Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Sunday, July 17, 2016

At the Core of Assisted Death in Canada

"The issue of conscientious objection is huge and it's related to the issue ... of how physicians feel about this [becoming medically involved as doctors in assisted death]."
"Some of them are obviously quite uncomfortable about referring as well."
Dr. Cindy Forbes, president, Canadian Medical Association

"In the early days of this [Alberta's Medical Aid in Dying program], we got hate mail. I've been publicly identified early on as doing this work [assisted suicide]. We have an email address, and I've been told I'm a murderer and other things."
"We could become targets, and we don't want that to happen. [The list of pharmacists is also] very tightly held."
Dr. James Silvius, medical director, Medical Aid in Dying, Alberta

"We are aware that physicians are concerned about the potential of unwanted interference [public protests, harassment, violence]."
"That probably dates back to the abortion struggles."
Dr. Douglas Bell, associate executive director, Canadian Medical Protective Association

"We do recognize that not everyone is comfortable with medical assistance in dying and it is for that reason that we will not be disclosing which primary-care providers are willing to be part of this new service."
Lauren Kelly, manager, physician services, Prince Edward Island

"My sense is not so much a polarization in terms of stigma where people are saying 'You're a euthanizer', and 'You're a fundamentalist'. I think there is still some basic confusion about some elements in the law and regulations. You'd think they'd be perfectly clear, but they're not."
Dr. Eugene Bereza, director, Centre for Applied Ethics, McGill University Health Centre

It might seem reasonable to most people to think that a critical medical service loathed by many and passionately longed for by many others, mandated as a human right in this country by the Supreme Court of Canada, with guidelines issued by the Government of Canada, would be available in all provinces with similar conditions applying everywhere. But the truth is, uniformity eludes. And the truth is that many health practitioners look upon the very idea of helping a patient die when their profession is geared toward sustaining life, are hugely unwilling to be involved in assisted death.

In Montreal, McGill hospital made it clear that it would not be offering that service to patients. Their doctors are appalled at the very notion that it would be expected of them to guide patients to their death rather than offer palliative care when their condition has become so dire that there is no hope to prolong life. This is what they consider to be death with dignity, not ushering people in pain and misery toward their own funerals.

Yet the Province of Quebec was the first in the country to begin the process of laying out guidelines and expecting medical practitioners to follow them. The result has been that in Quebec so far 166 such procedures have been completed to the end of June, as compared to 9 in Alberta, 18 in Ontario and 5 in Manitoba. Of the 254 requests made Canada-wide for assisted suicide, 166 of those took place in one province alone; the province that considers itself the most 'progressive' of all.

Ideally, Health Canada would prefer to see all provinces put together care-coordination services even though federal regulations do not require that be the case. Health officials visualize that terminally ill patients and their families will be faced with the need to themselves look about to find a physician who might be agreeable to taking part in the procedure they hope will follow. Surveys undertaken by the Canadian Medical Association reveal that sixty-one percent of doctors identified themselves as conscientious objects to assisted death.

On Prince Edward Island health authorities are undertaking a survey of physicians to determine whether they would be willing to discuss assisted dying only with their patients, or whether they might extend the service to any patient on request. The federal law was controversially passed on June 17 and since then Alberta, Ontario, Manitoba, New Brunswick and Northwest Territories still lack guidelines for a centralized service. Saskatchewan and PEI are in the process of compiling a list of doctors willing to administer the deadly drug cocktail when a terminally ill patient who meets the requirements for assent, asks for the service.

Quebec has had a head-start since doctor-assisted death has been legal in that province since December. Doctors there who refuse to take part in the procedure or to refer patients to another physician face censure. Neither Quebec nor Nova Scotia have a central referral service through their health ministries. And doctors generally fear to advertise that they will aid in the procedure and risk being identified as a provider of euthanasia.

Thus far, Alberta is one of the first to set up their central service to maintain doctor and pharmacist lists of those who can be relied upon to help patients take their lives. That list of doctors is held as a document not to be publicly disclosed which only the medical director in each of Alberta's five health zones may access. The issues of medical ethics and physician protection is an emotionally fraught one. Before the federal law on assisted death was passed physicians kept their identities confidential.

The McGill University Health Centre's reluctance to become involved, in support of their medical professionals who object to providing the service, has agreed to alter some of its policies in response to criticism generally, and pressure from government health agencies. The Quebec Health Minister's characterization of the policies as a "childish" reaction elicited the response from the head of the hospital's palliative care unit, Dr. Manuel Borod, that their figures for assisted dying were low owing to their high value of palliative care, minimizing patient suffering.

"The real question you should be asking", said Dr. Borod, is: "why are so many cases of medical aid in dying taking place elsewhere and so few at the MIHC?" It's a fair question in view of the province's oversight body having notified doctors that on occasion some have performed the procedure on patients not in a terminal phase as set out in provincial law. "Some people think aid-in-dying can be 12 months or more (before death is expected) whereas others think it means weeks -- maybe a month or two. That can make a big difference", observed Dr. Eugene Bereza, director of McGill's Centre for Applied Ethics.

And, added Dr Cathy Ferrier, a McGill hospital geriatrics division physician, and president of Physicians' Alliance Against Euthanasia: "I know of people who were trying to start a new palliative-care centre that they'd been working on for several years and were told this year that they would not get public funding. Is that because they don't intend to euthanize patients? I don't know, but it could be."

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