I would never refer one of my patients for an arranged suicide or euthanasia.

This article was published in the National Post on July 9, 2015.

Dr Will Johnston

Dr Will Johnston, is a family physician in Vancouver and the Chair of the Euthanasia Prevention Coalition - BC

I would never refer one of my patients for an arranged suicide or euthanasia, and there are people out there who would demand that I be disciplined for that.

Yet nothing in the Supreme Court’s Carter ruling compels physicians to be involved in arranging the suicide of a patient. The ruling simply allows an exception to the criminal law such that a physician who “aids or abets a person to commit suicide,” or kills the patient directly, is not necessarily guilty of an offence.

“Safeguards,” promised to be “stringent” and “rigorous” by the original B.C. trial court, are supposed to prevent abuse. This promise of transparency would indeed recognize some of the most compelling concerns about euthanasia going on in Belgium and the Netherlands. There, some disabled infants and psychiatric patients are now being killed by injection.

Remember that the Carter ruling requires only that the applicant for assisted suicide be a competent adult who describes their illness or disability, either physical or mental, to be grievous and intolerable. The Supreme Court left itself in the position, if its logic were to be followed, of not really being able to say “no” to anyone, dying or not, who prefers death over receiving therapy or coping with some other life situation.

It remains for future courts to decide exactly which life situations are to be solved by suicide or euthanasia, but the experience elsewhere suggests the answer is “more and more.”

These three points — the wide potential eligibility for state-endorsed suicide created by the Court, the professed need for rigour and transparency, and the wise absence of compulsion for any individual doctor to be involved in such a practice — give us direction.

Death-seekers who think they fit within the Court’s wide scope of eligibility could — themselves — notify a judge who would ensure that the Supreme Court’s instructions were going to be honoured. The requirement for a court order would ensure that alternatives to suicide had been effectively presented to the person and that the possibility of coercion had been questioned. With medical input, courts now routinely determine mental competency to write a will. It would seem even more important that a court create a transparent public record of someone’s competency and eligibility to engage the state to end their life.

Many Canadians want access to conscientious doctors who want nothing to do with assisted suicide or euthanasia.

Once the state, through the court, endorses a particular suicide, it would be the state’s responsibility to provide that “service.” No particular doctor would be compelled to provide it or coerced to refer for it. In fact, it would be wise to keep the “service” clearly separated from our usual places of treatment. The public should not have to worry for themselves or their loved ones in a hospital. The shadow of assisted suicide and euthanasia should not fall on our medical system any more than the law has suddenly required. Self-referral to a judge might be one route to this goal.

The Canadian Medical Association (CMA) is now consulting its members on these issues. Some influential academics want to force objecting doctors to override their conscience and judgment by referring their patients into whatever assisted suicide regime emerges in 2016. In effect, these euthanasia advocates are proposing to exclude doctors who oppose assisted suicide and euthanasia from the practice of medicine. This may seem despicable, but it is not impossible. Sadly, we are now in the “harm reduction” phase of Canada’s assisted suicide adventure.

Many Canadians want access to conscientious doctors who want nothing to do with assisted suicide or euthanasia. The CMA committed itself to respecting doctors’ conscience rights last year. As this year’s CMA General Assembly approaches, I and many of my fellow CMA members are hoping the wind will not blow our organization off course.