On Oct. 31, the Euthanasia Prevention Coalition held its annual symposium at downtown Montreal’s Best Western Ville Marie Hotel. Attendees spanned a wide range of ages and hometowns, including medical students from Calgary and veteran pro-life activists from the Maritimes. Talks were delivered in both official languages with simultaneous translation.

Though there was no official theme, Quebec’s Bill 52 and the Supreme Court of Canada’s landmark decision in the Carter case shaped much of the day’s discussion. Dr. Will Johnston, an obstetrician and the chair of the EPC in British Columbia, called the court’s February ruling “catastrophic and disastrous.” He told the story of Kay Carter, a woman from the same province who had a degenerative spinal disorder. Carter’s daughter Lee accompanied her to a Dignitas clinic in Switzerland where she ended her life. Lee Carter then sued the Canadian government over the “unconstitutional” sections of the Criminal Code prohibiting assisted suicide. Gloria Taylor, another British Columbia woman who had ALS, later signed onto the lawsuit and “became the face of the case.”

Nine Supreme Court judges unanimously ruled the existing laws unconstitutional. They recommended that assisted suicide be available for any Canadian aged 18 or older with a “serious illness or disability” that was “irremediable.” Johnston called use of the term “subjective.” It was defined as “preferring death to available treatment.” Parliament was then given a year to put forth new legislation. Johnston said “polls won out over Parliament.” The elimination of Criminal Code section 241b was “a misrepresentation of the argument against assisted suicide. (The judges believed that) 241b was meant to protect only the vulnerable,” so “any law that prevented more than the vulnerable from dying was too broad.” Instead, most opponents of the practice maintain that any suicide is wrong. Johnston believes the way forward should focus on reducing the harm that assisted suicide is bound to cause.

Both Dr. Catherine Ferrier and Aubert Martin discussed the aftermath of Bill 52, which legalizes “medical aid in dying” in Quebec as of December 10, 2015. Ferrier is president of the Physicians’ Alliance against Euthanasia. Bill 52 is meant to “hasten death at a patient’s request, to relieve suffering.” Eligibility conditions include: being of age and having capacity to consent, being at the end of life, having a serious and incurable illness that has caused an advanced and irreversible decline in capability, and “experiencing constant and unbearable physical or psychological suffering that the patient deems intolerable.”

How will this affect palliative care professionals? Ferrier advised them to “respect refusal of medical treatment, (and) use sedation if necessary for symptom control.” Every institution will be required to have an “end of life plan,” about which palliative care centres must inform patients before admittance. Ferrier said the centres and any conscientious objectors are exempt from involvement in assisted suicide. Objectors, however, must allow their institution’s executive director to refer to another provider. This means that Quebec “has the only coercive referral law in the world.” According to the Canadian Medical Association, 63 percent of Canadian doctors oppose the practice assisted-suicide.

Aubert Martin is the director of the Montreal non-profit Vivre Dans le Dignité. He lamented that the law “permits killing, and aid in killing,” even though it was adopted in June 2014 under the guise of providing “end of life care.” Martin noted that twenty-nine palliative care centres across the province refuse to perform assisted suicide. In contrast, Quebec’s College of Physicians and Surgeons called the practice “justified” in September. Martin said “the medical world needs to participate in the law’s implementation.” Part of the problem is that the word “euthanasia” is never used and does not prompt public discussion of the subject. Instead, the alternate term “medical aid in dying” is regarded as a key component of health care towards the end of life.

Dr. Margaret Cottle is vice president of the EPC and a palliative care physician in Vancouver. She called for a clarification of terms, in light of the “campaign of misinformation” surrounding the issue of assisted suicide. She reminded attendees that supporters’ concerns about suffering are real. “Suffering is a dirty word, but it is a part of life. We must acknowledge it.” References to “autonomy” hide the desire to “get out of suffering,” made worse by our society’s difficulty with “accompanying” others.

Other words that need to be replaced include “burden” (use “stress”) and “professional” in place of “provider.” Patients cannot consume health care as a commodity. “Physician-hastened death” is a more accurate and neutral substitute for “euthanasia” or “assisted suicide,” since “we’re all dying.” Furthermore, the difference between the two methods of death needs to be understood. “assisted suicide” means “prescribing pills for a patient to take,” while “euthanasia” involves “someone else pushing the syringe.” Finally, the frequent use of “‘dignity’…affirms (the view) that life is not worth living.” When the need for help is an indignity, “there is an assumption that only the purely independent are worthy of life.”

Other speakers included Nicolas Steenhout – former director of Vivre Dans le Dignité – and McGill University law professor Margaret Somerville. Steenhout explained how assisted suicide affects Canadians with disabilities, while Somerville described the secular understanding of “the common good” missing from the Carter judgement and society at large.

EPC executive director Alex Schadenberg called the event “a great success,” with more than 150 participants.