To the Honorable Members of the French National Assembly,
Let me begin with a personal experience. Eight years ago, one of my patients, Jim (a pseudonym), came to see me for a cough, thinking he had a cold. I ordered a Chest X-Ray. According to the radiologist’s report, Jim appeared to have lung cancer. I sat down with Jim and told him, “We need to do a CT scan immediately. You need to see a specialist. We need to do a bronchoscopy…”
Jim replied, “Dr. Saba, I know you’re against assisted suicide, but you know what? I don’t necessarily agree with you. “If I'm going to die, if my time has come...” I replied, "No, no. You need to go through all the steps of the diagnostic process, because this is only a preliminary diagnosis. Even if it is lung cancer, it's a disease that can be treated today. There are new treatments available. It might not even be lung cancer.”
I spoke with the radiologist who had performed the lung CT scan; he told me, “We don’t know exactly what it is. It looks like lung cancer, but it could be lymphoma, which would be highly treatable. ”
Jim is an intelligent, well-informed man, an engineer, who thought he had a cold, only to be told he might have cancer. He could have resigned himself to medical assistance in dying before even knowing what it was, since Canadian law allows a person to refuse all the testing necessary to confirm the diagnosis. He could have lost hope when the situation was still full of hope.
The power to move people to give up is one of the dangerous and misleading aspects of medically assisted dying. However, I was able to get his attention and persuade him that the situation was hopeful and that he should get more tests and undergo treatment. Today eight years after diagnosis, investigations and treatment he is happy to be alive with no further evidence of disease. He was finally diagnosed with Hodgkin’s lymphoma, which is a condition that is highly curable with targeted medical treatment.
A recent Canadian study found that nearly one-third of patients diagnosed with “lung cancer” who died by assisted suicide did not have a biopsy-confirmed diagnosis of lung cancer. Furthermore, they were less likely to consult a radiation oncologist or medical oncologist and less likely to receive treatment. This is what happens when the door is opened to assisted dying.
Since 2016, more than 100,000 Canadians have undergone assisted death —many with years or even decades, to live. What was initially began as an option reserved for terminally ill patients has expanded to include people suffering from chronic illnesses, often with associated mental health issues (psychological distress). The numbers continue to rise each year (Sixth Annual Report on Medical Assistance in Dying). Quebec, the province where I practice medicine, has the highest rate of medical assistance in dying in Canada and the world, accounting for 7.6% of all deaths. (Québec MAiD data).
In 2021, the law was expanded to include people with chronic illnesses and disabilities, in addition to those suffering from terminal illnesses. Those with fragile health are also considered candidates for assisted death.
As a physician, I serve on a committee at one of Canada’s most prestigious medical centers, responsible for reviewing cases of medical assistance in dying. The majority of the cases I have reviewed involve people with medical conditions or disabilities, most of whom have associated psychological and social factors that strongly influence their decision to seek medical assistance in dying. These factors include social isolation, feelings of being a burden, loss of autonomy, and psychological distress. Physical pain is the least common reason. My experience is corroborated by the recent Canadian report on medical assistance in dying. (Sixth Annual Report on Medical Assistance in Dying).
Another of my patients, Rachel (a pseudonym), in her fifties, underwent a screening mammogram followed by a biopsy that confirmed a diagnosis of breast cancer, which was treated surgically. However, traces of tumor cells remained and were growing rapidly. She was advised to undergo chemotherapy and immunotherapy, but she refused out of fear of side effects. She had given up hope and had even stopped eating. Eventually, she was persuaded to undergo treatment, which she ultimately accepted. Rachel has recovered very well: there is no longer any trace of the tumor or metastases. She says that when you have cancer, it can drive you crazy and prevent you from making good decisions.
Ultimately, hope is one of the most powerful forces driving quality medical care. When I say hope is a powerful force for health, I mean that hope inspires us to be patient, to seeing processes through, and to regard every step as part of the great gift of being made for life. Assisted death destroys this hope and leads people to give up on life before their time. For these reasons, I ask you to vote against medical assistance in dying.
Dr. Paul Saba is a Canadian who has practiced medicine in Canada and around the world. He currently practices family medicine in Montreal. He is a co-founder of the Physicians' Alliance against Euthanasia (https://collectifmedecins.org/en/about/) and author of the book *Made to Live* (madetolive.com) +1 514-886-3447
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