The Quebec College of Physicians ethics task force is pushing the envelope on euthanasia by proposing that some forms of euthanasia be considered “as part of the appropriate care in certain particular circumstances.” The task force has toyed with the issue for three years and now is prepared to release a “reflection” paper in November. Dr. Yves Robert, the college’s secretary, told the Globe and Mail that the doctors’ organization is proceeding with “caution” as it seeks to put pressure on the federal government to amend the Criminal Code.
Parliament will revisit the issue in the fall session when Bloc MP Francine Lalonde’s (La Pointe-de-l’Île) private member’s bill C-384 reaches Second Reading. According to the Euthanasia Prevention Coalition, C-384 would permit virtually limitless euthanasia and doctor-assisted suicide, because the restrictions are minimal and meaningless. EPC executive director Alex Schadenberg questions the timing of the release of the college document so near to the debate in the House of Commons on Lalonde’s bill.
The college is suggesting clear guidelines be established for the use of painkillers or analgesics used to control pain. Robert notes that sometimes, patients are given fatal dosages of analgesics and the law needs to be clarified to protect doctors.
Sometimes, he explained, “the amount of analgesic required could correspond to a form of euthanasia.” But Schadenberg says if death is not intentionally induced by high doses of pain medication, the accidental death of the patient is not considered euthanasia and is not illegal. He warned that if pain-control drugs are abused in such a way as to intentionally cause death, it could be “getting euthanasia through the back door.”
Dr. Ingrid de Kock, president-elect of the Canadian Society of Palliative Care Physicians, told the Globe and Mail the focus should be on providing proper palliative care, not changing the law. She said Canada does not “have optimized pain and symptom control,” because “most people who die never see a palliative care provider.” She added that once “you have good pain and symptom control, (euthanasia) becomes a non-issue.”
Still, the Quebec College of Physicians says that guidelines on when euthanasia should be permitted are necessary. Stressing they do not want the debate to be about whether euthanasia is right or wrong, Robert told the Globe the debate is about the doctor’s role in a patient’s dying care. “There’s not a politician or a lawyer who can tell me what that entails,” Robert defiantly said.
The college suggests three criteria for permitting euthanasia: that the patient make the decision; that doctors have input; and that rules be created to protect society from abuses.
Schadenberg says no system can be created that does not create loopholes through which vulnerable people will become victims of euthanasia. He pointed to Oregon, where non-terminally ill patients have been prescribed lethal drugs in contravention of state law, and the Netherlands, where people have been euthanized in the absence of a clear directives from the patient.
Quebec Health and Social Services Minister Yves Bolduc, a former physician who has supported euthanasia and doctor-assisted suicide in the past, said the provincial government will wait and see what the college presents in November and “then we will make our recommendations.” Despite admitting his past support for euthanasia, he told French reporters that “I have an open mind on the matter.”
Euthanasia and assisted suicide are prohibited under the Criminal Code and are thus a federal matter. The official Ministry of Justice line is that the “government monitors these issues,” but that “it has no plans to propose any reforms to this area of the law.”
Euthanasia advocates are excited about the college’s attempt to push the envelope a little further. Yvon Bureau, a pro-euthanasia social worker, called the actions of the college “bold, cautious and realistic,” as it attempts to “avoid having people commit suicide or die under terrible conditions.” Ruth von Fuchs, president of the Right to Die Society of Canada, said she thought the college “is trying to say that death is sometimes a benefit. It’s sometimes a form of care.”
Others say that change in the law is inevitable. Arthur Schafer, a University of Manitoba ethicist, said, “I think some kind of law reform will come in Canada, probably along the lines of Oregon.” He claimed that “the actual result is that our hospitals are kinder, gentler places.”
Schadenberg disagrees. He said, “If the Quebec College of Physicians allows for physicians to lethally inject their patients with overdoses, they will be erasing the distinction between caring for people and killing people.”