Tuesday, January 5, 2016

Québec physicians group opposes referring patients for euthanasia.

Scientific Objection to Dr. Yves Robert’s Editorial

[“Referring the patient’s request to a health care professional who would follow through with it would then seem the ultimate compromise, respecting patient’s and physician’s rights.”][1] Dr. Yves Robert, Le Collège, November 10, 2015

Dr Robert,

The above statement that you made as Secretary of the Collège des médecins du Québec is absolutely false.

First, let’s recall this excerpt, from of the Superior Court ruling (par. 97): “The lawyer of the Attorney General of Canada also expressed her concern about article 31 of an Act respecting end-of-life care, obliging physicians who do not want to grant a request for physician-assisted dying, to participate, despite their objection, in the process of finding a willing physician. She sees in this fact itself an indication that even a physician, conscientious objector, would inevitably become involved in a process leading to the commission of a criminal act under the current state of the law”.

This summarizes without ambiguity the thoughts of the Attorney General of Canada and the Quebec Superior Court concerning your “ultimate compromise” on the subject of conscientious objection, also shared by the Collège des médecins du Québec.

This form of collaboration in killing a patient, with all due respect, is not the ultimate compromise. It is an obligation to collaborate — which can be experienced by a physician as complicity in an act he considers to be harmful to his patient, irrelevant whether the act is criminal or not (the crime evoked here only compounds the insult of the obligation).

As for me, I want to continue to offer care to my patient; not sever the relationship. I simply refuse to cause his death. What will you do against my medical judgment?

If you suspend me, you are the one severing the care relationship by depriving a patient of his physician, whereas I am willing to continue caring for him. I do not consider sending my patient to be killed as providing care because… to be killed is not a treatment, neither for me, nor for the overwhelming majority of physicians and medical associations all over the world. This then is a question of medical obligation, because I apply the international norm, while the Collège has decided unilaterally to disagree.

The issue here is much more a question of scientific objection than an objection of conscience because the purpose is to apply the international norms and standards the Collège decided to disagree with.

Given that most physicians will never agree to stop preventing suicide among their patients, we cannot compel them to stop this prevention because their medical judgement and expertise—that they have applied for years—tells them not to do it. Simply put, preventing suicide remains good medicine.

Likewise, a hospital director cannot force me to perform surgery on my patient if my medical opinion tells me the surgery would be harmful. It does not mean that I sever the professional relationship with my patient, only that I exercise my profession with my judgement and my competence, which means to say that I am not a simple technician who will only serve to be “someone else’s hands.”

In the same way, no patient can force me to perform surgery that I consider bad or harmful, and it is understood that the minimum degree of professional consistency would prevent me from referring him to someone who would perform it in my place. I would simply tell him that it is not recommended, and he would be free to go elsewhere. If however, I were to transfer him to a colleague or health care professional knowing that the procedure I consider harmful will be conducted, it would be as though I performed it through the hands of another.

The Collège needs to recognize this logical response from physicians (palliative and other) who do not want to collaborate in paving the way toward the medically assisted death of their patients. These physicians, who are neither fanatical nor arrogant, see this intention of the state (and of the Collège) to impose on them a forced collaboration like an abuse of authority. The use of the term “ultimate compromise,” in this context, sounds a lot like “this is my final offer.” That, would sooner be called an ultimatum—and the Attorney General of Canada did well to note the real intention behind the words.

In conclusion, if the Collège hopes to avoid unjust and unnecessary confrontation with qualified and attentive physicians of integrity, it should find a way not to compel them to assist in the death of their patients against their medical judgement and their professional conscience.

Even if the new exception measures (not to read “rule”) that will soon be established in the Canadian Criminal Code allows for euthanasia or assisted suicide under certain conditions, you must remember that forcing physicians to refer—moreover to threaten them—is a sure-fire way to cause unnecessary and damaging battles for all, to cause division and spoil the collegial environment in our hospitals.

If, one day, euthanasia or assisted suicide are decriminalized, a true compromise—one that would respect everyone’s autonomy — would be something like this: let patients carry out their own wishes by putting a voluntary system in place, forcing no participants to act against their will—neither their doctors nor anyone else involved.

Marc Beauchamp, MD, FRCSC, orthopedic surgeon, Montreal

With the support of the undersigned:

1. Renata Sava, MD, médecin de famille, Montréal
2. Louis Morissette, MD, FRCPC., surspécialiste en psychiatrie légale, Montréal
3. Yousri Hanna, MD, chef de l'Unité des Soins Palliatifs de Santa Cabrini, Montréal
4. Yvan Roy, MD, médecin de famille, L’Assomption
5. Bernard H. Doray, MD, pédiatre, Montréal
6. Antonio Tongué, MD, radiologiste, Gatineau
7. Stephen Martin, MD, médecin de famille, Montréal
8. François Belzile, M.D, FRCPC, radiologiste, Sherbrooke
9. Roy Eappen, MD, endocrinologue, Montréal
10. Annik Dupras, MD, FRCPC, interniste-gériatre, Terrebonne
11. René Pouliot, MD, néphrologue, Québec
12. Francine Gaba, MD, gériatre, Montréal
13. Jacques R. Rouleau, MD, CSPQ, FRCPC, FACC (Institut universitaire de cardiologie et de pneumologie de Québec, Professeur titulaire de médecine, Université Laval)
14. Roger Roberge, MD, gériatre, Montréal
15. Elisabeth Fuvel-Girodias, MD, Kirkland
16. Louis Béland, MD, chirurgien, Québec
17. Nathalie de Grandpré, MD, médecin de famille, Montréal
18. Michelle Bergeron, MD retraitée, Québec
19. Mark Basik MDCM, FRCS(C), chirurgien oncologue, Montréal
20. Guy Bouchard, MD, médecin de famille, Québec
21. Valérie J. Brousseau, BScH, MDCM, FRCSC, oto-rhino-laryngologue, Victoriaville
22. Claude Morin, MD, médecin de famille, Québec
23. Nicholas Newman, MD, FRCSC, chirurgien orthopédiste, Montréal
24. Michel Brouillard, MD, médecin de famille, Rouyn-Noranda
25. Mance Luneau, MD, médecin de famille, Blainville
26. Suzanne Labelle, MD, médecin de famille, Laval
27. Jean-Bernard Girodias, MD, pédiatre, Montréal
28. Juan Francisco Asenjo, MD, anesthésiologiste, Montréal
29. Paul Barré, MD, nephrologue, Montréal
30. Michel Copti, MD, neurologue, Saint-Lambert
31. Liette Pilon, MD, médecin de famille, Montréal
32. André Rochon, MD, médecin de famille, Montréal
33. Douglass Dalton, MD, médecin de famille, Montréal
34. Marie-Chantal Piché, MD, médecin de famille, Vaudreuil-Dorion
35. Odile Michaud, MD, médecin de famille, Otterburn Park
36. Catherine Ferrier, MD, médecin de famille, Montréal
37. Michel de Maupeou, MD, médecin de famille, La Sarre
38. Vijayabalan Balasingam, MD, neurochirurgien, Pointe-Claire
39. Pierrette Girard, MD, chirurgienne orthopédiste, Pointe-Claire
40. Jacques Beaudoin, MD, cardiologue, Québec
41. Marc Bergeron, MD, hémato-oncologue, Québec
42. Rosaire Vaillancourt, MD, FRCPC, chirurgien thoracique, Québec
43. Louis Dionne, MD, chirurgien général, Québec
44. Juan Rivera, MD, endocrinologue, Montréal
45. Lyette St-Hilaire, MD, médecin de famille, Laval
46. Matthieu Tittley, MD, FRCPC, psychiatre, Sherbrooke
47. Luc Chaussé, MD, médecin de famille, L’Assomption
48. Gilles Gaudreau MD, médecin de famille, Sorel-Tracy
49. Evelyne Huglo, MD, médecin de famille, Montréal
50. Hong Phuc Tran-Le, MD, FCMF, médecin de famille, Val d’Or
51. Laurence Normand-Rivest, MD, médecin de famille, Châteauguay
52. Daniel Boulet, MD, FRCP(C), physiatre, Qu.bec
53. Anne-Louise Boucher, MD, responsable médical GMF du Carmel, Trois-Rivières
54. Mathieu Brouillet, MD, médecin de famille, Rimouski
55. David Bacon, MD, CM, CCFP-EM, médecin de famille, Pointe-Claire
56. Marcel D’Amours, MD, anesthésiologiste, Québec
57. Anne Marie Uhlir, MD, médecin de famille, Sainte-Croix
58. Mélanie Laberge, MD, omnipraticienne, Québec
59. Heather Coombs, MD, urgentologue, Montréal
60. Svetlana Ninkovic, MD, pédiatre, neurologue, Greenfield Park
61. Roland Leclerc, MD, pédiatre, Québec
62. Jean-Pierre Beauchef, MD, endocrinologue, Greenfield Park
63. Serge Daneault, MD, soins palliatifs, Montréal
64. Patricia Marchand, MD, médecin de famille, Trois-Rivières
65. Louis Martel, MD, médecin de famille, Trois-Rivières
66. Daniel Viens, MD, FRCPC, interniste, Drummondville
67. Roseline LeBel, MD, médecin de famille, Laval
68. Sonia Calouche, MD, psychiatre, Saint-Eustache
69. Cecile Hendrickx, MD
70. Marie-France Raynault, MD, santé publique, Montréal
71. Julie Gauthier, MD, médecin de famille, Montréal
72. Olivier Yaccarini, MD, médecin de famille, Québec
73. Caroline Girouard, MD, oncologue médicale, Hôpital Sacré-Cœur, Montréal
74. Pierre Duclos, MD, endocrinologue, Québec
75. Normand Lussier, MD, médecin de famille, Montréal
76. Paola Diadori, MD, neurologue, Montréal
77. Bruno Gagnon MD, MSc, Soins Palliatifs, Université Laval, Québec
78. Judith Trudeau, MD, rhumatologue, Hôtel-Dieu de Lévis
79. Yves Bacher, MD, gériatre, Montréal
80. Tommy Aumond-Beaupré, MD, médecin de famille, Montréal
81. Joseph Ayoub, MD, oncologie et soins palliatifs, Montréal
82. Xavier Coll, MD, cardiologue, Lachenaie
83. Léonard Langlois, MD, pédiatre, Sherbrooke
84. Anne Larkin, MD, généraliste depuis plus de 36 ans, Waterloo

[1] « La transmission de la demande d’un patient à une autorité du réseau de la santé qui pourra y donner suite apparaît donc comme l’ultime compromis pour respecter les droits du patient et ceux du médecin » Dr Yves Robert, LE COLLÈGE, 10 novembre 2015

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