We mourn the death of Dr Balfour Mount

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Balfour Mount

Katrine Desautels reported for the Canadian Press on September 30 that Dr Balfour Mount, the Father of Palliative Care in Canada, died on Thursday September 25 at the palliative care unit that bears his name at the Royal Victoria Hospital in Montreal. Mount was born on April 14, 1939. Desautels reported that:

Dr. Mount was born in Ottawa. He studied medicine at Queen’s University in Ontario, then specialized in urology at McGill University in Montreal and in surgical oncology at the Memorial Sloan Kettering Cancer Center in the United States.

Balfour Mount and Cicily Saunders

Desaults explains how he became the father of palliative care:

In the 1970s, Dr. Mount traveled to the United Kingdom to learn more about end-of-life care, notably from Dr. Cicely Saunders, who created the hospice movement, which is in some ways the basis of the palliative care we know today.

Upon his return in 1975, Dr. Mount founded the world’s first comprehensive palliative care unit at the Royal Victoria Hospital of the McGill University Health Centre.

The following year, he established the McGill University Biennial International Congress on Terminal Care, which he chaired until 2004.

He continued to be closely involved with McGill University in the 1990s, notably by becoming the Eric M. Flanders Chair in Palliative Medicine and then the founding director of McGill’s Holistic Care Program.

Today, his legacy in the field of palliative care is undeniable. According to the Canadian Medical Hall of Fame, in 2015, 67 per cent of acute care hospitals with more than 50 beds in North America had palliative care teams.

Balfour Mount Canada Post stamp

Balfour Mount commented on euthanasia (MAiD) in an interview for Palliative Care McGill. Devon Philips published the following:

Q: You have explained the demands and rewards in setting up palliative care services and how our healthcare system is currently failing to support the implementation of palliative care in many instances. Now the bill permitting medial aid in dying has been passed.  What would you say to people who support medical aid in dying?

A: The first thing I would say is that the very name of that intervention, “medical aid in dying”, is misleading rhetoric. Medical aid in dying is what I have been doing for 50 years. This bill is not talking about medical aid in dying really, it is not talking about ending the suffering, but instead, ending the sufferer. We are talking about legalizing killing people. We have to be clear what this is. I am totally in favour of medical aid in dying. I have spent my professional life working toward that end. But, I do not support euthanasia and assisted suicide.

Q: Can you talk about what you mean by medical aid in dying.

A: The chartered accountant that I admitted on the palliative care unit is an example that comes to mind. He came in with his wife. He had advanced cancer. They were lovely, articulate people and a devoted couple with two adult sons. She said, “I’ll speak for my husband because he has suffered terribly, he is so tired and we really want this to end.” I said, “I am glad you are here, give me a few days to get to know what this suffering is about and then let’s sit down again.” Later that afternoon, after his wife had left the PCU, I went to his bedside for a visit and after chatting for a while said “You know, I don’t see you as a person who wants to die. I see you as a person who wants to live but without the discomfort you have had”, and then this man in his late 50s started to cry. He said, “You are right but I don’t want to be a burden to my wife,” to which I responded, “It can be a big job to care for people at home, but that’s why we have a Palliative Care Unit. Your wife and your sons can come in when they feel up to it. You are not a burden for us. You are why we are here.” His comfort levels and quality of life were superb within a day or two. There was no more talk about his desire for death. There was talk about what interested him and the sources of his quality of life. We had removed his fear of being “a burden”.  Every time I see the words “medical aid in dying”, I think of him. Medical aid in dying was what this gentleman received, but it was certainly not euthanasia or assisted suicide.

Barbara Kay, in her article, Euthanasia is Killing, that was published in November 2014, commented on Balfour Mount's opposition to euthanasia by writing:

Dr. Mount’s passionate disdain for the medicalization of euthanasia remains undimmed. Calling euthanasia “medical aid in dying” is a “cowardly distortion of language,” he said. The dying do not want to be killed; they want an “easy death,” and “that is what palliative care gives them.”

CBC news reported Dr Mount as stating at a Physicians Alliance for the Total Refusal of Euthanasia conference in May 2013 that:

"Euthanasia and physician-assisted suicide makes it necessary for a society to legalize killing — ending life. It's a switch in goals," he told a crowd that gathered in downtown Montreal on Saturday to unite against the practice.

Dr Mount, in his reflections in Le Devoir on February 1, 2010 wrote:

The last weeks of life are "the most precious time of family life" because this is when people resolve the unresolved cases where we can say the love and attachment that is brought to the family. "This is an important moment of sharing that can soften the death of the person who is dying and who can make the next 40 years calmer and happier for those who survive. This time holds tremendous potential that is lost if the person were euthanized,"

Dr Ferrier, Balfour Mount award

I am fortunate to have had the opportunity to meet and speak with Dr Mount on a few occasions. The Euthanasia Prevention Coalition, several years ago, created the Balfour Mount award that we have given to many deserving people.

Balfour Mount was a sign of hope for our times. We need to listen to and learn from his wisdom and experience. 

We mourn his death, but we also mourn that our country did not follow his path of providing care and rejecting killing.

Euthanasia (MAiD): Nothing about this felt OK.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Ferrukh Faruqui is a Ottawa physician and freelance writer who wrote an essay examining how expanding eligibility for medical assistance in dying (MAiD) to those with non-terminal conditions is throwing the medical community into civil war. Faruqui's article was published by the National Post on April 1, 2022.

Dr Faruqui begins her essay by writing about the death of Alan Nichols, who died by MAiD in July 2019. Faruqui interviews Alan's brother Gary and sister-in-law Trish who maintain that Alan was not of sound mind and not terminally ill, nonetheless he died by MAiD.

Faruqui writes:

Alan was once “a bloody great goalie,” says Gary. But he faced a lifetime of challenges after his first brain surgery for a benign tumour at age 12 left him with a weak right side and hearing loss. Step by step, he learned to grasp a pencil and write with his left hand before completing high school.

Alan gave up hockey and picked up a Pentax camera instead. He became a loner who shot film, including beautiful prints for his parents’ silver wedding anniversary. He worked for years as a janitor before things got bad.

As an adult, he depended on his family for emotional as well as practical support. Once, when he didn’t show up for dinner and refused to open his door, they called a locksmith. When they rushed inside, they found him waiting in bed. “I knew someone would show up,” he said.

He was suspicious of authorities, refusing to accept his disability cheques. The family tried unsuccessfully to obtain guardianship over his affairs. His brother, Wayne, picked him up weekly to buy groceries and do his banking.

In June, alerted by his neighbour, Sharon, RCMP officers found Alan dehydrated and delirious. They quickly transported him to the hospital, where he was admitted under the Mental Health Act. Gary flew out to Chilliwack immediately. He was concerned but figured things would play out as usual — it wasn’t the first time Alan’s baseline depression plummeted and landed him in hospital. But he always got better, returning to his small, sparsely furnished condo, where Sharon kept an eye on him.

Alan & Gary Nichols

Faruqui explains that after entering the hospital, Alan stayed in the psychiatric unit for 5 days and was then released to the regular ward but uncharacteristically, this time Alan refused to speak to his family.

After five days in the psychiatric unit, Alan was discharged to the regular ward. Uncharacteristically, he refused to see or speak with his family. When reached by phone, staff assured them he was improving. On July 22, a doctor called Gary to say that Alan was scheduled to die in four days by medical assistance in dying.

Gary started to cry. How could a suicidal man who’d been involuntarily admitted be eligible for MAiD? He wasn’t facing imminent death. Despite the family’s pleas, the hospital insisted this was Alan’s decision, that his medical records were confidential, and they were lucky that Alan had grudgingly agreed to let them know.

A few days later, Gary and Trish, who’d spent decades helping Alan live, watched him die.

Faruqui explains that the family were not provided with answers to the decision to approve Alan's death.

A year later, despite getting legal advice and pressing the hospital and coroner for answers, they’re no further ahead. The Fraser Valley Health Authority told them the law doesn’t require patients to be actively dying to be eligible for MAiD.

Gary’s not a rich man and lawyers are expensive. He says he’s haunted by how families are shut out of these crucial decisions. He says Alan could have lived longer, that the system erred terribly. When he called Wayne to tell him what happened, Wayne was stunned.

“They killed our brother.”

Faruqui writes:

Gary Nichols’ grief demonstrates the heartache medical assistance in dying can inflict on family members. For many doctors like myself who’ve sworn to uphold life, decriminalizing the deliberate act of ending a patient’s life is an ethical turning point that’s transformed the very nature of the profession.

Faruqui explains how Canada's euthanasia (MAiD) law came to be. How the Supreme Court struck down the prohibition on euthanasia and assisted suicide. How the government passed Bill C-14 in June 2016. How the Truchon case, challenging the "terminal illness" requirement in the law was heard and decided in Québec, and how the current government expanded euthanasia (MAiD) by passing Bill C-7 in March 2021, a bill that removed the "terminal illness" requirement, eliminated the 10-day waiting period for terminally ill people and approved euthanasia for mental illness alone. She continues:

For millennia, it’s been taboo for doctors to kill their patients. In many places it still is. As western societies hurled off the shackles of religious authoritarianism, an ethical void was created. This gap’s been filled by humanist creeds that teach that the greatest good flows from personal independence. This libertarian ideal posits the individual as the master of his universe, however lonely that universe may be.

Dr Sonu Gaind

Faruqui writes that many physicians who oppose MAiD are silent for fear of repercussions, but now the issue has moved to euthanasia for mental illness putting psychiatrists on the line. She interviews Dr Sonu Gaind, a psychiatrist who doesn't oppose euthanasia in general but opposes euthanasia for mental illness. She writes:

Dr. Sonu Gaind is troubled, too. A professor at the University of Toronto, he’s not a conscientious objector. In fact, at the Humber River Hospital where he’s head of psychiatry, he’s the physician chair of the MAiD committee. He emphasizes that he’s speaking on his own behalf as an individual psychiatrist.

Pretending there’s no difference between physical as opposed to mental illness for the purposes of MAiD borders on “delusional,” he says. He can’t fathom why the statement of the Canadian Psychiatric Association, which declares that excluding access to MAiD for mental illness is discriminatory, makes no mention of the troubling suicidality that characterizes untreated psychiatric illness.

Language crystallizes key concepts of sweeping movements that reshape societies. But it can also mislead and flatten knotty issues such as euthanasia. Terms like discrimination and autonomy become missiles, annihilating debate. Offering death to the mentally ill, whose unique symptomatology includes pathological despair, is both illogical and unjust.

Faruqui further explains why Gaind opposes euthanasia for mental illness.

Gaind’s Senate testimony emphasized psychiatry’s essential incompatibility with the “irremediable” element of the MAiD framework. Society should recognize and address this contradiction, he insists. Doing otherwise is an exercise in obfuscation. Cardiologists know how heart disease works. But psychiatry hasn’t elucidated the pathophysiology of depression or schizophrenia. It’s impossible for clinicians to predict prognosis in individual cases, meaning that some who seek death would have gotten better.

He cites metrics that show a demographic divide. Those terminal patients who’ve lived a good life and have the privileged autonomy to choose a “good” death are overwhelmingly white and affluent. Unfortunately, their rights magnify the vulnerability of those who’ve never had a good shot at life. In the Netherlands, those marginalized by poverty and trauma are the ones seeking psychiatric euthanasia. Of these, 70 per cent are women. Gaind says these sad, lonely individuals need suicide prevention, which costs time and money and is mostly unavailable. Instead of the “right to die,” he wants to legislate the “right to live.” As for personal choice, he calls it a cruel fallacy. Guaranteed access to death in the setting of absent mental health treatment is no choice at all.

“You shift to MAiD to avoid a painful death — then you shift to MAiD to avoid a painful life. It’s like a Jenga tower — when you pull out one block, the tower comes tumbling down. It’s all connected.”

Faruqui writes that Gaind has now been suspended from the Canadian Psychiatric Association, a group the he is a past President, based on his opposition to their support for euthanasia for mental illness.

Faruqui then writes about the euthanasia death of Arthur Cole.

Jayde Curts’s long hair frames her sombre face. One November afternoon in 2020, she sat alone in her London, Ont., living room, cut off from the rest of her family. She heard the clock strike one. She remembers thinking, “I guess my grandpa’s dead now.”

She refused to attend his scheduled death by MAiD. She says her mother wouldn’t discuss it afterwards, while her grandmother isolated herself and refused to talk about it. Jayde says it didn’t feel right.

“Nothing about this felt OK,” she says. “It felt like putting a dog down.”

Her grandfather, Arthur Cole, was in his 80s. During surgery for thyroid cancer, doctors discovered it had spread. After being discharged home with a tracheostomy and without home care, his elderly wife had trouble managing the breathing tube. When the cancer spread to his brain, he requested home palliative care but was told it wasn’t available. Instead, a doctor offered to make a house call to administer MAiD.

Jayde says that her grand father did not receive the care that he needed and the decision has divided her family.

His granddaughter says Arthur worried aloud about burdening his family. Post-surgery, breathing through a tube, Jayde questions his psychological competence to make the critical decision to end his life.

“You read about this in the news. But it’s shocking when it happens to your family,” she says. She’s paid a heavy price for her outspokenness. She no longer speaks to her mother or her grandmother. She regrets the estrangement but stands by her conviction that the medical system blundered badly.

“They played on his emotions … He was vulnerable and it feels like they took advantage of him,” she says. She wonders why the health system offered death instead of help. She wants people to hear Arthur’s story so other families can speak up, too.

Faruqui then interviews Dr Balfour Mount the father of palliative care in Canada, who trained under Cicily Saunders, who developed modern palliative care. Faruqui writes:

Dr. Balfour Mount is the retired father of Canadian palliative care...

“Total pain” encompasses suffering across dimensions, especially the spiritual, where conventional medicine falters. Palliation supports patients through the arc of incurable conditions such as multiple sclerosis and heart failure. Mount believes the simple act of being present soothes existential pain and chases dread away, that once we slow down to appreciate each moment, the end of life holds infinite potential for joy. He once explained, “When pain and other symptoms are controlled, there really is limitless potential for quality of life at the end of life. … It’s not about ending things; it’s about the present moment. That’s all that any of us have — is just now. And, it turns out, that there’s endless potential in the present moment.”

Mount does not support (MAiD) euthanasia.

He calls MAiD a euphemism that confuses the public and muddies both the benefits of palliative care and the reality of euthanasia. He’s endorsed a joint statement by the Canadian Society of Palliative Care Physicians and the Canadian Hospice Palliative Care Association that rejects conflation of the respective practices, which are distinct in philosophy and intent. The latter exists purely to hasten death, while the former focuses on enhancing life.

Faruqui then speaks to Dr Leonie Herx, the past President of Canadian Society of Palliative Care Physicians, who lives in Kingston. Farququi writes:

“We’ve come so far in palliative care,” she says, adding that many patients either fear palliation will accelerate their deaths, don’t realize MAiD is a lethal injection, or both. She laments that even colleagues don’t appreciate how effective early palliation can be. Because of its absence from the conversation, too many patients opt for MAiD instead.

Herx has presented before parliamentary committee's and laments the quick expansion of MAiD. But not without a cost. Faruqui writes:

She’s withstood relentless attacks on her professional integrity by other physicians. She’s weary, despairing even as she wades into dangerous waters, citing hospital colleagues who complain they’re pressured, even bullied into going along with policies that trouble them. Doctors across the country call her to report that some MAiD providers refuse to assume transfer of care as the “most responsible physician,” thereby implicating them in a practice they are philosophically opposed to. Some institutions, perhaps lacking sufficient MAiD providers, even expect the MRP-conscientious objectors to conduct the initial MAiD assessment. All worry about professional ramifications. Some who’ve voiced doubts about MAiD in certain clinical scenarios have been called obstructionist, of trying to block access to a legal service. There’s no protection for whistleblowers. She knows of many doctors who’ve left the specialty or retired early. Her colleagues know of more. Some have left medicine for good. But they’re not talking. Few were willing to speak to me.

Herx is concerned that the pressure to participate in MAiD may cause her to leave medicine.

Herx warns that the implications of C-7, which expands MAiD from terminal to chronic conditions, will fan out to involve doctors across specialties. This tightening of the moral screw will likely precipitate more departures from the profession. With effective referral, mandated in only two provinces — Ontario and Nova Scotia — the pressure on these doctors to participate may become unbearable.

She describes the loss of moral integrity, “which is how we keep our resilience in medicine.” Dispensing with medical care to offer MAiD amps up moral distress. Herx speaks almost dispassionately about how she might have to quit medicine to avoid complicity.

Faruqui then interviews Dr. Karen Ethans who directs the Spinal Cord Unit at Winnipeg’s Health Sciences Centre, who says that she has seen patients being counselled to die by MAiD.

“My biggest concern,” she says, “is that people can’t initially see what their quality of life will be once they’ve adapted to their injury.”

It takes six months just to get out of the hospital, to go through denial and grief. Then comes vocational rehabilitation. Patients on ventilators within a week of injury are sometimes told their quality of life as quadriplegics will be poor, to turn off their breathing machines. One young man’s weeping mother followed Ethans outside the intensive care unit, looking for hope. Four months later, her son walked out of the hospital.

“Why does it have to be doctors involved in giving death serums?” she asks. Many of her colleagues are angry. They believe doctors should not be doing this work.

Faruqui continues her essay by speaking to the Nichols family again about the death of their brother Alan.

After the numbness wore off, the hurt set in, uneasy layers roiled by a gathering rage. Gary says that Alan wasn’t of sound mind, that his case warrants a thorough review. He’s bewildered by how patient confidentiality can trump common sense, bypassing grieving families in life-and-death scenarios such as MAiD.

Each institution they’ve appealed to for a review of Alan’s case denies jurisdiction. That includes the RCMP, the coroner’s office, the provincial and federal ministries of health and B.C.’s College of Physicians and Surgeons. Doors keep slamming shut. “They Ping-Pong you” back and forth, he says.

Faruqui then interviews Dr Stefanie Green, the President of the Canadian Association of MAiD Assessors and Providers (CAMAP) who clearly supports euthanasia and all the changes associated with the law.

Faruqui then tells the story of Elizabeth (71) a retired teacher in the United States who has lives with chronic pain for 30 years. Faruqui explains:

Elizabeth lays it out for me. She confesses that although she’s a devout Catholic, she plans to seek MAiD once her pain becomes unbearable, or she loses her independence. It’s not that she wants a doctor to put her to death. It’s that she has no other choice. She can’t move to the U.S. because, among other things, she’ll lose her pain specialist. And she can’t ask her son to upend his life for her. She says she’s a member of the growing ranks of the forgotten elderly, dismissed because they’re no longer productive.

“Rights don’t apply to us,” she says. “Our lives are cheap because we’re non-contributors.”

The inequalities in society scare her. She won’t use her real name because she hasn’t told her son yet. He’s an only child. She doesn’t want him to feel abandoned.

Faruqui then interviews Dr Sandy Buchman, a past President of the Canadian Medical Association, a palliative care physician and a (MAiD) provider. Buchman explains that with the passing of Bill C-7 he will limit his euthanasia practise to people who are terminally ill.

Faruqui continues her essay by speaking with Dr Natalia Novosedlik who opposes euthanasia but did refer a patient against her conscience. Faruqui writes:

“I oppose euthanasia in any case.” She says there’s a human need for contemplation, that this bill has been “rushed.”

She pauses. “Sometimes a picture is painted of MAiD being beautiful. The cases I saw — one involved pronounced social isolation — these deaths were not beautiful.”

She felt cornered by a patient who refused symptom management and insisted on a MAiD referral. Although he ultimately died naturally, she was terrified that every new patient would request MAiD. The anxiety was unrelenting.

“I knew I couldn’t do this again, it was so emotionally draining,” she says, so after the birth of her second child, she didn’t return to work.

When care coordination came up, many doctors asked to be taken off the list of providers and assessors. She feels guilty about pulling back, leaving patients to suffer. She hopes to eventually resume practice in a different field.

Faruqui then interviews Dr Mark D'Souza, who stopped being a palliative care doctor after euthanasia was legalized because of the pressure to participate in MAiD.

He couldn’t square his conscience with MAiD, a term he pronounces “Orwellian,” a form of “doublespeak” that’s critical to what he describes as the marketing of death. He calls such terms euphemisms for what’s really going on, which is “killing our patients,” so he settles for euthanasia, a less inflammatory term. He’s convinced that doctors have lost their way, that the radical left has taken over the profession. There’s an embargo on debating, much less opposing MAiD. He’s not sanguine about the profession, saying we “aren’t leaders anymore.

Dr. Viren Naik, the medical lead for Ottawa's Hospital's MAiD team admitted that only 5 of the 30 euthanasia providers are willing to participate in MAiD for people who are not terminally ill.

He describes how medically and ethically complex these patients are, and how emotionally taxing for clinicians, who question whether their MAiD requests are driven by underlying illness or vulnerability. He predicts that this exquisite challenge, what he terms “a grey area of practice,” will become more fraught once psychiatric MAiD is factored into the mix.

One MAiD providing doctor, who wished to remain anonymous, told Faruqui that research needs to be done on the effect of MAiD on the providers.

As Faruqui is closing her essay she states:

The doctors I spoke to are driven by altruism. Their compassion is compelling. But a number of MAiD providers refuse to offer death to those who aren’t dying. Personal autonomy as the overriding principle in this discourse overlooks the reality that state-sanctioned MAiD is not an autonomous act; involving doctors sanitizes it, makes it more palatable for everyone: lawmakers, patients, and society.

Faruqui quotes from Dr Herx who sees the changes in law as causing a schism in healthcare.

In the headlong rush to satisfy the individualistic need for control, we’ve glossed over MAiD’s practical, philosophical and moral harms. We’re on the cusp of sanctioning the deaths of the most helpless members of society — the mentally ill, children and the elderly — instead of caring for them. That existential nadir, when we’ve outlived our usefulness, is exactly when we should not, cannot abandon each other.

Faruqui ends her essay as she began it, with the Nichols family. Gary Nichols, Alan's brother states:

His family’s faced roadblock after roadblock. But they’re pushing on. The RCMP have opened a new case file. The Nichols family is angry at the way Alan — in equal measures volatile and vulnerable — was dispatched to death. They’re furious at the doctors who approved MAiD and the politicians who enacted the legislation that permits it. He says a lot of people care about this issue, but “so far, there’s been no accountability.” They’re fighting for safeguards to prevent the abuse of patient confidentiality by the profession.

If all else fails, Gary’s considering posting a YouTube video to warn complacent Canadians what can happen to them or their families under Bill C-7.

“We can’t save Alan now, Alan’s gone,” he concedes. “We’re trying to make some noise here to prevent other families going through this.”

Thank you Dr Ferrukh Faruqui.

The Treasure of Palliative Care – a video series

The Treasure of Palliative Care - a video series Link to the PDF English version.

Press Release

The Treasure of Palliative Care – a video series

There is always a better option than euthanasia

A Quebec perspective for a better understanding of palliative care

Montréal, CANADA – September 9, 2021 – The Living with Dignity citizen network (LWD), founded in 2010 in advance of the debate on the issue of "dying with dignity" in Quebec, is officially launching The Treasure of Palliative Care video series today.

Since 2015, the Canadian province has been the first jurisdiction in the world to propose euthanasia as end-of-life care, known as medical assistance in dying. "In this context, a Quebec perspective on the many benefits of palliative care is particularly pertinent and we wanted to share it internationally. It is becoming increasingly clear to us that there is always a better option than euthanasia," said LWD’s president Alex King.

Produced in English and French, the 10-minute video The Treasure of Palliative Care answers six essential questions to help you better understand this form of care whose name "palliative" was coined in Montreal in 1973 by Dr. Balfour Mount. In addition to the brief answers provided by two Quebec experts in the field, Dr. Golda Tradounsky and Dr. Patrick Vinay, six additional videos explore the following questions in greater depth:  

• Is palliative care only for people dying of cancer? 
• Where can we receive palliative care? 
• Does palliative care hasten death? 
• Does morphine cause death? 
• Should pain be part of the end of life?  
• Is medical assistance in dying (term used in Canada for euthanasia) part of palliative care?

Directed by Bruno Olivier and hosted in English by Angela Barrett and in French by Claudette Lambert, The Treasure of Palliative Care is available on the LWD Facebook page as of today (https://www.facebook.com/vivredignite/videos/560224695177761) as well as on YouTube via the https://vivredignite.org/treasure page.

A pre-launch of the video took place during the summer vacations on the occasion of LWD's participation in the Select Committee on the Evolution of the Act Respecting End-of-Life Care on August 9, 2021. This Quebec parliamentary commission is studying the potential extension of medical assistance dying (1) to people who have a mental illness as their only medical problem or (2) to those in a situation of incapacity (caused by a neurodegenerative disease such as Alzheimer’s) who have previously signed advance directives. For full details on LWD's participation in this committee, visit https://vivredignite.org/lwd-select-committee-2021.

The Living with Dignity citizen network is active on the following social networks:
Twitter https://twitter.com/Vivredignite
Facebook https://www.facebook.com/vivredignite
LinkedIn https://www.linkedin.com/company/vivredignite
YouTube https://www.youtube.com/channel/UCh3NsKMNpDum-RyhWSV4WzQ

Living with Dignity is a Quebec non-profit citizen network with no religious or political affiliation. Its mission is to promote the protection of the life and inherent dignity of people made vulnerable by sickness, old age or disability, by ensuring an end to their lives that is natural and respectful of the person and their dignity, through compassionate accompaniment.

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To request an interview with a member of the LWD team.

Jasmin Lemieux-Lefebvre
Coordinator, Living with Dignity
info@vivredignite.org

Imagine a world where every hour counts.

This article was published by the Catholic Register on June 30, 2021.

By Charles Lewis

I have thought a lot about euthanasia over the years. I have thought about it too much.

I was at the National Post covering religion and ethics when I first read a story about assisted suicide in Oregon, one of the first jurisdictions to offer such a service. That was about 12 years ago. At the same time polls in Canada were showing a majority of Canadians wanted something similar.

My faith aside, the idea of putting down human beings struck me as something out of the Third Reich. I sensed that if Canada legalized state-sponsored death there would be a huge slippery slope. Unfortunately, I was right.

But one element of this just recently crossed my mind: Legalized euthanasia reveals a society that lacks creativity, imagination and courage. Killing patients is the lazy way out. Because of our own aversion to suffering and death we conclude it’s best handled through a syringe filled with poison. Problem solved.

For centuries medicine was intent on getting better at curing and comfort. And those efforts bore fruit. In the early 1970s, a system of care was developed to deal with those who were terminal. Dr. Balfour Mount of Montreal coined the term “palliative care.” His intent was to provide quality of life up until the moment of death.It affirmed that every hour of life, even the last hours, was important.

What we have now instead is a belief that life in the days, weeks and months before death is meaningless. Instead of finding better ways to help the sick and the dying, we now prefer to snuff out that life before things get messy.

It is easy to blame those politicians who brought in the legislation that made killing patients legal. I’ve done that many times. However, they are able to get away with it because most Canadians think it’s a great idea.

In the five years since the first euthanasia bill was passed it has evolved from a system meant for those near death to one in which pain alone is requirement. In two years, it will be available to the mentally ill. Beyond that my guess is teens will be next.

All of us are going to die. It sounds ridiculously obvious to say that but it’s an absolute reality that most of us never want to give a thought to. To talk about death is considered morbid. Yet, I believe that it is death that haunts all of us. Not so much the act of dying but the fear of what might come first — pain, the lack of independence and loss of dignity.

Over the years I have talked to palliative doctors who have said that it’s the fear of pain rather than pain itself that worries those who are dying. I have dealt with severe and at times crippling pain for years. I’m no hero but I amazed myself in my ability to handle it and even learn from it.

The worry about losing independence and dignity, to me, is off. Many of us will take care of family and friends when they need us most and never judge them because they are no longer as independent as they once were. Nor would most of us think they now lack dignity. So then why is it when we are gravely ill we think we’ll be a burden or lose our dignity if someone helps us?

Those who support euthanasia argue it is their choice and the rest should keep morality out of it. They say they are autonomous but they forget that when they go they will leave behind others who will miss them terribly. And those friends and family left behind will ask themselves whether they could have done more. They will feel guilt.

The truth is, we could have done more. We could have demanded of our leaders first-class palliative care, rather than death as a solution. Why in a rich country is palliative care only available to 30 per cent of those who want it?

Imagine a system in which state-approved suicide would be a last resort not the norm. Imagine what it would be like to know that when our time comes we would be well taken care. In that world we would eventually lose our fear of death. We would see those who are going before us cared in a way that would give us comfort too.

In the meantime science can develop better pain medication. Cancers that once were lethal will more easily go into remission or be cured. The last hours of our life would be just as important as the first hours. Life would be viewed once again as sacred.

Imagine that world.

 

Indiana assisted suicide bill fails to protect objecting practitioners

This article was published by the Protection of Conscience Project on January 16, 2020

Assisted suicide evolves from "assistance" to "medical care" 

Affirmation has serious consequences for objecting Indiana physicians

By Sean Murphy

Introduction

On 7 January, 2020, Representative Matt Pierce introduced HB1020: End of life options in the Indiana General Assembly.1 HB1020 is the fourth assisted suicide bill introduced by Pierce since 2017; three previous bills died in committee without hearings.2,3,4,5,6 Parts of HB1020 relevant to protection of conscience are reproduced on the Project website.7
 
Overview

The bill permits physician assisted suicide for Indiana residents 18 years of age and older who have been diagnosed with a terminal illness likely to cause death within six months. Candidates must be competent to make health care decisions and must apply in writing for a lethal prescription; the application must be witnessed by two independent witnesses. Lethal medication can be prescribed or dispensed by an attending physician after a fifteen day waiting period if the patient is acting voluntarily and making an informed decision.

Neither the attending physician nor any other person need be present when the lethal medication is taken, though the attending physician must tell the patient that someone else should be present. The lethal medication must be self-administered. If the medication does not cause death, no one is authorized to kill the patient. 

HB1020 imposes obligations upon "attending physicians"8 and "consulting physicians"9 and it assumes the cooperation of pharmacists in dispensing lethal medication. There is some ambiguity in the description of what is expected of attending physicians. Section 4(a)(13) makes provision or prescription of lethal medication an absolute obligation if all of the conditions specified in the bill are met (". . .the attending physician shall. . ."). On the other hand, Section 4(c) seems to leave some discretion to the attending physician to refuse, even if the conditions are met (". . . the attending physician may . . ."). A later protective provision indicates that an attending physician can refuse, but the ambiguity in the wording of Section 4 remains.

Protective provisions: biased, insufficient and conflicting

The bill makes no reference to freedom of conscience or religion, but Section 12 offers some protection for "health care providers."

Under Section 12(d) a hospital (health care provider) can prohibit physicians (individual health care providers) from participating in assisted suicide on its premises, and, provided it has notified them in advance, can take action against those who defy the prohibition. This would seem to be broad enough to include a prohibition against assessing patients and arranging for assisted suicide elsewhere.

However, Section 12(e) pits health care "facilities" against health care "providers." A facility cannot prevent a physician from "providing services consistent with the applicable standard of medical care." This includes at least providing information about assisted suicide, being present at a suicide, and referring a patient for assisted suicide. What is not clear is whether or not this includes doing so on the facility's premises, notwithstanding a facility prohibition of participation in assisted suicide.

Unfortunately, HB1020 does not explain the distinction between a health care "provider" and a health care "facility." And while the Indiana Code defines both terms, it offers three different definitions of "health care facility"10 and five differing and very lengthy definitions of "health care provider."11 The latter can include individuals (thus covering attending physicians) but also health facilities and incorporated entities. This further complicates interpretation of Section 12(e).

Section 12(a) provides immunity against professional, criminal and civil liability, but only for those who prescribe or dispense assisted suicide medication or are present when it is taken. Those who refuse are unprotected. The bias in favour of assisted suicide practitioners and disadvantage imposed upon those unwilling to provide the service is obvious.

Section 12(b) protects both health care providers who participate and those who refuse to participate in assisted suicide against private disciplinary or punitive actions by professional associations, organizations and other health care providers. It offers the same protection for health care providers who provide "scientific and accurate information" about the service - but not those who refuse to do so.

Section 12(c) states that a health care provider cannot be required to participate in "the dispensing or providing of medication", but this does not clearly protect objecting physicians from demands that they do everything but dispense or prescribe lethal drugs.
Assisted suicide evolves from "assistance" to "medical care"

In 2017, HB1561 Section 12(a) described participation in assisted suicide as "provid[ing] assistance in the completion of a request for medication." It granted professional, civil and criminal immunity to those providing "assistance."

The following year, HB1157 Section 12(a) used the same phrase to describe participation. It conferred immunity upon those providing such "care."

In 2019, HB1184 Section 12(a) evolved further, so that participation in assisted suicide is described in HB1020 as the provision of "medical care," including prescribing or dispensing lethal medication and being present at a patient's suicide. The addition of Section 12(e) in HB1020 reflects and reinforces this evolution when it refers to participation in assisted suicide that conforms to "the applicable standard of medical care."

Now, in 2019 the American Medical Association (AMA) reaffirmed its rejection euthanasia and assisted suicide as contrary to medical ethics,12 so the AMA would presumable reject the bill's supposition that there can be a "medical standard of care" for either procedure. In this respect, the author of HB1020 may be looking to a future in which a medical standard of care is developed as a result of the legalization of physician assisted suicide.

When assisted suicide becomes "medical care"  

Seven Canadian physicians have described what that future looks like.

"For refusing to collaborate in killing our patients," they write, "many of us now risk discipline and expulsion from the medical profession," are accused of human rights violations and "even called bigots."13

How did this come about?

An important part of the explanation is the Canadian Medical Association's (CMA) classification of assisted suicide and euthanasia as "therapeutic service[s]"14 and "legally permissible medical service[s]."15

Since there is no dispute that physicians have a professional obligation to provide or arrange for therapeutic medical services for their patients, the change in CMA policy implicitly made participation normative for the medical profession (and, by extension, for other health care workers and institutions). From that perspective, as the Canadian physicians note, refusing to provide or arrange for euthanasia and assisted suicide services for legally eligible patients "became an exception requiring justification or excuse." Hence, discussion in Canada is now largely about "whether or under what circumstances physicians and institutions should be allowed to refuse to provide or collaborate in homicide and suicide."13

The seven Canadian physicians authors can't be dismissed as outlying cranks. Almost 60 Canadian physicians from across the country endorsed the article, which appeared in the World Medical Association's professional journal. Signatories included a Canadian Medical Hall of Fame member known as the father of palliative care in North America,16,17 a member of an expert advisory group on euthanasia and assisted suicide convened by Canadian provinces and territories,18 and a regional director of palliative care who resigned when a health authority demanded that objecting hospices permit euthanasia and assisted suicide on their premises.19

Thus, in the long term, statutory affirmation that assisted suicide is not only permitted but is a form of "medical care" would likely have serious adverse consequences for objecting Indiana physicians.

Notes

1. US, HB 1020, End of life options, 121st Gen Assembly, 2nd Reg Sess, Ind, 2020 [Internet]. Indianapolis: Indiana General Assembly; 2020 Jan 7 [cited 2020 Jan 14].

2. US, HB 1561, End of life options, 120th Gen Assembly, 1st Reg Sess, Ind, 2017 [Internet]. Indianapolis: Indiana General Assembly; 2017 Jan 23 [cited 2020 Jan 14].

3. US, HB 1157, End of life options, 120th Gen Assembly, 2nd Reg Sess, Ind, 2018 [Internet]. Indianapolis: Indiana General Assembly; 2018 Jul 1 [cited 2020 Jan 14].

4. US, HB 1184, End of life options, 121st Gen Assembly, 1st Reg Sess, Ind, 2019 [Internet]. Indianapolis: Indiana General Assembly; 2019 Jul 1 [cited 2020 Jan 14].

5. Hussein F. Indiana lawmaker proposes assisted suicide bill. Indianapolis Star [Internet]. 2018 Jan 4 [cited 2020 Jan 14].

6. Arthur V. Assisted suicide legislation stalls in Indiana. Today's Catholic (Fort Wayne, IN) [Internet]. 2019 Apr 4 [cited 2020 Jan 14].

7. Indiana: House Bill 1020 (2020): End of life options [Internet]. Powell River (BC): Protection of Conscience Project; 2020 Jan 14 [cited 2020 Jan 14].

8. "'Attending physician' means the licensed physician who has the primary responsibility for the treatment and care of the patient. For purposes of IC 16-36-5, the term includes a physician licensed in another state." IN Code § 16-18-2-29 (2018) [Internet]. Mountainview, CA: Justia [cited 2020 Jan 14].

9. The term is undefined, so it appears to refer to any licensed physician.

10. For "health care facility" see IN Code § 16-18-2-161 (2018) [Internet]. Mountainview, CA: Justia [cited 2020 Jan 14].

11. For "health care provider" see IN Code § 16-18-2-163 (2018) [Internet]. Mountainview, CA: Justia [cited 2020 Jan 14]

12. Frellick M. AMA Reaffirms Stance Against Physician-Aided Death. Medscape [Internet]. 2019 Jun 11 [cited 2020 Jan 14].

13. Leiva R, Cottle MM, Ferrier C, Harding SR, Lau T, Scott JF. Euthanasia in Canada: A Cautionary Tale. WMJ 2018 Sep [cited 2020 Jan 14]; 64:3 17-23.

14. Doctor-assisted suicide a therapeutic service, says Canadian Medical Association [Internet]. CBC News; 2015 Feb 06 [cited 2020 Jan 14]. Emphasis added.

15. CMA Policy: Medical Assistance in Dying [Internet]. Canadian Medical Association; 2017 May [cited 2020 Jan 14]. Emphasis added.

16. (Dr. Balfour Mount). Phillips D. Balfour Mount [Internet]. Montreal (Quebec): McGill University; 2016 May 03 [cited 2020 Jan 14].

17. The Canadian Medical Hall of Fame. Dr. Balfour Mount, 2018 Inductee [Internet]. [cited 2020 Jan 14].

18. (Dr. Nuala Kenny). Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying. Final Report [Internet]. Toronto (Ont): Government of Ontario, Ministry of Health and Long Term Care; 2015 Nov 30 [cited 2020 Jan 14].

19. (Dr. Dr. Neil Hilliard). Fayerman P. Delta hospice rebels against Fraser Health's mandate to provide medical assistance in dying [Internet]. Vancouver Sun; 2018 Feb 06 [2020 Jan 14].