There is no role for palliative care in providing euthanasia

The following letter was written by Dr. Manuel Borod, the director of Supportive and Palliative Care at the McGill University Health Centre in Montreal Quebec. 

This letter was published in the Montreal Gazette on January 21, 2013 under the title: There is no role for palliative care in providing euthanasia

Re: “End of life rules to be set out in new law” (Gazette, Jan. 16) 

Dr. Manuel Borod

In the reports about the proposed end-of-life legislation, there have been numerous statements that may confuse readers. 

You report that the proposed law would protect the right to refuse treatment, withdraw treatment, withhold treatment, receive palliative care — including the right to receive palliative sedation, and the right to have medical assistance in dying. The first four of these rights are already generally accepted standards of care. 

And a statement describing palliative sedation as “the process of putting a dying patient to sleep, ending feeding and artificial hydration, a procedure that ends in death” is completely misleading and false. Palliative sedation is legal, does not necessarily hasten death (as noted, the patient is dying), and on our palliative care ward, we have very specific policies and follow international guidelines as to when and how to initiate this treatment. 

The only thing new here would be to allow an act that directly causes death, and this is euthanasia. The rest is a smokescreen. 

It is an affront to all those who care for the terminally ill to refer to this act as death with dignity — it is our objective that all our patients die with dignity. It is also misleading to refer to euthanasia as medical or physician aid in dying — once again, all the physicians, nurses, psychologists, social workers, music therapists, occupational therapists, physiotherapists, spiritual care counsellors, pharmacists, dietitians, volunteers and coordinators who work with the dying patient offer aid in dying. 

This has become a political and legal issue, and the lawmakers should call this act what it really is: lawful death or legally acceptable death. 

If the legislators decide to put this act into law, they should also provide for judges and technicians to approve the request and carry out the orders. There is no role for palliative care in providing euthanasia for terminally ill patients. The proposed law calls for improving and expanding the role of palliative care. The opposite will result if palliative care and euthanasia are expected to coexist under the same roof. 

Manuel Borod MDDirector, Division of Supportive and Palliative CareMcGill University Health CentreMontreal