Sunday, October 13, 2013

Palliative care leaders oppose Quebec euthanasia (Bill 52)

The following letter was written by Dr's Bernard Lapointe, Manuel Borod, and Balfour Mount and published in the Montreal Gazette on October 10, 2013. 

Bernard Lapointe is chief of palliative care services at the Jewish General Hospital, 

Manuel Borod is director of palliative care services at the Montreal General Hospital.

Balfour Mount is considered to be the founder of palliative care in North America.

He is former director of palliative care services at the McGill University Health Centre.

If we were to build a bridge and 90 per cent of the engineers felt the design was dangerous, there would be a public outcry. Why is there no such outcry in Quebec in response to Bill 52, which the great majority of palliative-care providers oppose?

Bill 52, Quebec’s proposed legislation on medically assisted death, makes the following dangerous assertion:
“End-of-life care means palliative care provided to persons at the end of their lives, including terminal palliative sedation and medical aid in dying.”
The bill, as proposed, unilaterally and without consultation with palliative-care specialists, redefines the meaning of palliative care. It proposes end-of-life care that is contrary to the internationally defined goals of palliative care. This is dangerous, as it will harm the provision of palliative-care services.

The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness. It can be provided from the time of diagnosis and includes, but is not limited to, end-of-life care.

Palliative care neither hastens nor postpones death. “Medical aid in dying,” as defined in this bill, is in fact a specific act to end a person’s life.


This is euthanasia.

It is contrary to the goals of palliative care, and is not part of palliative-care services.

All patients currently have the right to refuse or withdraw from treatment and can be offered palliative sedation if their suffering cannot be alleviated. This is legal and ethical. Euthanasia, on the other hand, is neither legal nor ethical in most parts of the world. Bill 52 groups together these very different interventions and makes it seem as if they are all equivalent.

There are specific international guidelines regarding palliative sedation and the criteria for its use. Palliative sedation is begun when a patient has intractable symptoms, and is perceived to be at the end of life.

Bill 52 calls for annual reporting of terminal palliative sedation and “medical aid in dying.” Once again, this provision would lump together currently legal palliative sedation and illegal euthanasia. It is our concern that by so regulating a medical therapy that is useful, legal and ethically acceptable (palliative sedation), there will be reluctance on the part of practitioners to initiate this clinically important treatment option.

There are many obstacles to referral to palliative care — not enough palliative-care professionals or palliative-care centres; not enough home care; and not enough teaching and training for all health-care professionals. This bill, if passed, would make patients more afraid to seek quality palliative care and it could become more difficult to recruit physicians to practice palliative medicine.

Balfour Mount.
The term palliative care in this setting was originally proposed in 1973 by Balfour Mount, and the very first Palliative Care Service was at Montreal’s Royal Victoria Hospital.

McGill has hosted the International Congresses on Care of the Terminally Ill for the past 40 years. It is thus ironic that steps are being taken in this province that may have terrible consequences for our care of dying patients.

We strongly recommend that members of the National Assembly ask themselves why the vast majority of palliative-care doctors, nurses and allied health professionals, including psychologists, social workers, occupational therapists, physiotherapists, nutritionists, music therapists as well as the volunteers, and consultants who provide care to the seriously ill and dying patients, oppose Bill 52.

Our elected officials in Quebec City should also visit our patients and their families prior to leading Quebec down this dangerous road that would place the most vulnerable among us at risk.

Balfour Mount is the founder of palliative care in North America.

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