Euthanasia: Turning physicians into executioners

By Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

Sean Murphy, the administrator of the Conscience Protection Project wrote an excellent article that was published by the National Post on August 20, 2015. In his article: Turning physicians into executioners, Murphy informs readers that the Canadian Medical Association (CMA) are debating the physicians role in euthanasia and assisted suicide at their annual meeting in Halifax next week.

Murphy quotes Dr Jeff Blackmer, the former ethicist with the CMA who called the legalization of assisted suicide the:

biggest change in the medical profession in Canada, maybe in centuries

Murphy quotes Dr Blackmer and past CMA President Dr Louis Hugo Francescutti, who stated while reflecting on intervening in the Supreme Court of Canada assisted suicide case:

One person’s right is another person’s obligation, and sometimes great burden, they wrote. And in this case, a patient’s right to assisted dying becomes the physician’s obligation to take that patient’s life. 

Murphy then focuses on what an obligation to take a patient's life actually means. 

An obligation to kill is distinct from authority to use potentially deadly force; neither police nor soldiers are obliged to kill. Traditionally, an obligation to kill has been imposed only on public executioners, its essence captured by Blackstone’s explanation that if the condemned were not killed by hanging, the sheriff would have to hang him again.

CMA leaders at Supreme Court

Murphy provides an update as to how the CMA changed its policy from opposing assisted suicide to that of regulating assisted suicide.

At the CMA’s 2014 General Council, delegates learned that almost 27 per cent of Canadian physicians were willing to participate in assisted suicide if it were legalized — and 73 per cent were not. This was urged as a reason to adopt a policy of neutrality. The board of directors helpfully sponsored a resolution affirming that, should the law change, the CMA would support physicians who follow their conscience in either providing or refusing to provide medical aid in dying. It was overwhelmingly approved. 

Four months later, the board, citing the resolution, reversed CMA policy by declaring physician-assisted suicide and euthanasia to be end-of-life care. The new policy did not exclude minors, the incompetent or the mentally ill, nor did it suggest restricting euthanasia and assisted suicide to terminally ill patients or those experiencing uncontrollable suffering. 

The board’s Christmas present for the Supreme Court of Canada was a blank cheque. It offered the unconditional support of the medical profession for the legalization of euthanasia and assisted suicide for any patient group, for any reason and under any conditions approved by the courts or legislatures.

Murphy then examines the issue of conscience rights:

What about those ... physicians who utterly reject the claim that physicians are ever obliged to participate in euthanasia or assisted suicide? 

The policy states that they should not be compelled to do so, but adds that there should be no undue delay in providing the services. That is: conscientious objection is allowed only to the extent that it does not interfere with the obligation to kill, more felicitously phrased from the patient perspective as access to services. 

The priority of killing over conscience was a consequence of the board’s decision to adopt a partisan rather than neutral position on medical aid in dying. By accepting the morally contested obligation to kill as normative, CMA directors imposed a paradigm for medical practice and a framework for discussion that’s inherently prejudiced against physicians unwilling to participate in euthanasia and assisted suicide. ...

In March, the board declared that all Canadians who meet the criteria should have access to assisted dying, as with any other medically approved intervention. This was accompanied by strong statements supporting conscientious objection, including refusal to refer for the services. 

By June, these foundational principles had been rewritten to give priority to the obligation to kill at the expense of freedom of conscience. They were incorporated into a draft framework for consultation and presentation at the General Council in Halifax. 

The draft framework proposes that objecting physicians be made to work with others to support equitable and timely access to euthanasia and assisted suicide. ... 

The framework supports conscientious objection, but only to providing euthanasia and assisted suicide, only if refusal does not cause undue delay and only if the physician refers the patient to a third party for assistance and information — whatever that might mean. 

It is abundantly clear that CMA officials favour some form of compulsory referral, not only because they offer no other options, but because their draft framework is erroneous, incomplete and misleading — sometimes seriously so — and every error, omission and misleading statement favours referral. 

Last year, CMA delegates approved a resolution said to be neutral with respect to euthanasia and assisted suicide, which the CMA’s board cited when it approved both and made an obligation to kill part of medical practice. 

This year, delegates will be asked to approve some form of compulsory referral as a middle ground between this contested obligation to kill and freedom of conscience. What is presented as pragmatic middle ground is really an ethical quagmire.

The Euthanasia Prevention Coalition is wants the CMA to reject their support for euthanasia while recognizing physicians conscience rights.