The Joint Select Committee on End of Life Choices in WA majority report (“Sanderson Report”) has recommended that assisted suicide be legalised in Western Australia. The model that has been recommended is one that closely mirrors the regime in place in Canada.
Three years after the Canada legalised assisted suicide, an article has been published in the World Medical Journal by a group of medical professionals. Their purpose is to raise awareness about the impact the Canadian regime is having on doctors and medical practice more generally in their country. They name the euthanasia and assisted suicide regime in Canada as “one of the most radical in the world”, even more so than the regimes in place in Belgium and the Netherlands. The impact it has had on the medical profession is profound:
“Our observations and personal experiences over the last two years confirm our belief that the practice of Hippocratic medicine is fundamentally incompatible with euthanasia and assisted suicide. Mandating system-wide provision and physician involvement in the practices can be expected to transform medical culture, ultimately making Hippocratic medical practice impossible.”
The practitioners are “disturbed that the number of Quebec practitioners entering palliative care dropped after legalization of euthanasia, and the CMQ and the Quebec Society for Palliative Care are concerned that patients are choosing euthanasia because adequate palliative care is unavailable.” There is a growing body of research about the negative impact on practitioners in providing euthanasia and assisted suicide, including a ‘huge burden of conscience, tangled emotions and a large psychological toll on the participating physicians.”
Whilst the Canadian legislation provides for strict procedural safeguards, one year after it came into force, euthanasia practitioners are asking for the safeguards to be moved out of the way of killing patients. They complain that reviewing medical histories, counselling and overcoming resistance from family members, referring patients to psychiatrists and social workers and making accurate records are burdensome for doctors wanting to administer lethal drugs without restraint. “What others see as safeguards they characterized as ‘disincentives’ to physician participation that were creating ‘barriers’ to access.”
As Dr Yves Robert, Secretary of the College Des Medecins Du Quebec (CMQ) states, “if anything has become apparent over the past year, it is this paradoxical discourse that calls for safeguards to avoid abuse, while asking the doctor to act as if there were none.”
These same ‘safeguards’ and eligibility requirements are now the subject of challenge. Patients who wish to access the scheme but are deemed ineligible seek to argue that they are unfairly excluded and the law should be changed to include their particular circumstances. This is not surprising once the door is opened to one group of citizens in a jurisdiction. Arguments about unfair exclusion and discrimination are potentially limitless.
Other concerns about the regime relate to the coercion of physicians to participate in the scheme. Physicians in Canada who are unwilling to personally provide euthanasia or assisted suicide must refer to a practitioner who is willing to do so. The suggested model in WA similarly requires that practitioners who object to assisted suicide must nevertheless ‘offer to refer the patient to a doctor who is willing to provide assistance.’
The result in Canada has been that many doctors who conscientiously object to assisted suicide “risk discipline and expulsion from the medical profession.”
The Canadian doctors assert that if a country insists on legalising euthanasia and assisted suicide, it should be by way of a completely new discipline, set up to provide these services, but that they should never be provided ‘in the name of Medicine’. They correctly assert that ‘Euthanasia is not medicine’.
Parliamentarians in Western Australia would do well to heed the cautionary warning from physicians in Canada when considering the path forward for WA. Whilst recommending a model similar to that in Canada, the Sanderson Report nevertheless fails to disclose critical information about the regime’s operation in the three years since it was legalised. There is no mention of the impact it has had on the palliative care system (including on the reduced number of practitioners specialising in palliative care since the introduction of assisted suicide), nor the fact that government has commissioned independent reviews to look into extending euthanasia and assisted suicide to ‘competent minors’, those with psychiatric disorders and through the use of advance directives. These changes, if legislated, would fundamentally extend the original model in a very short timeframe, and give lie to the Sanderson Report’s cursorily researched conclusion that there is no slippery slope.