Showing posts with label Manitoba College of Physician and Surgeons. Show all posts
Showing posts with label Manitoba College of Physician and Surgeons. Show all posts

Thursday, July 20, 2017

Euthanasia, Conscience and Canadian doctors

This article was published by Physicians Alliance Against Euthanasia on July 16, 2017

In the year since euthanasia became legal, we have witnessed a powerful political push to normalize it as part of medicine in Canada. Yet many doctors remain opposed to the practice. Most would like to see it rigorously limited. And some, for reasons of personal and/or professional conscience, refuse categorically to be part of it.

Unfortunately, our politicians have made it perfectly clear that they intend to ignore the judgement of opposing doctors and to stifle their dissent. In fact, the worst of these politicians are to be found within our own profession.

Consider, as a case in point, the new (2015) College of Physicians and Surgeons of Ontario policy on doctors’ conscience rights.

This CPSO policy is identified as a mere “revised update”, but it actually bears little resemblance to the earlier version (2008).

And it is obvious why this is so: Without ever honestly mentioning euthanasia, assisted suicide, or even MAID, the new policy was designed from the start to facilitate a radical new Orwellian redefinition of “euthanasia”, from homicide to medical treatment. It effectively obliges all Ontario physicians and surgeons to participate in the euthanasia program.

In practical terms:

“Where physicians are unwilling to provide certain elements of care for reasons of conscience or religion, an effective referral to another health-care provider must be provided to the patient.”
This, of course, is the main sticking point for many doctors, who consider referring their patient to any agency of death to be an act just as abhorrent as performing the euthanasia themselves.

But “effective referral” is by no means all. There is also the “duty to inform”:

“Physicians must provide information about all clinical options that may be available or appropriate to meet patients’ clinical needs or concerns.”

“Physicians must not withhold information about the existence of any procedure or treatment because it conflicts with their conscience or religious beliefs.”
Please note the italics: The physician apparently has a duty to inform his patients of all options legally available even if they are inappropriate! And this obligation shall override any moral or professional convictions that physician might hold.

The violence of the obligation to “inform” goes even beyond that of “effective referral” itself. Every patient who fits the criteria for euthanasia must be subjected to the terrible stress and doubt of learning that he or she belongs to that select group of people for whom medically-inflicted death has become an option. And no objection of judgement or of conscience can free the doctor from delivering that terrible message and its implicit suggestion.

In Ontario, then, by proclamation of the CPSO, the doctor’s role is reduced to that of an automatic vending machine which simply displays state-mandated euthanasia options and passively offers corresponding buttons for the patient to push.

Obviously, the scope and impact of such a policy is astounding. Professional judgement is the bedrock of medical practice. Freedom of conscience is the underpinning for our entire system of secular democracy. Both are set aside. The scale of the emergency must be colossal to require such draconian measures!

But, of course, there is no such urgency.

Let us remember that the original euthanasia program was sold to us as an imperative response to a hypothetical terminally ill patient in unbearable and untreatable pain. Let us recall how that extreme, no, that virtually mythical case, was leveraged into all of the totally unrelated deaths that we now apprehend. Once again, a similar strategy is at work. This time, the absolute need for all doctors to promote euthanasia (all the time and to all of their most vulnerable patients), is presented as a required response to the hypothetical possibility of even one patient, desirous to die, but who is frustrated in her wish.

We are asked to believe that any real burden whatsoever, financial, professional, or moral, can be justified in the interest of allowing that one sacred voluntary death. It is a sort of grotesque inversion of the proposition that “no price is too high” provided that “only one child be saved…”. Which becomes in this case: “if only one person might die…”.

Other jurisdictions, no less respectable than Ontario have taken an opposite stance, and there is no evidence that anybody has suffered or will suffer.

Manitoba is in the process of explicitly recognizing the right of non-participation and non-referral of all health professionals and others working in health care. Major hospitals in Winnipeg have announced their refusal to euthanize patients.

In the State of Vermont a judicial battle over similar issues has resulted in an unambiguous victory for doctors’ rights.

And in Ontario, a group of dedicated and courageous doctors launched a court challenge in defense of doctors’ conscience, which was heard June 13-15, 2017.

That judgement will be rendered later this year. Let’s hope our courts get it right this time! But regardless of that outcome, regardless of the timeframe, and regardless of expense; regardless of the legislative efforts that may ultimately be required: This authoritarian policy of the College of Physicians and Surgeons of Ontario is neither necessary nor justified. It is not desirable. It is not even reasonably defensible. It is extreme. And it is irrational. Above all, it is profoundly harmful to individual doctors and patients and to the whole medical profession. It constitutes both an injustice and an embarrassment which cannot be allowed to stand.

Monday, October 19, 2015

Euthanasia lobby pressures College of Physicians of Manitoba to force doctors to refer for euthanasia.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

An article published in the Winnipeg Free Press, today, explains that Dying with Dignity, Canada's leading euthanasia lobby group, is pressuring the College of Physicians and Surgeons of Manitoba to require doctors to refer patients for euthanasia.

The Manitoba College is seeking input concerning guidelines for euthanasia in Manitoba. These guidelines do not require physicians who oppose euthanasia and assisted suicide to refer their patients to a physician who is willing to lethally inject their patient.

According to the Winnipeg Free Press article Shanaaz Gokool from Dying with Dignity is upset that the Manitoba College is not requiring doctors to refer patients for euthanasia:

"There are two main problems with the Manitoba statement," Gokool said. "There isn't a duty to refer and there's also not a duty to provide a patient with information about physicians who would assist with dying.
The article explains that Colleges of Physicians and Surgeons in Manitoba and Alberta are not requiring physicians to refer patients while the Ontario College is requiring physicians to refer.

The Euthanasia Prevention Coalition considers conscience rights for healthcare workers to be of paramount importance.

When physicians have the right to say - I will not kill you and I will not refer you to death - then physicians also have the right to say - I will protect you in your time of need.

Tuesday, June 7, 2011

Living and Dying in Manitoba

Recently, the Council of Canadians with Disabilities and the Manitoba League of Persons with Disabilities held a conference concerning the fact that in Manitoba, the College of Physicians and Surgeons have determined that doctors have the right to withdraw medical treatment without the consent of the person or the person's family.

Link to the Youtube video of the event. http://www.youtube.com/watch?v=5qEI-yqDw2A&feature=share

The presentation features Rhonda Wiebe, Jim Derksen from the Council of Canadians with Disabilities, Dean Richert lawyer and co-chair Council of Canadians with Disabilities - Human Rights Committee, and Valerie Wolbert & Catherine Rodgers - People First Canada.

This is the same power that the physicians in Ontario are seeking in the Rasouli case.

In the Rasouli case, the family sought a court injunction to prevent doctors from withdrawing the ventilator from Mr. Rasouli. Justice Himel decided that the family did not need a court injunction because consent was necessary before the ventilator could be withdrawn, and if the doctors could not attain consent they could bring the case to the Consent and Capacity Board in Ontario.

In Manitoba, the Golubchuk family sought an injunction to prevent doctors from withdrawing the ventilator from Mr. Golubchuk. Once again, the physicians stated that they had the right to decide to withdraw treatment, without the consent of the family.

These decisions are based on the values of the physician, who would have the sole right to decide whether or not the treatment or the patient's life is futile.

This is a very important issue for people with disabilities and other people who's lives are deemed to lack "quality of life." by the physicians.

Thursday, June 17, 2010

End-of-life guide a risk, MPs told

Jim Derksen
The following story appeared in the Winnipeg Free Press today. Rhonda Wiebe and Jim Derksen made a presentation in Ottawa to the Parliamentary Committee on Palliative and Compassionate Care yesterday. The focus of the presentation was the direction Canada needs to go to ensure dignity and equality for people with disabilities in relation to medical treatment and end-of-life care.

Wiebe and Derksen focused on the Manitoba College of Physicians and Surgeons policy that gives the physician the right to determine the level of medical treatment or when treatment will be withheld. This policy has significant ramifications for people with disabilities.

The article stated:
End-of-life guide a risk, MPs told

By Jen Skerritt - June 17, 2010

Giving Manitoba doctors the power to pull the plug on a patient discriminates against disabled people who may fall short of the minimum standards to remain on life-support, local advocates told a Parliamentary committee Wednesday.

Jim Derksen and Rhonda Wiebe, Winnipeg members of the Council of Canadians with Disabilities, said certain policies -- including Manitoba's end-of-life guidelines -- put disabled patients at risk of improper treatment because of common attitudes that "it's better to be dead than disabled." They spoke out in front of a federal palliative and compassionate care committee in Ottawa, and voiced their concerns about legalizing assisted suicide and other inequities in end-of-life care.

Manitoba's medical regulatory body is the first in Canada to introduce guidelines for physicians to follow when dealing with end-of-life issues. They say the minimum goal of life-sustaining treatment is for patients to recover to a level in which they can be aware of themselves, their environment and their existence.

In the event families and physicians don't agree life-support should be withdrawn, doctors have the final say.

Derksen said some patients with cognitive impairment or conditions such as dementia may not be able to articulate that awareness, forcing doctors to make a judgment call. He said there is no objective test or brain scan performed to determine whether a person meets the minimum standard to remain on life-support.

"In other words, if there's too much disability, the patient (does not) meet the minimum goal," Derksen said. "That, to me, is pretty wrong and probably unconstitutional."

His concerns over Manitoba's College of Physicians and Surgeons end-of-life guidelines come just shy of the second anniversary of Samuel Golubchuk's death. The 85-year-old man died in Grace Hospital on June 24, 2008, at the centre of a controversial debate over who should decide when a person is pulled off life-support. Golubchuk's eight-month battle to remain alive pitted a patient's right to continue treatment against Winnipeg physicians who argued continuing to care for the elderly man was "tantamount to torture." They said Golubchuk had no self-awareness and that their decision to terminate support is in no way biased against disabled persons.

The court injunction Golubchuk's children sought to keep him alive died with him, and the question of who gets to decide when someone dies hasn't been fully answered.

Winnipeg Regional Health Authority officials conducted a review of Golubchuk's case to shed light on how to better handle conflict between patients and physicians, but the report is still in draft stages.

A spokesman from the Manitoba College of Physicians and Surgeons was unavailable for comment Wednesday.

Wiebe said she's concerned some medical professionals could be swayed by a common stereotype that living with a disability is "miserable." She said there should be more supports in place within the medical system to ensure disabled patients aren't treated differently. Wiebe said she wants the public to know a disabled person's quality of life is as good as anyone else's.

"We see that as a human rights violation because if you are a person with a cognitive disability you may not meet that standard," Wiebe said. "It shouldn't be a medical decision."
Link to the article in the Winnipeg Free Press: http://www.winnipegfreepress.com/breakingnews/dont-give-mds-power-to-pull-plug-disabled-96545859.html

Wednesday, June 25, 2008

Samuel Golubchuk dies on June 24

On Tuesday, June 24, Samuel Golubchuk died a peaceful and natural death.

The death of Samuel Golubchuk needs to be remembered by the courage that his children Miriam and Percy had in defending his wishes and his faith.

Very few parents can say that their children would go this far to protect them.

The link to the Winnipeg Free Press Article:
http://www.winnipegfreepress.com/breakingnews/story/4190883p-4781717c.html

We still need to pressure the Manitoba College of Physicians and Surgeons to amend their Statement on Withholding and Withdrawing Life-Sustaining Treatment.

Judge Schulman stated in his decision to grant a temporary injunction from removing life-sustaining treatment from Golubchuk that the issue of "who decides" when removing life-sustaining treatment is not settled in law.

Jocelyn Downie stated on June 9th to a conference in Winnipeg Manitoba that doctors do not have the right to remove life-sustaining treatment against the wishes of the patient.

Downie stated that there is no legal precedent in Canada that gives doctors the authority to remove a feeding tube or issue do not resuscitate orders against a patient’s wishes.
http://alexschadenberg.blogspot.com/2008/06/manitoba-doctors-do-not-have-right-to.html

The Manitoba College believe that physicians have the right to decide when to withhold or withdraw life-sustaining treatment.

This needs to change.

Link to the College of Physicians and Surgeons of Manitoba Statement on Withholding and Withdrawing Life-Sustaining Treatment.
http://www.cpsm.mb.ca/statements/1602.pdf

Monday, June 9, 2008

Manitoba doctors do not have the right to remove life-sustaining treatment against the wishes of the patient

Dr. Jocelyn Downie, the Canada Research Chair of Health Law and Policy said at a End-of-Life Ethics & Decision-Making conference at the University of Manitoba in Winnipeg today that doctors do not have the legal right to withdraw life-sustaining medical treatment against a patient’s wishes.

Downie stated that there is no legal precedent in Canada that gives doctors the authority to remove a feeding tube or issue do not resuscitate orders against a patient’s wishes.

Downie directly contradicted the statement of the College of Physicians and Surgeons of Manitoba who assert in their February 1, 2008 policy statement that a physician could unilaterally decide to remove life-sustaining treatment, including fluids and food, in certain circumstances.

The Statement said that even when a patient is likely to regain a level of self-awareness, that the physician could still withdraw life-sustaining medical treatment if the doctor has agreement from at least one other physician. If the family disagrees the doctor must seek agreement with the family, but if agreement cannot be achieved the doctor must give 96 hour notice before removing life-sustaining treatment, including fluids and food.

Downie said that the guidelines need to be revised because they go too far. Doctors can't medically determine whether a life is worth living.
http://www.winnipegfreepress.com/breakingnews/story/4184124p-4774196c.html

The comments made by Downie may also affect the case of Samuel Golubchuk, an orthodox Jewish man who’s family is seeking to have his life-sustaining treatment continued while Grace Hospital in Winnipeg is seeking to withdraw it.
http://alexschadenberg.blogspot.com/2008/03/response-to-college-of-physicians.html
http://alexschadenberg.blogspot.com/2008/05/new-york-doctor-to-testify-in-favor-of.html

Tuesday, March 18, 2008

Response to: The College of Physicians & Surgeons of Manitoba


Response to: The College of Physicians & Surgeons of Manitoba
Statement on "Withholding and Withdrawing Life-Sustaining Treatment"

By: Alex Schadenberg,
Euthanasia Prevention Coalition, February 8, 2008

The Euthanasia Prevention Coalition is a national coalition of groups and individuals who support measures that will create an effective social barrier to euthanasia and assisted suicide.

The College of Physicians and Surgeons of Manitoba announced on January 30, 2008 a Statement on Withholding and Withdrawing Life-Sustaining Treatment [henceforth referred to as the Statement. see www.cpsm.mb.ca/statements/1602.pdf]. The Statement came into effect on February 1, 2008 , and is binding on all Manitoba physicians.

The Euthanasia Prevention Coalition is concerned that the Statement will result in patients having basic medical care, including fluids, food and the respirator, withheld or withdrawn against a patient’s consent or personal values.

Euthanasia by omission includes the intentional withholding or withdrawal of fluids and food from a person who is not otherwise dying.

Post-modern bioethicists have falsely redefined fluids and food as medical treatment even though the provision of fluids and food do not constitute a treatment of a medical condition, but rather provide a basic necessity of life. Medical treatment is always optional whereas basic care is a necessity that must be provided based on need.

The Statement claims to: "assist physicians, their patients and others involved with decisions to withhold or withdraw life-sustaining treatment by establishing a process for physicians to follow when withholding or withdrawing life-sustaining treatment is being considered. It stipulates the ethical obligations of physicians, open communications aimed at achieving consensus and provides for conflict resolution in circumstances consensus cannot be reached." [No. 1602, 15-S1]

In reality, the Statement establishes that the physician has the final decision pertaining to the withholding or withdrawal of Life-Sustaining Medical Treatment. When the family disagrees with the physician, the physician must attempt to achieve consensus, but when consensus is not reached, the family will receive notice before Life-Sustaining Medical Treatment is withheld or withdrawn.

The Statement does not promote open communication between families and physicians, but rather defines the rights of the physician and informs the family that whether they agree with the physician or not, the final decision on withholding and withdrawing life-sustaining treatment is made by the physician.

Definitions are paramount:

Life-Sustaining Treatment is defined as: "Any treatment that is undertaken for the purpose of prolonging the patient’s life and that is not intended to reverse the underlying medical condition." [No. 1602, 15-S3]

This definition of Life-Sustaining Treatment includes basic care provisions such as fluids and food (provided by any and all means) and respiration.
Traditionally, fluids and food were considered basic care and not medical treatment. Fluids and food provide a basic human need and should be considered basic care and obligatory until the point when the patient is imminently dying and unable to physiologically benefit from its provision or until the burden of its provision exceeds the benefit.

It is important to note that the definition of Life-Sustaining Treatment in the Statement is not the withholding and withdrawal of medical treatment in general but rather treatments that are not intended to reverse the underlying medical condition. Medical treatment that is intended to reverse the underlying medical condition, most likely, will have already been withheld or withdrawn.

Therefore, the Statement is not based on withholding or withdrawing futile medical treatment but rather decisions concerning patients that are deemed to be futile.

"Minimum goal of life-sustaining treatment is clinically defined as the maintenance of or recovery to a level of cerebral function that enables the patient to:
• achieve awareness of self; and
• achieve awareness of environment; and
• experience his/her own existence.
For pediatric patients, the potential for neurological development must be factored into the assessment." [No. 1602, 15-S6]

The Statement says that: "Where a Physician concludes that the minimum goal is not realistically achievable and that life-sustaining treatment should be withheld or withdrawn and there is no consensus with the patient/proxy/representative, the physician is not obligated to continue to reach a consensus before withholding or withdrawing treatment, but must meet the implementation requirements ... before treatment can be withheld or withdrawn." [No. 1602, 15-S11]

Therefore, the physician is not obligated to reach a consensus before withholding or withdrawing fluids and food which may result in the person dying of dehydration. To intentionally cause the death of another person is a very serious decision. It is even more serious when it is done without the consent of the patient.

The Statement also says that: "Where the physician concludes that the minimum goal is realistically achievable but that treatment should be withheld or withdrawn, and the patient/proxy/representative does not agree and/or demands life-sustaining treatment." that a second physician must be consulted. If the second physician agrees that "treatment should be withheld or withdrawn and there is no consensus reached with the patient/proxy/ representative then the physician must provide at least 96 hours advance notice to the patient or proxy. [No. 1602, 15-S12]

Therefore, even in cases where the person is expected to reach the "minimum goal of life-sustaining treatment" as described above, the person can still be dehydrated to death, if two physicians agree that the patients life is futile or lacks a subjective quality of life.

The authors of the Statement must have understood that this part of the Statement would be criticized and therefore it states under the heading of communication that: "the concerns in these circumstances may not relate to clinical assessment or care and may involve values and judgements regarding quality of life."(emphasis is ours) [No. 1602, 15-S12]. By admitting to the reality of subjective quality of life assessments they are trying to deflect criticism by acknowledged these concerns ahead of time. When did doctors become the arbiters of who has the right to live and who must die?

Once again, the Statement is not about withholding surgery or cancer treatment from someone who is unconscious or nearing death. This is about withholding and withdrawing basic care measures.

It is interesting to note that when the "Physician offers life-sustaining treatment but the patient/proxy declines treatment or the representative advocates withholding or withdrawing treatment" the Statement says:
• "If the physician has satisfied him/herself of the matters referred to in the Communications section ... he/she must withhold or withdraw treatment in accordance with the patient/proxy’s wishes." [No. 1602, 15-S10]

In other words, the physician cannot provide life-sustaining treatment, when it is of benefit to the patient, against the expressed wishes of the patient or the consent of the proxy/representative. But it doesn’t work both ways. The physician can withhold or withdraw life-sustaining treatment/care against the expressed wishes of the patient and without the consent of the proxy/representative.

In Ontario, the Consent to Treatment Act recognizes that consent is paramount. The same Consent to Treatment Act defines a ‘Plan of Treatment’ as being comprised of various treatments or courses of treatment and may provide for the withholding or withdrawal of treatment. In both cases consent is necessary.

The Ontario model recognizes that a plan of treatment includes a consent for treatment and non-treatment.

In conclusion the Euthanasia Prevention Coalition opposes the College of Physicians & Surgeons of Manitoba Statement on Withholding and Withdrawing Life-Sustaining Medical Treatment because it directly threatens the lives of vulnerable persons and approves acts which may result in euthanasia by omission.

We recognize that medical treatment may become futile and may need to be withheld or withdrawn under certain conditions. Futile treatments are those that offer little to no benefit based on the condition of the person or where the burden of the treatment exceeds its possible benefit. We do not approve of decisions to remove basic care provisions, such as fluids, food and respiration because the patient has been deemed as futile.

There is a difference between letting a person die and intentionally causing a person’s death by action or omission. The Statement equates omissions that lead to the death of people who are not otherwise dying, with that of omissions that allow a natural death for those who are dying.

Patients depend on physicians who are willing to protect them and give them basic care, as deemed by their human need. Medical decisions must not be made based on supposed "quality of life" arguments that threaten the rights of people with disabilities and demean the value of each individual person.

In Canada medical professionals must be very concerned about safeguarding the trust relationship that exists with their patients. Canadians have a right to quality end-of-life care. Due to our medical system, patients are not free to purchase medical care. Therefore, there needs to be a recognition that the values of individuals should be upheld and protected.

The future of medical care and the confidence Canadians have in our medical system depend on rejecting policies such as the Statement on Withholding and Withdrawing Life-Sustaining Medical Treatment by The College of Physicians and Surgeons of Manitoba.