Canada is Free and Freedom is Its Nationality

Sir Wilfrid Laurier

Sunday, November 15, 2009

Event Blogging the Wilberforce Weekend: Assisted Suicide and Euthanasia Debate Quebec

Please Note: This is a summary of the events and speeches in my own words for educational, information, and entertainment purposes only. It is not the speakers' exact words and should not be taken as such. It also may contain errors due to the nature of the medium. I am not responsible for any of them, use at your own risk and consult the official videos and/or audio record if you want to verify or quote anything.

Dr Andre Bourque

There is an issue that this is about choice, individual autonomy. There is a breakdown of human solidarity, we don't want to be dependent on anyone else.

We claim to want to fight youth suicide, then say suicide is a right. I am a doctor, I have the privilege and responsibility to give help and not to kill people.

This is also linked to evolution. We believe that euthanasia is about progress. Old people are against progress. Young practitioners don't want to be involved in a reactionary movement.

There was a quick survey done of doctors and 75% were in favour of euthanasia. The survey results are misleading. For one thing most were specialists, not generalists. It is in light of this that myself and five colleagues decided that we needed to react. We wrote a brief from a non-religious basis, because there is a total allergy against a religion and we would have alienated many people. We wrote it in French but it reads very well in English. However some in Quebec are very impressed by the surveys.

We couldn't present a brief with just five doctors so we decided to get 100 doctors, to be a choir singing against euthanasia. We went through the lists of medical faculty and managed to get that number without too much trouble.

We got lots of visibility as the only voice speaking against euthanasia. You begin to wonder who the opposition is, where it is hiding. We didn't find doctors opposing us too much. They are there but they are hiding. The College's statement in favour of euthanasia is irresponsible. They haven't consulted their members. They are attacking a long standing tradition and there is much confusion on the matter.

They say we use palliative sedation which is the same as euthanasia. It is not the same and it is almost never used.

We are taken hostages by a minority that we don't see very often. When you have worked as long as I have you see progress over time. When I studied we did not talk about end of life issues. We have seen remarkable progress, we have improved palliative care. Students today are getting much training that I never got. There is no comparison. We have palliative care specialists for one thing.

The population does not know what we do, that we can alleviate their pain. They have fears of imposing, of pain, of so much. These fears are accentuated by the problems people have getting care and finding a doctor. People feel that they will be all alone and won't have good healthcare.
It is not easy to confront patients who are in advocacy for euthanasia because you have to look at their eyes and suffering. However these people can be badly informed, they want euthanasia because they want to die peacefully. They don't know about the alternatives.

You can stop a disproportional treatment when it gets to that point and thus die a natural death.
There is a case of a person who had a degenerative disease. He wants a "pocket coupon" for when he has to leave his home. This person seemed to be quite happy and could move around but became sick as soon as he was on camera. He probably has 10-15 years of life ahead of him.

I ask people why they don't interview others like palliative care doctors who have been working in this area for decades. These doctors create systems that work well. Someone he knows has been in palliative care for 25 years and has never had a simple request for euthanasia.

A Doctor in Quebec is a palliative care doctor who fought for euthanasia. This doctor creates disinformation. There is only one case of euthanasia in Quebec that is recognized and in that case the patient was not well treated. The patient was delirious, he had HIV/AIDS and it didn't seem possible to help so a doctor gave him a lethal injection. I was asked to help this case. This doctor was withdrawn from practice, and retrained. The doctor was not justified, he was ill informed.

The College of Doctors in Quebec brings up cases where there is agony. They believe that appropriate care could include illegal things. The Legislative framework reassures patients. The College wants euthanasia to be called medical care which is mental gymnastics.

Terminal agony is a difficult area in palliative care. Patients go through periods of anguish, but finally they go through a period of final agony where they are often in a coma. The family does suffer through this period as people are in this state for days or weeks with no or little hydration and nutrition. They have sores, they don't smell good, but they still breath and move a little. There is a temptation to end this period.

It is difficult to understand at this point why we shouldn't open the door to euthanasia.
Doctors have great power over patients. They must have a position of giving life and not death. Doctors have so much power and freedom to do what needs to be done, if they are allowed to give death it will undermine the doctor/patient relationship of trust. If they can give death it will be abused.

It is the whole question of the slippery slope and it is difficult to explain. With euthanasia the doctor/patient relationship is made dangerous. We should use the language of powerlessness.
People will be dying at home more and more. I can tell you that when we have people who are going to hospitals where they are not known they are very much at risk.

Q1 When you talk about the Quebec values that are at the root of the problem, how do we fix that?

A1 There is not enough exposure to what we do in palliative care. We need a better and more flexible system. Information about the right to refuse over-treatment. We have great tools so very few palliative care physicians are in favour of euthanasia.

Q2 The argument that there is no need for euthanasia because of palliative care lost badly in other areas. We need to show different reasons.

A2 Sees point but we still need to make the doctor/patient relationship argument better.

Q2 That didn't do much for me before euthanasia was legalized (in a state) but when my doctor actually voted for euthanasia it did affect my trust.

Q3 Some family physicians see this as part of their long tern relationship with a patient to offer euthanasia. This is very common in Holland

A3 Family physicians who are better informed in Palliative care can advise patients against euthanasia. Patients often ask doctors for advice because they are not sure what to do. Doctors have great power to persuade.

1 comment:

  1. For assisted suicide but against voluntary euthanasia !

    About the difference between euthanasia and assisted suicide, one must distinguish between the legal, ethical and religious arguments. One cannot just say without qualification that there is no difference between the two : in one case it is the patient himself who take his own life (assisted suicide), whereas in euthanasia it is the physician. One must first specify on what grounds (legal, ethical or religious) he draws is arguments. In the field of ethics, one can reasonably argue that there is no difference between the two. However, in the legal field, there is a difference between euthanasia (so-called first-degree murder with a minimum sentence of life imprisonment) and assisted suicide (which is not a murder or homicide and which the maximum sentence is 14 years of imprisonment). In the case of assisted suicide, the cause of death is the patient's suicide and assisted suicide is somehow a form of complicity (infraction of complicity). But since the attempted suicide was decriminalized in Canada in 1972 (and in 1810 in France), this complicity (infraction of abetting suicide) makes no sense because this infraction should only exist if there is a main offence. But the suicide (or attempted suicide) is no longer a crime since 1972. So, logically, there cannot be any form of complicity in suicide. The offense of assisted suicide is a nonsense. Judge McLachlin said :

    « In summary, the law draws a distinction between suicide and assisted suicide. The latter is criminal, the former is not. The effect of the distinction is to prevent people like Sue Rodriguez from exercising the autonomy over their bodies available to other people. The distinction, to borrow the language of the Law Reform Commission of Canada, "is difficult to justify on grounds of logic alone": Working Paper 28, Euthanasia, Aiding Suicide and Cessation of Treatment (1982), at p. 53. In short, it is arbitrary »

    In contrast, voluntary euthanasia is considered a first-degree murder. The doctor kills the patient (at his request) by compassion to relieve his pain and suffering. There's a violation of one of the most fundamental ethical and legal principles : the prohibition to kill a human being. Our democratic societies are based on the principle that no one can remove a person's life. The end of the social contract is "the preservation of the contractors" and the protection of life has always founded the social fabric. We've abolished the death penalty in 1976 (and in 1981 in France) in response to the « broader public concerns about the taking of life by the state » (see United States v. Burns, [2001] 1 S.C.R. 283) ! Even if voluntary euthanasia (at the request of the patient) may, under certain circumstances, be justified ethically, we cannot ipso facto concluded that euthanasia should be legalized or decriminalized. The legalization or decriminalization of such an act requires that we take into account the social consequences of the legalization or decriminalization. The undeniable potential of abuse (especially for the weak and vulnerable who are unable to express their will) and the risk of erosion of the social ethos by the recognition of this practice are factors that must be taken into account. The risk of slippery slope from voluntary euthanasia (at the request of the competent patient) to non-voluntary euthanasia (without the consent of the incompetent patient) or involuntary (without regard to or against the consent of the competent patient) are real as confirmed by the Law Reform Commission of Canada which states :

    "There is, first of all, a real danger that the procedure developed to allow the death of those who are a burden to themselves may be gradually diverted from its original purpose and eventually used as well to eliminate those who are a burden to others or to society. There is also the constant danger that the subject's consent to euthanasia may not really be a perfectly free and voluntary act ».

    Eric Folot