By Paul Russell:
After holding the line against euthanasia and assisted suicide and re-affirming opposition to it as recently as August 2013 the Canadian Medical Association rolled over and played dead earlier this month in the wake of the passage of euthanasia legislation in the Province of Quebec.
To be fair, the CMA Annual General meeting did re-affirm its earlier statement on euthanasia and assisted suicide but also debated and passed the following motion that supports:
"the right of all physicians, within the bonds of existing legislation, to follow their conscience when deciding whether to provide so-called medical aid in dying."
Yet at a national dialogue on end-of-life convened by the CMA from February to May this year, they affirmed that:
1. Canadians need to discuss end-of life wishes and they need to prepare appropriate and legally binding advanced care directives.
2. All Canadians should have access to palliative care services within a national palliative care strategy. Public and professional education concerning palliative care and its services is also required.
3. Canadians are divided on euthanasia and physician assisted dying. If the law is changed strict protocols and safeguards are required to protect vulnerable individuals and populations.
Point One is entirely uncontroversial whilst Point Three shows a startling lack of appreciation of the real dangers of euthanasia or assisted suicide law. But it is Point Two that most concerns me here, because, in spite of repeated efforts to move to improve Canadian's access to palliative care, the dearth of services is startling. Referring to the CMA motion (above), CTV News Canada quotes former CMA President, Dr John Haggie, as saying:
"The driver for this discussion is a desperate lack of palliative-care services," John Haggie, a Newfoundland physician, told the conference. "We don't have a hospice in the province anywhere."
Haggie responded with an "unequivocal no" to a question posed by the CMA to its members on whether their patients have access to adequate palliative care.
In short, this motion passed by the CMA caves in to the poor provision of services and abandons vulnerable and sick Canadians - especially in places where access to palliative care is limited or zero. The CMA has allowed medical ethics to be dictated to by the actions of one province (Quebec) and the inadequate health policy of Ottawa. Moreover, acquiescing to euthanasia using the lack of services as a 'driver' simply makes no sense.
This is incredibly disappointing, especially considering that the Quebec Law will not come into effect until 2015 and is currently subject to a court challenge. The CMA could have easily deferred such a motion and either joined the existing court action or taken up their own challenge. Undoubtedly, the CMA would need to grapple with Quebec at some point in time, but to roll over so easily, especially when plus 70% of Canadian doctors oppose the practice, is mind-bogglingly senseless.
The Royal Dutch Medical Association (KNMG) began its weakening of the defence against euthanasia in the 1980's after a series of court cases, starting as far back as 1973, had provided increasing precedents for legal defence for euthanasia. And yet, in 2002 they were roundly criticised and somewhat isolated by the World Medical Association who re-affirmed that euthanasia is contrary to "basic ethical principles of medical practice" and "must be condemned by the medical profession."
At the time of the Belgian debate in 2000 and 2001, the Belgian Medical Association opposed the move with 70% of doctors in opposition and 80% not willing to provide lethal injections. Head of the association, Dr Marc Moens, commented at the time that legal euthanasia would make 'the exception the rule.' Both the Belgian and Dutch associations capitulated; 'roll-over and play-dead' has its precedents.
That medical ethics should be dictated by the law is vexing. But medical ethics clearly isn't a strong point for incoming CMA head, Dr Chris Simpson.
Commenting on the CMA motion, Simpson told Canada.com that, "Doctor-hastened death would only be appropriate after all other reasonable choices have been exhausted". The article continued:
'But doctors' first need safeguards to protect the vulnerable and a strategy to urgently shore up palliative care "so that this is not seen as a first, or second or even third choice, but a choice that's appropriate for people after all other reasonable options are exhausted," he said.'
Even if the palliative care 'choice' was available to all Canadians - which clearly it isn't - there's the reality that no-one can be forced to accept any medical intervention. Simpson's weasel words suggest otherwise. But, a competent patient can say 'nix' to palliation and go straight to the top of the list on 'death row'.
Even his call to 'urgently shore up palliative care' as some sort of caveat is really a bridge too far. If Dr Haggie's comments about 'a desperate lack of palliative-care services' is accurate, we're not talking about a quick fix here but, rather, a significant change in health policy and allocation of resources to make it happen. Simpson should know this: his words are weak and empty and amount to an abandonment of patients and principle.
As Wesley Smith observed:
The "last resort" justification is a hiding place for those without sufficient guts or principleâ€“either to admit they are for assisted suicide or who don't have the bone marrowâ€“I am tempted to use a cruder imageâ€“to stand against it and be accused of lacking compassion.
Reading the balance of the article, it seems that Simpson comes in the former category.