Beyond Conscience

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"[Assisted death is not a] natural [death by definition]. Which then raises the whole ethical issue, the one of honesty and integrity: Should a doctor knowingly fill out something incorrectly."
"There has to be some way of monitoring what is going on [with assisted suicide in every jurisdiction in the country]."
Dr. William Cunningham, past president, Doctors of British Columbia

"Probably our proposal will be to write on the death certificate [that] the cause of death [was] the basic pathology that was behind the reason why physician assisted death was used."
"The consensus was to say that. It's a guideline and maybe it will be updated as further discussion occurs."
"Whatever is written on the death certificate, it is mandated by the law that a report on the whole process must be reported to the commission on end-of-life care and/or the college."
"[There is no] cover-up. Surveillance [of physician-assisted death] is not done by death certificates. It is done through reports required by the law."
Dr. Yves Robert, secretary, College of Physicians of Quebec

"You may decide, 'OK, doctor, I'm at the end of my life, I just want to stop the suffering. I don't want my family to be involved in the process because maybe they will disagree with me, they may pressure me, so I prefer this is going to be between you and me."
"[Assisted dying] is done with full, free and informed consent of the patient. It belongs to the patient to decide if he wants his relatives to be aware of the condition of his death."
Jean-Pierre Menard, lawyer commissioned by the province to review Bill 52

"You are talking about the intentional killing of a patient by a doctor. And now we're suggesting that we're going to cover up that intentional killing of a patient by a doctor and call it something else."
"How is anybody supposed to have any confidence in a publicly administered system of euthanasia that is based upon a fraud?"
Hugh Scher, Toronto lawyer, Euthanasia Prevention Coalition

"Even if [the death certificate] does say 'euthanasia' or 'assisted death', if it's after the two-year exclusion period, there would be no concern."
Wendy Hope, Canadian Life & Health Insurance Association

"I think there are members of the profession who say, 'Let's make sure we're as accurate and as honest as we can be in our reporting and, if it is assisted dying, let's say that."
"I think it's important, whether it's on the death certificate or somewhere else, to capture what did occur."
Dr. Jeff Blackmer, vice-president, medical professionalism, Canadian Medical Association 

"The trouble with calling them all 'natural' -- and I have to say I would not be in favour of that -- is that there is no way of knowing if the person who helped the patient did this legitimately or not."
"You need oversight to make sure these are not lumped in with all other natural deaths. You need someone to be able to investigate each of these deaths to make sure the consent was proper and that everything was done legally."
"The important thing is that there be legislation in each province allowing for this new manner of death. If each province proceeds differently, we will not be able to assess what is happening nationally."
Dr. Pauline Alakija, forensic pathologist, Alberta

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The knotty problem of how to approach legalized suicide assistance for end-of-life patients has assailed the medical profession with the moral consideration of whether their profession, geared to healing, not dealing the final morbid blow for a fading life, can in all due conscience, lend itself to aiding a suffering patient to end a life degraded by disease or chronic ill health beyond endurance. Does helping to end such a life fit into the medical injunction to "do no harm"?

The Supreme Court of Canada has ruled that it does. And Quebec will become the first jurisdiction within Canada to initiate its own program of 'euthanasia'. Quebec's Bill 52 makes it official, from December ten forward it becomes an imperative that physicians in the province be prepared to give assistance to those of their patients requesting aid in dying. As reluctant as many doctors may be to become involved in this end-stage finalization of a living human being's time on Earth, momentum has carried the situation into reality.

Now, even though the Quebec law has a provision that euthanasia cannot be cited as reason to deny death benefits to the family involved, the Quebec College of Physicians has foreseen some difficulties in life insurance policies refusing to render benefits on the basis of suicide disqualification. It has been pointed out that most people with life insurance obtained their policies long before they might have suffered from an incurable illness, and insurance requires a two-year lapse on issuance before such benefits can accrue from suicide.

Those who are opposed to euthanasia in concept and in practise insist that full disclosure must be on the public record. And that the Quebec physicians' group's initiative to have doctors classify deaths that they are involved in through lethal injunction, to have been caused by the specific illness responsible for the individual's morbid state of decline does not sit well with them. Signing off the death certificate not as an instance of assisted dying, but heart disease, or cancer, or multiple sclerosis, for example.

The two-year suicide clause is a standard in most life insurance policies; should the insured individual take his/her life within two years of buying such a policy, no benefit can be expected. On the other hand, most people take out such policies years before they ever encounter dire medical conditions impacting so deleteriously on the quality of their lives; such policies are bought looking to the future, when such occurrences may eventuate, with the individual concerned to ensure their family is financially secure in their absence.

When the Supreme Court of Canada overturned the Criminal Code ban on doctor-assisted death on February, the justices must have been quite aware of just how much a stir it would cause -- in the public discourse, and within the medical community. On the other hand, they would also have been very aware that a majority of Canadians appear to support the initiative for the country to legalize euthanasia, following the lead of many European countries.