Press Release: A growing number of Canadian physicians are being bullied to participate in MAiD.

PRESS RELEASE 

Alert from a growing number of Canadian physicians 

“We are being bullied to participate in Medical Assistance in Dying”

Petition: Reject euthanasia Bill C-7 (Link).

Montréal, March 9, 2020 - The Physicians’ Alliance against Euthanasia has received reports that unwilling physicians are being pressured and bullied to participate in Medical Assistance in Dying (MAiD): euphemism for euthanasia and assisted suicide. Fearing reprisals, physicians have asked that no information that could identify them be disclosed.

The pressure has been intense for many physicians, especially amongst palliative specialists, some leaving their profession even before this latest development. Descriptions were made of toxic practice environments and fear of discipline by medical regulators.

“The anxiety, fear, and sadness surrounding my work bled into my family life, and I ultimately felt that I could not manage practicing palliative care at this stage of my life.”
(Former palliative care physician, March 2020)

In different locations across Canada over the last months there has been a change in certain hospital MAiD policies. The change seems intended to provoke crisis or confrontation: to force objecting physicians to facilitate MAiD, or to have to refuse — and face contrived allegations of “obstructing access.” Reports consistently focus on the MAiD providers refusing to accept full responsibility for the death of the patient and forcing other physicians to share responsibility for the death. If the physician asks to withdraw from care and allow the MAiD provider to take over as before, the MAiD provider resists assuming the natural pattern of care.

The reports we are hearing from distressed physicians describe deliberate disruption of arrangements that were previously working satisfactorily and that had permitted patients to have access to MAiD while still allowing for conscience objectors to not be involved in facilitating the patient’s death. This bullying and betrayal of collegial relationships can poison practice environments and compromise patient care. Such behavior should not be tolerated by health care administrators in Canada.

Canadian physicians having similar stories of bullying are encouraged to contact the Physicians’ Alliance by email: info@collectifmedecins.org.

Contact:
Charmine Francis
Coordinator
438-938-9410
info@collectifmedecins.org

BILL C-7 and broadening Medical Assistance in Dying (MAiD) in Canada

For immediate release Montreal, 26 February, 2020 PRESS RELEASE   BILL C-7 and broadening Medical Assistance in Dying (MAiD) in Canada   Do we collectively seek the most permissive voluntary euthanasia program in the world?

Petition: Reject euthanasia Bill C-7 (Link).

Following Monday’s tabling of Bill C-7 in the Canadian Parliament, Living with Dignity and the Physicians’ Alliance against Euthanasia deplore this new chapter in a political approach leading step by step to death on demand for suffering people in Canada. Bill C-7, removes the requirement that a person receiving “medical assistance in dying” (MAiD) be in a situation where natural death is reasonably foreseeable. This effectively opens the door to any Canadian who is physically sick and suffering, and who wishes it, to be legally killed by a doctor.

Let us be very clear: if this bill is not significantly amended, Canada will have the most permissive euthanasia program in the world.

The Truchon-Gladu decision of the Quebec Superior Court, the government’s refusal to appeal it, and the present bill are proof of the validity of the concerns expressed before MAiD was decriminalized in 2016. We and many other groups insisted that, once anyone is permitted to directly cause the death of another person, there is no safeguard that can prevent this “right” from being extended to groups not initially foreseen.

As opposed to Quebec, which simply decided to conform to the Truchon-Gladu decision by removing de facto the end of life criterion, the federal government at least chose to maintain the use of the reasonably foreseeable natural death criterion, as a way of creating safeguards for MAID requested by patients who are not dying.

However, despite assurances in the Preamble that “Canada is a State Party to the United Nations Convention on the Rights of Persons with Disabilities and recognizes its obligations under it, including in respect of the right to life… [and] Parliament affirms the inherent and equal value of every person’s life and the importance of taking a human rights-based approach to disability inclusion, Bill C-7 constitutes a threat for some citizens.

It would permit any person who has a serious and incurable illness, disease or disability, and is in an advanced state of irreversible decline in capability, to obtain MAID without being near the end of life, only 90 days after making the request.

We are assured that the Bill excludes MAiD on the basis of mental illness, but we know that a Parliamentary committee scheduled for a few months from now will study this possibility, as well as those of the euthanasia of mature minors and of adults incapable of decision-making who have made an advance request. We are concerned that the present bill will pave the way to extension of MAID to these groups.

The “added safeguards” promised for people whose end of life is not approaching are weak indeed. While in the Netherlands the doctor must agree that there are no other potential means of alleviating suffering before euthanizing a patient, Bill C-7 only specifies that the doctor must “ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care …”, and “… that the person has given serious consideration to those means…” There is no need for the patient to try other options; indeed, there is no need for the means to be even available to him.

Accessibility to such services should, on the contrary, be the priority for our federal and provincial legislatures, long before any new extension of euthanasia.

The Physicians’ Alliance against Euthanasia seeks to ensure quality medical care and respectful decision-making for vulnerable patients, especially those at risk of pressure to end their lives prematurely through euthanasia or assisted suicide, and to protect the professional integrity of all health care workers.

For further information or to request an interview with
Dr. Catherine Ferrier (Physicians' Alliance) or Me Michel Racicot (LWD), please contact: Charmine Francis (Coordinator)
Tel: +1 (438) 938-9410
Website: www.collectifmedecins.org/en
Email: info@collectifmedecins.org

Physicians Urge Protection of Vulnerable Persons Standard: Call on Attorney General of Canada to Appeal Quebec Medical Assistance in Dying Decision

TORONTO, ON – More than 250 doctors from across Canada have signed an urgent open letter to the Attorney General, David Lametti, asking him to appeal a Quebec Superior Court decision that would expand access to medical assistance in dying to those who are not nearing natural death. The decision on the appeal must be made by October 18.

The signatories agree that medical assistance in dying must have limits, and that individual rights must be balanced with protections for vulnerable citizens and greater society. The letter calls for Parliament to address equality gaps that cause suffering and poor health for patients with life left to live rather than provide them medical assistance in dying.

The letter (La lettre ouverte est disponsible en français ici) was penned by Dr. Margaret Cottle and her colleagues who act as advisors to the Vulnerable Persons Standard (VPS).

Catherine Frazee, Professor Emerita, Ryerson University School of Disability Studies, is a founding advisor on the Vulnerable Persons Standard. Frazee commented:

“In the robust debates that gave shape in 2016 to our present law, Canadians with disabilities were fully engaged and our contributions earned the respect of our legislators and fellow citizens. We raised the alarm that discrimination, stigma and social and economic deprivation could make people vulnerable to seeking a premature death.

When Bill C-14 became law, it carefully balanced the needs of persons whose suffering at the end-of-life was intolerable, and persons who would be vulnerable to suicide when denied the supports and conditions for a dignified life. The foundational requirement that MAiD be reserved for persons already nearing the end of life was a bulwark against this grave danger, and an affirmation of the inherent value and dignity of our lives. The same Prime Minister who heard us in 2016 is now arbitrarily refusing to appeal the Truchon and Gladu decision and has betrayed the commitments of a carefully considered law.”

Dr. Cottle recognized this vulnerability in her patients,

“As physicians, we have extensive, first-hand experience in journeying with our fellow citizens, including those who are living with illnesses and disabilities. We understand--and mourn--the many challenges we encounter together due to inadequate supports of every kind. Each member of our Canadian family deserves to be equally valued, equally supported, and equally protected. This is why we call upon the government of Canada to appeal the Truchon and Gladu court decision, and to affirm every Canadian’s right to live with dignity.”

The letter expands upon the concerns raised by 65+ community organizations - including members of the disability rights community, and health-focused organizations like the Canadian Association for Mental Health and the Canadian Society of Palliative Care Physicians - in an open letter released late last week.

- 30 - 

For media inquiries, please contact Natalia Hicks, Vulnerable Persons Standard Secretariat at info@vps-npv.ca 1-855-661-9611 ext 221

Conscience rights of physicians and the decision of the Ontario Court of Appeal

This article was published on June 30, 2019 by the Physicians Alliance Against Euthanasia.

By Dr Catherine Ferrier
President: Physicians Alliance Against Euthanasia

All Doctors are Needed

On May 15, 2019, the Court of Appeal for Ontario confirmed a lower court ruling defending the requirement of the College of Physicians and Surgeons of Ontario (CPSO) that dissenting physicians make “effective referrals” for euthanasia (“MAiD”).

We consider this decision to be not only wrong, but founded upon non-factual assumptions, contrary to the needs of patients, and contrary to the opinion of those doctors most aware of the needs of terminally ill patients. The Canadian Society of Palliative Care Physicians (CSPCP) in a recent messaging update states, notably: that MAID referral should not be the responsibility of the individual physician, but requires a separate, publicly accessible information service, and, of course, that dissenting physicians should be respected in their choice.

In its judgement the Court described CPSO policy in these terms:

“[The policies] strike a reasonable balance between patients’ interests and physicians’ Charter-protected religious freedom.”

Underlying this assessment lies the false assumption that the “rights” of objecting doctors are a threat to the “interests” of patients. Needless to say, in our view, the reason these doctors exercise their charter rights is to protect the interests of their patients.

In response to the judgement Dr. Nancy Whitmore, registrar and CEO of the CPSO, spoke of “ensuring patients get access to the care they need”. Again, we believe that euthanasia is not medical care, and that if patients were getting the care they needed, the demand for euthanasia would approach zero.

Above all, there is one key fact that has been insufficiently considered in this debate: that the vast majority of patients do not want to die, that they do not ask for euthanasia, and that they refuse it when offered.

In other words, the perception that objecting doctors, with their narrow personal prejudices, are somehow in conflict with the “interests” of their own patients is plainly false with regard to the majority. On the contrary, at great personal cost, these doctors are publicly defending the sort of care that is desired by the majority of patients.

It is evident that we are facing two distinct clienteles requiring two distinct services, and that there is a large discrepancy in the numerical importance of the two. In the Netherlands, for example, where euthanasia has been aggressively marketed to patients for nearly twenty years, only 13 % of cancer patients consent to die in this manner. We must ask ourselves, therefore: what acceptance of negative consequences are we prepared to require of the 87% who do not?

In this regard, The Canadian Society of Palliative Care Physicians (as above) maintains that providing euthanasia is a service “distinct from palliative care”; and that “The Canadian public must be able to continue to trust that the principles of palliative care remain… to help people live as well as they can until their natural death.” A particular criticism is made of the so-called “duty to inform” being promoted by some euthanasia activists, which would require doctors to systematically inform seriously ill patients of their “right to die”. The CSPCP rightly observes that this “… could exert undue pressure or cause subtle/overt coercion of patients.” i.e. it is nothing less than universal suicidal suggestion imposed upon this vulnerable group.

Euthanasia enthusiasts often make their case in these terms: “It is legal; we pay for it with our taxes; and we have the right to enjoy it”. We would respond however, that the very same can be said of the life-centered care desired by the majority. This majority should be able to access medical care with the confident expectation that those doctors randomly assigned to them would never “give a lethal drug to anyone… nor… advise such a plan” (Hippocrates) , i.e. that they will be allowed to feel safe.

That is the root problem with the evolving forms of euthanasia implementation in Canada: The entire industry is being retooled to optimize the satisfaction of a small minority, to the serious detriment of that much larger share of patients who are non-suicidal. Or, as has been remarked (Le Devoir, July 2016): 

“Every citizen has the right to a smoke-free environment, but not to one that is free of euthanasia…”

Let us remember that the court cases leading to the legalization of euthanasia were only concerned with the decriminalization of such an act. It was decreed that a consenting doctor might euthanize a patient, under certain circumstances, without going to jail. That is all. It was never stated that society at large, or the medical profession (much less the individual doctor) would ever be responsible for providing such a “service”.

More generally, health care services, being accessed by different clienteles having different desired outcomes, must adjust to these competing demands. There may be specialized delivery systems, and there may be general facilities where the default procedure will logically favor the expected majority, ensuring reasonable minority access without reducing the quality and availability of majority service.

In this case, we believe that minority access should be perfectly satisfied with the simple legality of euthanasia, coupled with the free dissemination of information regarding service availability. Public funding for such information (not to mention funding for the procedure itself) would be a further, non-obligatory, gesture of goodwill.

On the other hand, consider the new standard of care required by the College of Physicians and Surgeons of Ontario and upheld by the Court of Appeal, which will lead to patients justifiably living in fear of being treated by doctors who would be happy to euthanize them; who patiently (and even insistently) inform them of their “right to die”; and who await only the required consent to proceed. Is this not a paradigm hugely unfair to the non-suicidal majority?

But even that is not all, for onerous regulations requiring some physicians to do that to which they cannot in good conscience consent will necessarily force them out of practice or out of the country. How, we ask, can the satisfaction of a minority demand possibly justify the purging of doctors who are urgently required to serve the majority? There are not even enough doctors as things are now! And yet some of our best are to be drummed out under accusations of ideological impurity? The very idea surpasses the notion of “absurd”.

Let us be clear:

• The exercise of conscience rights by individual doctors does not threaten the interests of patients (Overall, doctor conscience has historically provided the long-term guarantee of those interests).
• The refusal of individual doctors to collaborate in euthanasia does not significantly affect access to that service (Supply is organically dynamic and grows with demand).
• It is not rational to reconfigure the entire health care system for optimal minority satisfaction when that transformation destroys the infrastructure designed to serve a different (and quantitatively greater) purpose.
• If there are two distinct clienteles with two distinct treatment models, then two parallel streams must be allowed to evolve independently.

And most importantly, the very last thing we need is to lose professionals who are ideally suited to serve.

Make euthanasia unimaginable.

Sincerely,
Catherine Ferrier
President

Truchon, Gladu and the euthanasia of people who are not terminally ill

This article was published on February 7, 2019.

By Dr Catherine Ferrier

President, Physicians Alliance Against Euthanasia

In recent issues of this Newsletter we have considered the dangers of different ongoing schemes for enlarging the qualifying criteria for euthanasia, to include people with dementia (by advance directive), “mature” minors (with or without parental consent or knowledge) and those for whom psychiatric illness is the sole underlying condition.

Unfortunately, by virtue of a challenge currently undertaken by Mr. Jean Truchon and Ms. Nicole Gladu before the Québec Superior Court, there is now something quantitatively much worse on the table: euthanasia for people who are not at the “end of life” (as required by the Quebec law) or for whom, contrary to what Canadian law requires, “natural death is not reasonably foreseeable”. In other words, doctors may soon be asked to “medically” kill people who are not dying.

It is evident that to permit this would allow the phenomenon to assume proportions many times that of the original context of “unbearable suffering at the end of life”. Therefore, whatever dangers were first invoked in that discussion must now be multiplied a hundredfold.

Unfortunately, the plaintiffs and their counsel do not admit that any such dangers exist. Increased suicide, for example, is impossible in their world because “Medical aid in dying” is never suicide, by definition (although any qualified and suicidal patient would have the absolute right to die using a compliant doctor in the place of poison or gun). Moreover, no matter how many “vulnerable” persons were to die for the wrong reasons, that too is irrelevant, because Mr. Truchon and Ms. Gladu are not vulnerable. And in the myopic priorities of the petitioners: if even one, single, non-vulnerable ill or disabled person wishes to die, then society has a sacred duty to provide that death, even if it means completely transforming medical culture, regardless of what mayhem may ensue.

The law, however, must not uncritically endorse the perspective of any one stakeholder. The law has a duty to balance competing interests.

Jean Truchon & Nicole Gladu

These conflicting interests and the balancing function of the law were sharply illustrated on the first day of hearings by the presence of two severely disabled individuals, vehemently opposed to the demands of Mr. Truchon and Ms. Gladu, and determined to defend their own rights: not the right to benefit from a discriminatory exception to our criminal code which would allow their deaths; but the right to an equal and non-discriminatory application of existing law to prevent those deaths.

For that is what the law against assisted suicide does: it prevents deaths. Before the Carter decision and Bill C-14, it provided this protection to everyone; and even since the law was adopted, it has still protected those who are not at the end of life; but if the Truchon-Gladu challenge prevails, the entire population of chronically ill and disabled individuals will be stripped of such protection. And that is horribly wrong.

It has been reported that Mr. Truchon and Ms. Gladu’s counsel summarily rejected any notion of lost protection, using what has so often been accepted as an unassailable argument: “each one may choose”. But if apparent choice were sufficient protection from the dangers of assisted suicide, why do we still have a law at all? Why do “normal” people still require protection? The answer is obvious: Because the existing law does in fact provide real protection for the general population. And non-suicidal people who are ill or disabled (whether “vulnerable” or not), naturally resent this attempt to deprive them of their right to equal treatment before the law.

This is not different from many regulations in existence, such as, for example, those requiring doors to close off open elevator shafts (in spite of the fact that people may simply “choose” not to jump). We recognize that people can fall down the shaft by accident; or that in a period of existential weakness they might regrettably decide to jump; and yes, they may even be pushed. Doors prevent such tragedies. And so do our laws against assisted suicide.

Here, then, fundamentally, are the two sides to this issue: There are people who seek an exceptional “right” to jump, with the help of the medical profession; and there are those, every bit as qualified for that proposed exemption, who wish to benefit from the same level of protection accorded to every other citizen.

How, then, can we decide between these two competing and mutually exclusive views?

1. The number of suicidal people like Mr. Truchon and Ms. Gladu is greatly inferior to those in similar circumstances who wish to continue living.
2. It is impossible that people with the intellectual resources and networking skills of the non-vulnerable Mr. Truchon and Ms. Gladu can be prevented from dying if they really want to. Many thousands of Canadians commit suicide each year, and it is estimated that hundreds are assisted to do so. What Mr. Truchon and Mme Gladu risk, then, is not a requirement to live, but simply that society will not arrange for their deaths.
3. Should Mr. Truchon and Ms. Gladu win, others, who will inevitably and regrettably succumb to the open elevator shaft of missing protection, will lose their lives. Our choice, therefore, is between providing a more convenient death for a few, or protection of ongoing life for many more.
4. Fair minded people must realize the reality of intimidation, coercion – or even mere suggestion – originating from overwrought family, overburdened caregivers, and yes, perhaps blatantly greedy heirs; recognize also the danger of passing self-doubt, or existential despair, translated into state-sanctioned, medicalized suicide. We believe that what the legislators considered an acceptable weight of tragedy, in a compromise involving only those wishing to die more quickly and less painfully at the very end of life, should certainly be considered unacceptable when applied to the much larger population of those with non-terminal illness and disability.
5. Law is a framework under which we live. The benefits of law should be maximized for those who are alive – and for those who wish to go on living.

From these several facts, we arrive naturally at the conclusion that the existing law (bad as it may be) should remain as it is without further expansion. Mr. Truchon and Ms. Gladu will die, as all people die, and probably much sooner, by their own hand or by the hand of others.

But when they leave this world, they must not be permitted to bequeath to us a framework that works to the detriment of those who have chosen to remain behind.

Make euthanasia unimaginable.

Sincerely,
Catherine Ferrier
President, Physician Alliance Against Euthanasia.

Canadian physicians warn Spanish Parliament about euthanasia

Media Release: October 23, 2018

As the Spanish Parliament debates the euthanasia and assisted suicide bill, Canadian physicians feel it is essential to bring to your attention the dangers and failures of the euthanasia and assisted suicide laws in Canada which have been in place since 2016. 

Link to this media release in Spanish (Link).

Since then, there has been constant pressure to normalize and expand these practices and to abandon the safeguards instituted to protect vulnerable people.

The Canadian government is now looking into extending euthanasia and assisted suicide to children, people with mental illness, and cognitive disorders.

Doctors and hospitals are under pressure to provide euthanasia or to refer cases to another clinician, even when it violates their fundamental principles to do so. 

(Euthanasia in Canada: A Cautionary Tale, World Medical Journal September 2018).

Dr Paul Saba

Dr. Paul Saba alleges that a patient’s consent to be euthanized cannot be free and informed if the patient does not have access to the proper health care including palliative care.

Dr. Saba’s argument is not theoretical given the report from the Quebec Commission on end of life care. It indicates that the euthanasia laws are not being respected. In Quebec, 52 cases not conforming to the law were performed in 2016-2017.

The lack of health services in the province and particularly palliative care, was denounced recently by the President of the College of Physicians which is the regulatory body for medical practice. The College reported some patients were seeking euthanasia because of the lack of palliative care.

Dr Saba states:

“The present Canadian laws are not safe. In the same way the proposed Spanish laws will have the same outcome. You cannot safely put into place euthanasia and assisted suicide without having a comprehensive palliative care system active and running. People need assistance in living and not assistance for suicide.”

Dr. Rene Leiva, a family physician contends that the present Canadian laws and proposed Spanish laws do not protect patients from ending their lives prematurely because of feelings of hopelessness, lack of future, feelings of being overwhelmed, being a burden and not having access to medical care which would treat their pain and suffering.

Dr Laurence Normand-Rivest

Dr. Laurence Normand-Rivest who is a palliative care physician reminds the world that Canada’s present legalization of euthanasia and assisted suicide and the proposed Spanish law are contrary to practices in the vast majority of countries around the world. These laws protect the lives of its citizens and particularly those facing disease, disabilities and conditions that could make them candidates for euthanasia and assisted suicide.

The World Medical Association, which comprises 114 countries worldwide, has consistently rejected euthanasia and describes this practice as unethical.

Presently only 6 countries of the world have laws legalizing either euthanasia or assisted suicide. This represents less than 2% of the world’s population.

Dr. Paul Saba, Dr. Rene Leiva and [mC1] Dr. Laurence Normand-Rivest are members of the Physicians’ Alliance against Euthanasia, representing more than 1100 Canadian doctors.

Contact information: Dr. Paul Saba 001-514-886-3447, pauljsaba@gmail.com
Link to media articles from Spain:

https://www.actuall.com/vida/medicos-canadienses-advierten-a-espana-sobre-el-peligro-de-la-eutanasia/

https://www.consalud.es/profesionales/medicos-canadienses-advierten-a-espana-del-peligro-de-la-eutanasia_56184_102.html

https://www.cope.es/actualidad/sociedad/noticias/medicos-canadienses-advierten-parlamento-espanol-sobre-peligro-eutanasia-20181023_281190