On January 15, 2013, Veronique Hivon, Quebec Junior Health Minister responsible for the Dying with Dignity portfolio, presented in a press conference the report of a legal panel, headed by lawyer Jean Pierre Menard, regarding the implementation of the recommendations of the Select Committee on Dying with Dignity, which was held last year. Both Hivon and Menard said that there is a strong social consensus in Quebec in favor of ‘assisted dying’, and that the Quebec Government would present a bill on this issue by the end of June, 2013.
Even though the word “euthanasia” had not been uttered during this press conference — they instead used the expression “dying with dignity” — it is indeed about euthanasia. Menard explained that one had to affirm the patients’ “right to decide when and how they will die”. Even though euthanasia and assisted suicide are illegal in Canada under the Criminal Code (being considered as a murder), Menard said that the Province of Quebec has the legal jurisdiction to go ahead (and bypass the federal ban), by simply defining euthanasia as “appropriate health care”, which comes under provincial jurisdiction, according to the Canadian Constitution.
In his 400-page report, Menard said that even though the Canadian government can intervene in matters of criminal law to ban some gestures, like assisted suicide, the Canadian law stipulates that it is up to the Attorney General (Justice Minister) of each province to lay . “In the context where the Quebec legislature adopts a law to organize the required legal framework for end-of-life within the health-care system, including provisions on “medical-aid-in-dying”, Quebec’s Attorney General could decide that no criminal charge will be laid against anyone who acts in conformity with the dispositions of the law passed by the Quebec National Assembly (provincial parliament). In other words, Quebec doctors who will “help someone to die” will be protected by the law of the province and not be prosecuted.
Reactions to this coming bill were quick to come among the various groups defending life. Alex Schadenberg, Executive Director of Euthanasia Prevention Coalition, wrote: “Euthanasia is the intentional causing of death, whereby the death occurs directly from that act... How can killing be defined as a form of healthcare? By defining euthanasia as a healthcare, access to euthanasia will inevitably be extended to everyone, because everyone is provided given equal access to healthcare.”
On January 18, 2013, the Assembly of Quebec Bishops reacted with this press release:
“The report of the committee chaired by Jean-Pierre Menard, following the Select Committee on dying with dignity, takes a dangerous way. Taking the phrase “assisted dying” — that the Commission had chosen to refer to both assisted suicide and euthanasia — the Menard report defines euthanasia as “healthcare” and sees it as a “right.” In addition, given that euthanasia and assisted suicide are prohibited by the Criminal Code of Canada, the report urges the Attorney General of Quebec to forego prosecution against persons who might be involved in “assisted dying” provided that they have acted in accordance with the provisions of the national law adopted by the Assembly on the subject. There is every reason to worry when a way causing death so intentionally is considered a care and claimed as a right.”
The Catholic Organization for Life and Family (COLF, founded by the Canadian Conference of Catholic Bishops) strongly objects to the idea of “medical-aid-in-dying” and is deeply concerned about the legal, ethical and social ramifications such a practice would have: “The main proponents of ‘medical-aid-in-dying’ also want us to believe that there is a strong social consensus in favor of ‘assisted dying’. However, this is not so: 60% of the individuals and groups that made submissions to the Select Committee on Dying with Dignity opposed euthanasia and assisted suicide.
“Nevertheless, in as much as the Government of Quebec intends to bring in a bill on “medical-aid-in-dying” by June of this year, anyone who still believes in the first of all human rights — the right to life — has the responsibility to take action. As citizens of a country that claims to be civilized, all people of good will have the right and the duty to counter any attempt to legalize euthanasia and assisted suicide, and, instead, to promote palliative care and true compassion. The media, together with every member of Quebec’s National Assembly, need to hear from constituents who are opposed to the bill soon to be tabled by the Marois Government. If passed, this bill will bypass the Criminal Code of Canada, which clearly prohibits both euthanasia and assisted suicide.
“COLF recommends that concerned individuals consult organizations involved in end of life issues whose perspectives respect the inalienable dignity of every human person, like the Physicians’ Alliance for Total Refusal of Euthanasia (PATRE) (www.totalrefusal.blogspot.ca) whose manifesto can be signed, and “Euthanasia Prevention Coalition” (www.epcc.ca). COLF also offers a series of documents to guide reflection on this theme (http://www.colf.ca/).”
According to Dr. Catherine Ferrier, spokesperson for the Physicians’ Alliance (which has the signed support of more than 300 leading physicians), the Menard report “is the work of some hand-picked lawyers who present the act of doctors killing patients as if it were part of a natural continuum with good end-of-life care. They and the politicians who appointed them introduce the term “medically-assisted dying” as if it were something different from killing patients. This act is abhorrent to us as doctors, and should appall Quebecers who care about social justice and building communities that care about the most vulnerable.”
Here is the declaration of the Physicians’ Alliance for Total Refusal of Euthanasia (PATRE):
We are physicians who see any law allowing doctors to intentionally end the life of their patients as contrary to the goals of medicine and the good of our patients, especially the most vulnerable and those who cannot speak for themselves.
We affirm that:
1/ Patients at the end of life should receive diligent and competent care to relieve their pain and suffering. The physician has the obligation to use all the means available to achieve this end.
2/ If a patient refuses treatment or requests its withdrawal, his or her wishes must be respected.
3/ Modern palliative care skills, drugs and technology permit adequate symptom control for all terminally ill patients. These methods should be universally accessible.
4/ A physician who is caring for a dying patient, and who cannot adequately control the person’s symptoms, should have access to the necessary expertise and support to be able to do so.
5/ When suffering remains uncontrolled by state-of-the-art palliative care, individually adjusted sedation to a point of comfort may be used. In this, as in all palliative care, the goal remains optimal quality of life.
6/ To provoke death voluntarily, by lethal injection or any other method, cannot be considered under any circumstance as “medical care”, and is contrary to medical ethics. It is never necessary to kill a patient in order to end his or her suffering. The 2400-year-old Hippocratic tradition was a major advance in civilization. It forbids euthanasia and mandates the protection of the weak and the maintenance of trust between the physician and the patient. It calls on physicians and other health professionals to use their knowledge and skills to heal the sick, creating a climate of mutual solidarity. It is ironic that the accepted standards of this ancient code of conduct, written at a time when the means of countering end of life suffering were very limited, might be considered inadequate in this age of refined capacity to control symptoms.
7/ We must learn from the negative experiences of countries that have legalized euthanasia. Decriminalization often causes more problems than it is claimed to solve; those documented in the medical and legal literature include:
l High rates of euthanasia without consent;
l The impossibility of ensuring adequate reporting and respect for safeguards;
l A loss of trust in the physician-patient relationship;
l Conflicts within medical teams and within patients’ families.
8/ Medical licensing bodies must continue to fulfil their role as protectors of the public and of life, and support physicians in their efforts to improve the quality and accessibility of care of the dying, thus allowing all patients to receive excellent symptom relief throughout their illness and at the time of death.