Tom Koch: Euthanasia is legal in Canada but that doesn't make it ethical.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Delta Hospice Society in BC was recently told by Adrian dix, the BC Minister of Health, that they must start doing euthanasia by February 3 or loss provincial funding. In response to this dilemma Dr Tom Koch, a consulting medical ethicist and gerontologist and author of the book Ethics in Everyday Places, wrote an opinion article that was published in the Globe and Mail on January 6.

• Sign the petition: Hospice Organizations Must NOT be Forced to do Euthanasia (Link).

Koch begins:

Because something is legal doesn’t mean it is ethically acceptable or, in medicine, clinically appropriate. The debate swirling over the Delta Hospice Society’s refusal of medical termination, “medical aid in dying” (MAID), in its beds is an example.

Diagnosed with terminal cancer, Clint Gossard, 59, hoped for a bed at the society’s 10-bed Irene Thomas Hospice in Delta, B.C. But he also wanted what they refuse to permit: medical aid in dying. For that, he had to go to Delta Hospital where his life was ended last January.

His widow and MAID advocates found that unacceptable. As a result, B.C. Minister of Health Adrian Dix has threatened the society’s funding if they don’t permit medical termination on their premises. Hospices I know elsewhere are similarly under pressure.

Koch explains that assisted dying is not part of hospice or palliative care. He writes: 

Speaking for the Delta Hospice Society, its founder and former director, Nancy Macey, argued not only that MAID violates the hospice’s constitution but the goals of palliative and hospice care. The society’s position is shared by many including those, like me, who are at best agnostic. Instead, it follows the guidelines in this area.

In November, 2019, for example, the Canadian Hospice Palliative Care Association (CHPCA) and the Canadian Association of Palliative Care Physicians (CAPCP) issued a joint statement stating categorically that “National and international hospice palliative care organizations are unified in the position that MAID is not part of the practice of hospice palliative care."
Medical aid in dying, they argued, is not an “extension of palliative care” but a violation of hospice and palliative medical goals of care.

Koch goes on to explain that good palliative care is not a simple process:

In its focus on the best of life to the end of life, hospice practice requires an understanding not only of clinical but also psychological needs. I have several times been engaged in discussions with those who wanted to die because of problems, clinical, personal or social, that were then addressed by palliative caregivers. In these cases, “I want to die” was really “I need help with this.”

A simple "it's your choice" removes our opportunity to find and provide the necessities of an acceptable life to the end of a patient's days. It replaces complexity with a simple, “Well, they wanted it” even where the reasons for wanting could be palliated.

Koch concludes by stating that he believes that Mr. Dix’s threat seems to violate the spirit if not the letter of enabling federal legislation that assured the rights of practitioner conscience would be protected.