The Canadian Medical A ssociation released a new ethics statement concerning euthanasia and assisted suicide on May 29 that re-affirmed the CMA’s opposition to these practices and asks its membership to uphold the principles of palliative care. The policy summary includes definitions of euthanasia and assisted suicide, background information, basic medical ethical principles and physician concerns about legalization of euthanasia and assisted suicide.
The CMA defines euthanasia as knowingly and intentionally performing an act that is explicitly intended to end another person’s life and that includes the following elements: the subject has an incurable illness; the agent knows about the person’s condition and commits the act with the primary intention of ending the life of that person; and the act is undertaken with empathy and compassion and without personal gain.
This is a very narrow definition of euthanasia. It lacks circumstances whereby the physician knowingly and intentionally omits an act that is explicitly intended to end another person’s life. Under the CMA definition, Terri Schiavo’s death, for example, would not be considered euthanasia. The definition also assumes that euthanasia is always based on an incurable illness (not a chronic or degenerative condition). The euthanasia movement considers personal autonomy to be the primary reason for seeking euthanasia and would therefore only seek limits to euthanasia based on incurable illness for political expediency and not based on long-term safeguards.
The CMA correctly defines assisted suicide as: knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide, including counselling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs.
The CMA reminds physicians that basic ethical principles tend to lead to physicians opposing euthanasia and assisted suicide. These principles include:
· To first consider the well-being of the patient
· To provide for appropriate care for the patient, even when cure is no longer possible
· To provide patients with the information they need to make informed decisions about their medical care and answer their questions to the best of the physician’s ability
· To respect the right of a competent patient to accept or reject medical treatment
· To ascertain and respect a patient’s wishes concerning the continuation of medical treatment
· To recognize the responsibility of the physician to society concerning legislation that affects the health and well-being of the community
· To inform patients when a physician’s personal values influence the recommendation or practice of any medical procedure that the patient needs or wants
· The CMA states that physicians should not participate in euthanasia or assisted suicide and that the CMA recognizes it is the prerogative of society to decide whether laws dealing with euthanasia and assisted suicide should be changed
· The CMA states that before any change in the laws concerning euthanasia and assisted suicide be considered, society should first address the following concerns:
· Adequate palliative care should be available to all Canadians
· Suicide prevention programs should be maintained and strengthened, where necessary
· A Canadian study concerning medical decision-making during dying should be under-taken
· The public should be given adequate opportunity to comment on any legislation
· Consideration should be given as to whether any legislation could safeguard vulnerable groups from euthanasia and assisted suicide
The CMA then emphasized concerns related to the effects of possible legal challenges to any proposed laws. It stated that there may be legal challenges, based on the Canadian Charter of Rights and Freedoms, to extend these practices to others who are not competent, suffering or terminally ill. Such extension is the “slippery slope” that many fear.
The CMA emphasized concerns related to the “Gronigan Protocol” in the Netherlands that has advanced euthanasia to neurologically impaired patients or newborns with severe congenital abnormalities.
The CMA also pointed out that psychiatrists recognize the possibility that a rational, otherwise well person may request suicide. Such a person could petition the courts for physician-assisted suicide.
The Euthanasia Prevention Coalition is encouraged by the fact that the CMA has renewed its ethics policy of opposing euthanasia and assisted suicide. However, the EPC remains concerned that the CMA doesn’t recognize euthanasia as intentionally causing death by both actions and omissions. Intentionally causing death by dehydration will continue as a problem in Canada, because medical ethicists refuse to recognize that both actions and omissions can be the same based on the circumstances.
EPC urges all physicians who recognize that the dignity of the person and the dignity of their profession is threatened by legalizing euthanasia or assisted suicide remain (or become) involved in the professional conduct and decision-making of the CMA and the other medical associations.
Alex Schadenberg is the executive director of the Euthanasia Prevention Coalition.