Friday, April 18, 2014

Susan Martinuk: Euthanasia debate is alive and well

This column was written by Susan Martinuk and published in the Calgary Herald on April 18.

Susan Martinuk
By Susan Martinuk

When you don’t have facts and/or good arguments, the only way to win a debate is to declare the discussion obsolete and anoint yourself the winner.

That’s what happened last week in the debate over euthanasia (where one individual deliberately kills another to “end their suffering”) and assisted suicide (where one individual provides the means, information or whatever is required for another to commit suicide so as to “end their suffering”).

An April 7 commentary in the Canadian Medical Association Journal arrogantly suggested that the “yes or no debate” is over, arguments about sanctity of life, personal autonomy and intolerable suffering may now be obsolete and it’s time for doctors to focus on establishing guidelines and policies (“we may need them very soon”) that would “suit the Canadian context.”

As the authors no doubt hoped, the editorial created substantial media buzz, and some headlines and news reports gave the public the incorrect perception that this was a dictate of the Canadian Medical Association or Canada’s palliative care physicians.

That it was printed in the Canadian Medical Association Journal in no way means that it is CMA policy. As in any truly free academic journal, editorial opinions and scientific interpretations are not censored. However, in this particular case, this commentary runs counter to CMA policies (reaffirmed as recently as 2013) that overwhelmingly oppose euthanasia and assisted suicide, calling it “unethical” and “in conflict with basic ethical principles of medical practice.”

In addition, the suggestion that the debate is over and doctors should practically prepare to deal with euthanasia does not have the support of Canada’s doctors or palliative care physicians.

A 2013 Canadian Medical Association poll showed that just 16 per cent of its members would be willing to participate in the taking of a life. A 2010 survey by the Canadian Society of Palliative Care Physicians found that 88 per cent of its members were opposed to euthanasia and 80 per cent were against legalization of assisted suicide.

The American Medical Association says euthanasia/assisted suicide is “fundamentally incompatible with the physician’s role” and the World Medical Association calls it “unethical” and asks all national medical associations and physicians to refrain from participating in it — even if laws allow it.

In other words, the vast majority of physicians oppose any legalization of the practice and the insistence on calling it an unethical practice reinforces the idea that even if these practices are legalized, they will still be anathema to a physicians’ role and responsibility to a patient.

That leaves a few doctors on the periphery to advocate for what they sincerely believe is a good way to end life.

From what I can discern, this does not reflect the opinion of many. It was an editorial/opinion commentary that represented the opinions of four individuals — three doctors from the University of Toronto and one health policy lawyer from Alberta. Although I don’t believe it is mentioned as a potential conflict of interest, the lead author is also the co-chair of the Advisory Council of Physicians to Canada’s Death with Dignity group, a pro-euthanasia group that, according to its website, works to achieve “quality” and “choice” for dying Canadians.

He absolutely has the right to take on this role and to write about his opinions in medical journals. But academic journals are typically strict about authors publicly stating any possible conflict of interest related to a published work and that seems to be missing here. This may lead readers to consider his thoughts outside of their full context.

Dr Francescutti
Unfortunately, a letter in response to this commentary, written by the president of the CMA, Dr. L.H. Francescutti, received much less media attention. He notes that “contrary to the author’s assertion,” there is little support for assisted death among Canadian physicians and says that Dr. James Downar is putting “the cart well before the horse” by looking to euthanasia for end of life care, rather than first looking to improved palliative care services and a national pain strategy.

That said, Downar is correct in his assessment that the law is often far behind medical advances. Indeed, physicians could be found in legal limbo and without professional guidelines if it is quickly legalized by government or by a court decision.

So, yes, we need to talk about the above. But Downar is sadly mistaken in thinking that we can discuss guidelines and policies in a vacuum, permanently separated from much-needed discussions on other issues such as sanctity of life and personal autonomy.

Links to similar articles:
Poll: the majority of doctors oppose assisted suicide
Most Canadian doctors oppose euthanasia.
- The World Medical Association opposes euthanasia and assisted suicide.
Canadian society of Palliative care physicians oppose euthanasia and assisted suicide.


Anonymous said...

pretty nice blog, following :)

Winston said...

You've already lost, Alex. You've lost since 9/11, 2001. Why? Because Al Qaeda proved that they are more compassionate than you.

Killing almost 3000 people instantly proved it.

Alex Schadenberg said...

Dear Winston:

Your comment is sick and disgusting.

Winston said...

It's also true. I'd rather be killed by a terrorist than go into a hospice.

Alex Schadenberg said...

Dear Winston:

You spend too much time thinking about terrorism.

Most hospices are operated by caring people.

Winston said...

I don't care how caring they are. Palliative care is NOT a panacea.

A 2007 study published in the Journal of Clinical Oncology showed that despite the availability of good palliative care, one quarter of late-stage cancer patients experience moderate to severe suffering.