and confirms expected tensions between an important stakeholder and the practice of VAE as guided by the new legislation.

JAMA Psychiatry. 2018; 75(11):1099-1100 Suicide and Physician-Assisted Death for Persons with Psychiatric Disorders Scott Y. H. Kim, Yeates Conwell and Eric D. Caine. “The statement that PAS for persons with psychiatric illness is distinguishable from suicide as we ordinarily know it and, therefore, not the purview of an organization dedicated to preventing suicide, suggests that evidence supports the distinction.” The authors demonstrate that this is not the case.

CMAJ November 05, 2018 190 (44) E1310 Losing doctors with integrity will harm patients and profession Karol F. Boschung

Journal of General Internal Medicine, August 2018 In the wake of the American Academy of Family Physicians moving to a neutral stance on euthanasia, the authors (Sulmasy, D. et al.,) provide a good perspective in their article: Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate.”

Journal of Medical Ethics Published Online First: 22 November Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations. Seller L, Bouthillier M and Fraser V.

Here is a CTV Montreal News report: MUHC study seeks to ensure patients have enough information on medical aid in dying and a commentary published in La Presse+: Aide médicale à mourir : pas toujours un choix éclairé

Journal of Medical Ethics Published Online First: 21 November Drawing the line on physician-assisted death. Jansen, L.A., Wall, S. and Miller F.G.

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

SUPPORT OUR EFFORTS so that we can continue to speak on your behalf:

Increase our media impact:

19
DEC
2018
0

About the Author: