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There is something ironic and horrible in the notion that the first clear breach in the voluntariness of legal euthanasia \u2013 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.<\/p>\n
One of the traditional cornerstones of the determination of decision-making capacity in clinical settings is the observation of a patient\u2019s 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 \u201crational\u201d 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…<\/span><\/a><\/p>\n Make euthanasia unimaginable.<\/p>\n *********************************************************************<\/p>\n With special thanks for the collaboration of Dr. Mark Komrad.<\/p>\n *********************************************************************<\/p>\n Catherine Ferrier Alliance news\u00a0<\/span><\/b><\/p>\n<\/div>\n The Physicians\u2019 Alliance against Euthanasia is pleased to announce our 2nd<\/sup> medical conference, Improving Care 2019<\/strong>, which will take place in Montreal on Saturday, April 6th, 2019.<\/p>\n Topics include:<\/p>\n More details to follow soon.<\/p>\n Doctor’s voices\u00a0<\/span><\/b><\/p>\n In a recently published opinion piece in La Tribune, \u201cLes r\u00e8gles nous emp\u00eachent d\u2019offrir les soins palliatifs<\/a>\u201d<\/u>, Dr. Christiane Martel addresses the issue of access to palliative care in Quebec.<\/p>\n A letter to the editor in the November issue of the CMAJ addresses the need to protect the conscience rights of Canadian physicians<\/a>.<\/p>\n Dying with dignity: a palliative care comparison<\/a>: A thought-provoking CMAJ blog post by Stephanie Hinton, a\u00a0medical student\u00a0in the Class of 2019 at Queen’s University.<\/p>\n 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 \u2018faith-based hospitals should not be bullied\u2019 into providing MAID\u2019:\u00a0Opinion: Church out of medicine will worsen palliative care.<\/a><\/p>\n Call to action<\/span><\/b>\u00a0<\/span><\/b><\/p>\n 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\/<\/a>.<\/p>\n In<\/span><\/b>\u00a0the news\u00a0<\/span><\/b><\/p>\n As per our recent mailing, the report on euthanasia extension to vulnerable groups<\/strong> was released by the Council of Canadian Academies (CCA) on December 12, 2018. Here is a Summary of the report<\/a>.<\/p>\n Revised Canadian Medical Association Code of Ethics and Professionalism<\/strong><\/a>.<\/u><\/strong><\/p>\n Of note:<\/p>\n The Commission on End-of-Life care<\/strong> published their annual report<\/a> (for the period from July 1st<\/sup>, 2017 \u2013 March 31st<\/sup>, 2018): Original report available in French only, on the website of the National Assembly: Le rapport annuel d’activit\u00e9s de la Commission sur les soins de fin de vie, pour la p\u00e9riode du 1er juillet 2017 au 31 mars 2018<\/a>.<\/p>\n Covenant Health<\/strong> recently released their updated policy<\/a> on medical assistance in dying.\u00a0The policy states that \u201cCovenant Health will not provide\u00a0nor explicitly refer for MAID given the incompatibility of MAID with the organization\u2019s mission and ethical tradition.\u00a0At the same time,\u00a0Covenant 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\u00a0can facilitate these processes independently of Covenant Health.\u201d<\/p>\n In a similar vein, Delta Hospice reaffirms position on MAiD, still at odds with Fraser Health<\/a>.<\/p>\n The medically assisted death of a Nova Scotia woman<\/strong>, 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 \u201cthe 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.\u201d<\/a><\/p>\n In her article, “The Canadian euthanasia express rolls on: The right to life can be flipped into a right to die<\/a>”\u00a0bioethicist Margaret Somerville reflects on the Audrey Parker case and highlights what Australians can learn from Canada:\u00a0\u201cAudrey\u2019s case is a good example showing that once we step over the line that we must not intentionally kill there\u2019s no logical stopping point\u2026 Australia can avoid all such problems by persuading the Victorians to repeal the Voluntary Assisted Dying Act and not legalizing PAS-E.\u201d<\/p>\n Euthanasia for children<\/strong>:\u00a0It\u2019s 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<\/a>. The main argument being that it is illegal under the Quebec Consumer Protection Act, which prohibits\u00a0commercial 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<\/a><\/p>\n Advertising for MAiD in a Canadian hospital waiting room<\/strong>:\u00a0A\u00a0deeply disturbing advertisement for MAiD was recently seen in a William Osler Health System\u00a0hospital waiting room. Saskatchewan Conservative MP David <\/strong>Anderson<\/strong> tables bill to protect conscience rights of health care professionals<\/a>: \u201cI believe it\u2019s time to stand up for doctors and health care providers who aren\u2019t willing to leave their core ethics behind when they\u2019re at a patient\u2019s bedside,\u201d said Anderson.<\/p>\n Information from the Quebec College of Physicians<\/strong> (CMQ):\u00a0Members of the Quebec College of Physicians (CMQ) recently received updated requirements for reporting \u201cmedical aid in dying\u201d, which result from the implementation on November 1, 2018 of the federal reporting guidelines<\/a>. The CMQ initially called on its members to refuse to complete the federal form<\/a>, invoking double documentation requirements and confidentiality issues. Quebec and Ottawa rapidly agreed on a common online reporting system.\u00a0The main change that is relevant to our members is that any physician receiving a written request for \u201cmedical aid in dying\u201d must report the request, regardless of the outcome:<\/p>\n Le m\u00e9decin du Qu\u00e9bec qui re\u00e7oit une demande au moyen du\u00a0Formulaire de demande d\u2019aide m\u00e9dicale \u00e0 mourir\u00a0prescrit par le ministre doit en faire rapport, s\u2019il ne l\u2019administre pas lui-m\u00eame et si, dans les 90 jours qui suivent la date de la demande, l\u2019un ou l\u2019autre des \u00e9v\u00e9nements suivants se produit :\u00a0<\/em><\/p>\n 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<\/a> regulations\u00a0: see page 4)<\/u><\/p>\n At the 2018 American Medical Association (AMA) Interim Meeting<\/strong>, held in November,the\u00a0American Medical Association continues to debate assisted suicide.<\/a><\/p>\n If you have an article, letter or interview relevant to our work published in any media, please let us know at\u00a0<\/em>info@collectifmedecins.org<\/em><\/a>.<\/p>\n From the trenches<\/span><\/b><\/p>\n An interesting opinion piece in the Prince George Citizen<\/strong>: Consent doesn’t justify assisted suicide<\/a><\/p>\n An update on the Legal and regulatory proceedings provided by the CMPA<\/strong>: Medical assistance in dying: Where do we stand two years later?<\/a>\u00a0Originally published June 2018\u00a0\/ Revised November 2018<\/em><\/p>\n Soins palliatifs: signaux d\u2019alarme<\/a> <\/em>(Sounding the alarm in palliative care<\/strong>): An editorial in Le Soleil,<\/em> reflecting on the law surrounding end-of-life care in Quebec. Original article in French.<\/p>\n Une direction nationale en soins palliatifs r\u00e9clam\u00e9e<\/a><\/em> (Reclaiming Federal leadership of Palliative Care<\/strong>): Original article in French.<\/p>\n Resources<\/span><\/b><\/p>\n Editor\u00a0: Jean Pichette (\u00c9ditions Somme Toute)<\/p>\n 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.<\/p>\n <\/p>\n In the literature\u00a0<\/span><\/b><\/p>\n Journal of Medical Ethics, (Online:\u00a030 October 2018<\/em><\/strong>)\u00a0Of dilemmas and tensions: a qualitative study of palliative care physicians\u2019 positions regarding voluntary active euthanasia in Quebec, Canada<\/a> by Emmanuelle B\u00e9langer,\u00a0Anna Towers,\u00a0David Kenneth et al.\u00a0This 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.<\/p>\n JAMA Psychiatry.\u00a02018; 75(11):1099-1100\u00a0<\/em><\/strong>Suicide and Physician-Assisted Death for Persons with Psychiatric Disorders<\/a><\/u>\u00a0Scott Y. H.\u00a0Kim,\u00a0Yeates\u00a0Conwell and Eric D.\u00a0Caine.\u00a0\u201cThe 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,\u00a0suggests that evidence supports the distinction.\u201d The authors demonstrate that this is not the case.<\/p>\n CMAJ\u00a0November 05, 2018\u00a0190\u00a0(44)\u00a0E1310\u00a0<\/em><\/strong>Losing doctors with integrity will harm patients and profession\u00a0<\/a><\/u>Karol F. Boschung<\/p>\n Journal of General Internal Medicine, August 2018\u00a0<\/em><\/strong>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<\/a>.”<\/p>\n Journal of Medical Ethics\u00a0Published Online First:\u00a022 November\u00a0<\/em><\/strong>Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations.<\/a> <\/u>Seller\u00a0L,\u00a0Bouthillier\u00a0M and\u00a0Fraser\u00a0V.<\/p>\n Here is a CTV Montreal News report: MUHC study seeks to ensure patients have enough information on medical aid in dying<\/a> and a <\/u>commentary published in La Presse+: Aide m\u00e9dicale \u00e0 mourir\u00a0: pas toujours un choix \u00e9clair\u00e9<\/a><\/em><\/p>\n Journal of Medical Ethics\u00a0Published Online First:\u00a021 November<\/em><\/strong> Drawing the line on physician-assisted death.<\/a> Jansen,\u00a0L.A.,\u00a0Wall,\u00a0S. and\u00a0Miller\u00a0F.G.<\/p>\n If you come across articles that could be of interest to colleagues in the Alliance please send the reference to info@collectifmedecins.org<\/a>.<\/em><\/p>\n SUPPORT OUR EFFORTS<\/strong>\u00a0so that we can continue to speak on your behalf:<\/p>\n<\/div>\nWe 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.<\/i><\/h4>\n
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\nEven 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<\/a><\/p>\n\n
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Authors\u00a0: Luce Des Aulniers<\/a> and Bernard J. Lapointe<\/a><\/p>\n\n
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