REALity   Volume XXXVI Issue No. 10 October 2017

The assisted suicide law that came into effect in June, 2016 is causing problems within the medical community. Physicians are raising concerns from widely different perspectives.  They are all over the map on this issue.

Dozens of physicians in Canada, who had initially signed up to assist in terminating the lives of patients, have now removed themselves permanently from a voluntary referral list. Another 30 physicians have put their names on temporary hold.  The Canadian Medical Association does not know exactly how many more physicians are having second thoughts about participating in this procedure.

Some physicians are objecting to the requirement to refer a patient if they do not want to end the patient’s life themselves. According to them, a referral is an act which connects the patient to assisted death and is essentially morally the same as actually performing the wrongful act itself.

The Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians’ Societies and Canadian Physicians for Life, along with five individual physicians, argued, in June 2017, in the Ontario Superior Court, that the Charter of Rights and Freedoms protects them from being required to refer patients. The decision will be handed down within a few months.

They are fighting the policy of the College of Physicians and Surgeons of Ontario that says doctors must provide an “effective referral” if they themselves refuse to help patients end their lives due to reasons of conscience or religion. To do otherwise, according to the College, amounts to abandoning the patient.

The Province of Alberta has tried to protect physicians by providing four care co-ordinators, all of them nurses, who act as central intake officers and arrange all aspects of the end-of-life procedure, including, finding a doctor and two assessors, lining up the medications, scheduling the death and helping with the voluminous official paperwork.

This approach has apparently worked well for Alberta assisted suicide providers and also for doctors who refuse, on moral grounds, to refer patients for assisted death. Conscientious objectors need only give their patients contact information for the co-ordinating service and avoid a formal referral.  Other provinces, however, do not provide this service, which is raising the wrath of some physicians.

In Ontario, only 74 doctors and nurse practitioners have signed up to provide assisted suicide, down from 181 when the Ontario Ministry of Health set up its care co-ordination service. The Ontario service only connects patients to doctors willing to help them, but does not make the arrangements for the whole process, which, physicians claim, takes too much of their valuable time, such as travelling to the patient, connecting up with the pharmacist for the lethal drug, doing all the troublesome paperwork.

Other physicians, located mainly in British Columbia and Ontario, have bowed out of assisted suicide because they claim they are not being paid enough to kill their patients and can’t afford to continue in their new found “specialty”. In Nova Scotia and Ontario, about half of the claims filed by physicians for assisted suicide have been stuck in processing because the provincial governments have not yet developed their “fee codes” for activities related to assisted suicide.  In short, some physicians are perfectly willing to kill their patients, provided they are being paid enough for their effort, and provided it doesn’t take too much time and effort for them to do so.

Clinical Practice Guidelines on Assisted Suicide

A group of physicians in British Columbia, all of whom are assisted death providers, have published the first clinical-practice guidelines on how doctors should apply the clause in the assisted suicide legislation that says a patient’s natural death must be “reasonably foreseeable”. Naturally, these assisted suicide physicians want the expression to be interpreted broadly, with no specific measure of how long a patient has left to live, claiming that this will ensure that people who would otherwise qualify, are not denied a ready death.  The guidelines encourage doctors to consider a patient eligible if his or her natural death is “reasonably foreseeable”, to be determined by a combination of the patient’s known medical conditions and factors such as age and frailty.  This broad definition would, of course, ensure a lot of customers for the assisted suicide physician brigade.

There are other physicians who argue that this activist groups’ definition goes well beyond how the law was intended to apply to the terminally ill. They complain that the guidelines were not developed with the widespread consultation that usually precedes the publication of a medical association’s formal recommendations for treating patients.  The clinical practice guidelines, it seems, were drafted to gain credibility and acceptance, for the physicians willing to participate in assisted suicide.  Further, these guidelines failed to disclose the very pertinent fact that they were spearheaded by a group of doctors who have a conflict of interest because many of them have spoken out in favour of scrapping the “reasonably foreseeable” clause altogether.

The physicians who drafted the guidelines held their first national conference in Victoria in early June, to agitate to both interpret the law broadly, and to increase remuneration for their specialty.

Those physicians demanding elimination of the “reasonably foreseeable” death clause, are, in fact, demanding a form of death “a la carte”, claiming that refusals of physicians to perform assisted suicide causes discrimination and exclusion, and creates barriers to access for patients.

The Erosion of the Assisted Suicide Law

In slightly more than a year after the assisted suicide legislation became law, assisted suicide has gone from an exceptional act to one that is now promoted. The “end of life” criterion is now presented as discrimination, which prevents people with disabilities, for example, from accessing the service, because their living conditions not their closeness to death, justify their desire to die.  Also, the argument in support of assisted suicide only for “capable and consenting people” is giving way to the idea of killing an incapable person (with Alzheimer’s or Dementia) regardless of the person’s consent at the time of death.

Finally, according to a Canadian study, published in May, 2017, the proverbial patient writhing in pain on his deathbed has morphed into a person in crisis over his loss of autonomy because, for example, of a disability. Next we will be dealing with the ludicrous proposition now gaining popularity in the Netherlands, which has opened physician aid in dying to elderly people who feel they have accomplished their life goals, or, to put it another way, are simply tired of living.  This, of course, is sold to us as “progress”.

What is reasonably “foreseeable” in the assisted suicide legislation is that it is being extended to more and more groups of people – provided, of course, that their physicians are paid enough for killing them.