Action Life’s 2015 Annual General Meeting was held on November 24, 2015. The meeting was well attended, and concluded with a presentation by Dr. Catherine Ferrier of the Physicians Alliance against Euthanasia. Dr. Ferrier is a faculty member with McGill University’s Medical Health Centre, and practices at the Division of Geriatric Medicine at Montreal General Hospital. She presented a comprehensive outline of the moral and legal issues surrounding euthanasia from a health practitioner’s perspective. She also informed attendees of the history around euthanasia legislation in Canada.
The key principle of palliative care is that it neither hastens nor prolongs patient death. By contrast, euthanasia is the act of directly and intentionally causing an individual’s death in order to put an end to his suffering. Similarly, assisted suicide is the act of helping someone to end her life by providing her with the tools and/or information necessary to commit suicide.
Palliative care consists in controlling pain or other symptoms in dying patients. With respect to patient control of their care during the palliative process, in Canada, any patient may refuse treatment or request withdrawal of treatment even if this hastens their death. However, the right to refuse treatment is not the same as the so called ‘right to die’.
Between 16 to 30% of people who die in Canada receive palliative care. Of those who do receive palliative care, there are several groups vulnerable to euthanasia. These vulnerable groups include: the frail elderly; persons with disabilities; patients and families in crisis because of a catastrophic event or illness; and patients suffering from depression, anxiety and existential distress. These points have been discussed compellingly by many who oppose euthanasia. For me, the most telling testimony came when Dr. Ferrier discussed the impact the suggestion of euthanasia may have on those who are transiently depressed (i.e., those who are not clinically or chronically depressed) or lonely. For example, Dr. Ferrier presented that 20-50 % of terminally ill patients suffer from depression, but only 3% are treated for it. Similarly, in cancer patients with a terminal prognosis, 45% express a desire to die at some time – but the desire only persists in 8% of cases. How vulnerable these patients must be if euthanasia is included as a palliative care option while they are depressed and feeling hopeless! Similarly, what does it say about us as a society when the easiest “cure” for loneliness in terminal patients is death?
Dr. Ferrier argues that society has a duty to protect vulnerable people, and that (because of known abuses in jurisdictions that permit euthanasia (e.g., Buiting et al., 2009; Chambaere et al., 2010)) individual freedom ends where it impinges on the freedom and well-being of others. Furthermore, she stressed that good control of pain and other symptoms is possible in almost all palliative cases, and there are no obstacles to refusing or withdrawing treatment. As such the practices required of physicians when “medical aid in dying” and “physician assisted death” become legal are not only unnecessary for patient comfort, they are incongruent with palliative patient care. They are euphemisms for the direct killing of patients by the physician by euthanasia. Physician-inflicted death undermines palliative care and compromises physician conscience rights (63% of physicians in Canada oppose euthanasia (Fletcher, 2015)). Those who lobby for euthanasia do not acknowledge the harm this practice causes to vulnerable patients, to physician conscience rights, and to society, in general.
Buiting, et al. 2009. Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study. BMC Medical Ethics. 10:18.
Chambaere K, et al. 2010. Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey. CMAJ. 182: 895-901.
Fletcher. 2015. Right to die in Canada: respecting the wishes of physician conscientious objectors. CMAJ, 187:18.