OTTAWA, Nov. 17, 2009 (CCRL) – Earlier this month we saw an interesting convergence of stories. On November 3, the Quebec College of Physicians and Surgeons (CMQ), as expected,  recommended making euthanasia legal in certain circumstances. Just days earlier, an Environics poll commissioned by Life Canada showed that while most Canadians support some legalization of the practice, they also have significant concerns about its abuse. As these debates unfold, Private Members’ Bill C-384, which would legalize euthanasia in some cases, has received first reading in the House of Commons and is scheduled for second reading, probably in early December.

The Environics Research Group poll found 61% of all Canadians (75% of Quebecers) approve of legalized euthanasia — figures that have been fairly consistent for the past several years. But the poll also revealed that support may be weaker once respondents are asked to consider the potential consequences of such a law.

Fifty-five per cent of those who expressed strong support for euthanasia are worried that a “significant number” of people could be put to death against their wishes, according to the pollster. Among those showing tentative support, that number rose to 72%. This concern is a key reason why many disability rights advocates have opposed any liberalization of the law.

“Among those who express tentative support for legalizing euthanasia, a large majority think the government should place a greater priority on investing in more and better palliative and hospice care than on legalizing euthanasia,” Environics said. This finding is in keeping with a shortage of suitable palliative care in many parts of Canada. As the Canadian Medical Association points out, programs to prevent suicide and promote good palliative care, not liberalized euthanasia laws, are the best way to promote the true spirit of compassionate care. “The CMA does not support euthanasia or assisted-suicide and urges its members to uphold the principles of palliative care,” said a letter from CMA President Anne Doig, MD to all MPs.

The Quebec college (CMQ) is the first official council of medical professionals in Canada to take a formal stand in favour of euthanasia. Their press release reads, in part:

“The CMQ embraces the point of view of the patient who is confronting imminent and inevitable death. In such a situation, the patient looks to their physician and generally requests that they be able to die without undue suffering and with dignity. Neither surveys, nor attorneys, nor politicians can properly advise the physician and the patient facing this situation. In the majority of cases, the patient and their doctor find the appropriate analgesia that respects the ethical obligation of physicians not to preserve life at any cost, but rather, when the death of a patient appears to be inevitable, to act so that it occurs with dignity and to ensure that the patient obtains the appropriate support and relief.

“However, there are exceptional situations,” underlines Dr. Yves Lamontagne, President and Chief Executive Officer of the Collège des médecins du Québec, “where agony and suffering persists and where physicians are asked to act in certain ways that could be interpreted as being prohibited by the Criminal Code. We are of the opinion that many of these actions constitute appropriate medical care.”

The fact that no other medical body has come out in favour of euthanasia is significant. Any change in our laws about end-of-life care, even if, as some claim, it would only legalize things that are already happening, would mark a change in the dynamic between doctor and patient. Those who were once perceived exclusively as healers would also be seen, occasionally, as killers.

Step back a year or so, to the debates about compliance by doctors with the Ontario Human Rights Code and how it might co-exist with doctors’ religious or conscientious refusal to prescribe or participate in morally contentious treatments or procedures (including abortion, non-therapeutic sterilization and certain forms of birth control, for example). After the circulation of draft policies, public debate and debate by the governing council of the Ontario College of Physicians and Surgeons, the right to conscientious objection was upheld, albeit with perhaps a grey area over the requirement to refer patients to others for these treatments. A similar debate has since played out in Alberta.

What became obvious to the League, as observers and participants in the draft process, and later in the public debate, is that many people already see a doctor merely as a service provider who should be expected to give the patient what he or she wants, despite the doctor’s religious or conscientious beliefs or even, in some cases, his or her professional evaluation. Polls taken by the CPSO at the time showed a strong majority of respondents said patients’ wishes should take precedence over the physicians’ beliefs.

It’s not too difficult to see where this could lead in an environment where euthanasia is legal, regardless of how many safeguards we include in any law. Doctors who believe they must never take active steps to end life may be pressured to change their views. Doctors who believe euthanasia is appropriate in some situations may pressure family members to opt for an earlier end of life for their loved one, or be perceived as exerting such pressure.

While most observers expect that Bill C-384 will be defeated, it is probably only a matter of time before such legislation is sought again.
Canadians should not be misled about what is at stake. It is already legal to refuse treatment, to discontinue futile treatment, and to receive sufficient pain medication even if a secondary effect would be the risk of shortening life. A commitment to palliative care could go a long way to addressing the fears of extended, futile treatment, uncontrolled pain and loss of hope that often lie behind the belief that euthanasia is acceptable. 

Clearly, the liberalization of euthanasia will create serious problems for the religious and conscientious rights of doctors and other health care providers and their patients.