MDs group disappointed by recommendation to require referrals for assisted death

Canadian Press

Sheryl Ubelacker

TORONTO — A parliamentary committee’s recommendation that doctors who object to assisted dying be required to at least refer patients to a willing colleague is not only disappointing, but has also led some physicians to consider leaving their practices, says the Canadian Medical Association.

The all-party committee, which released a set of recommendations Thursday aimed at helping the federal government draft legislation governing medically aided death, said Ottawa should work with the provinces and territories to establish a process that respects a doctor’s freedom of conscience, while respecting the needs of patients.

“At a minimum, the objecting practitioner must provide an effective referral for the patient,” the committee said. . . [Full text]

The CCRL Strongly Opposes Parliamentary Committee’s Assisted Suicide/Euthanasia Recommendations

News Release

Catholic Civil Rights League

TORONTO, ON February 25, 2016 – The Catholic Civil Rights League (CCRL) strongly opposes the recommendations of the Report of the Special Joint Committee on Physician-Assisted Dying, titled “Medical Assistance in Dying:  A Patient-Centred Approach.” The CCRL uses the more accurate terms “assisted suicide” and “euthanasia” since there is nothing medicinal whatsoever in the process of killing a patient or intervening so that a patient may commit suicide more easily.

The majority report is problematic as it brings Canada further along the path of unrestricted assisted suicide and euthanasia, a regime which began with the Supreme Court’s unanimous decision in Carter v. Canada and with it, the overturning of the prohibition against assisted suicide and euthanasia from the Criminal Code. In the twenty-two years since the 1993 Supreme Court of Canada decision in Rodriguez, Parliament not only continued to oppose assisted suicide and euthanasia in six separate votes, but rather passed near unanimous resolutions for a national anti-suicide prevention policy, and for a further national strategy to support increased palliative care throughout Canada.

The Joint Committee’s majority recommends the practically unfettered and immediate implementation of death on demand for Canadians. The CCRL made submissions to previous consultation panels on euthanasia in response to the decision in Carter, but the League was not prepared to collaborate in the legislative process of advocating for a liberal bill as now proposed.  The CCRL remains of the view, based on the experience of other jurisdictions, that “safeguards”, even as minimally expressed by the Joint Committee, are illusory.  The League fears for the elderly, the disabled, and the those with mental health afflictions, that they will be the subject of increased pressure to take their own lives, rather than gain access to treatment, or palliative care.  In every other jurisdiction, the scope of assisted suicide and euthanasia widens, and instances of egregious circumstances of premature death prevail.

Of particular concern to the CCRL is recommendation #11:

That the Government of Canada work with the provinces and territories to ensure that all publicly funded health care institutions provide medical assistance in dying.

Catholic health institutions cannot and will not participate in the intrinsically evil act of assisted suicide/euthanasia. The Liberals, as professed guarantors of the Charter, cannot in good conscience merely deny the religious and conscientious rights of such institutions. Is the government’s enthusiasm for such a proposal intended to bring about the demise of the Catholic health system?

Recommendation #10 is wholly unacceptable:

That the Government of Canada work with the provinces and territories and their medical regulatory bodies to establish a process that respects a health care practitioner’s freedom of conscience while at the same time respecting the needs of a patient who seeks medical assistance in dying. At a minimum, the objecting practitioner must provide an effective referral for the patient.

As the CCRL has stated many times, the compulsion to make an “effective referral” is an infringement of the Charter right of freedom of conscience and religion.  Compelling an objecting physician to provide an effective referral to another physician, health-care provider, or third party agency in order to carry out assisted death or euthanasia, involves that physician in the objectionable procedure.  The Parliamentary Committee has ignored numerous presentations and submissions opposing any compulsion to force a physician to violate his or her own conscience by being a participant in the very act, the very procedure to which he or she objects in the first place.

We urge members of the media and others who care for the future of Canada to have reference to the dissenting report of four Conservative MPs who have taken issue with the majority recommendations of the Joint Committee.

Canada is entering fully into the culture of death.

The CCRL asks all of our supporters to join us in rejecting this report and we plead with all Canadians, and indeed all Catholics to wake up and join us in this fight, spiritually through prayer, and politically by using our collective voice. Let us announce that we will not accept this.

About the CCRL
Catholic Civil Rights League (CCRL) (www.ccrl.ca) assists in creating conditions within which Catholic teachings can be better understood, cooperates with other organizations in defending civil rights in Canada, and opposes defamation and discrimination against Catholics on the basis of their beliefs. The CCRL was founded in 1985 as an independent lay organization with a large nationwide membership base. The CCRL is a Canadian non-profit organization entirely supported by the generosity of its members.

 For further information:
Christian Domenic Elia, PhD
CCRL Executive Director
416-466-8244
@CCRLtweets

Canadian parliamentary committee recommends mandatory participation in euthanasia, assisted suicide

Federal committee wants provincial governments to address most contentious issue

News Release

Protection of Conscience Project

A special joint committee of the Canadian House of Commons and Senate has produced a first report concerning legalization of euthanasia and physician assisted suicide.

The report recommends that physicians who, for reasons of conscience, are unwilling to kill patients or help them to commit suicide  should be compelled to find someone willing to do so.  It also recommends that all publicly funded facilities – not excluding objecting denominational institutions – be compelled
to provide euthanasia and assisted suicide.  This goes beyond recommendations made by others to the effect that objecting institutions should at least allow an external provider to perform the procedures on their premises.  It also ignores the advice of the Canadian Medical Association, which told the Committee that euthanasia and assisted suicide could be provided without suppressing freedom of conscience by forcing objecting physicians to refer for the procedures.

The main report is followed by a dissenting report signed by four Conservative (C) Members of Parliament.  With respect to freedom of conscience, the dissenting report erroneously states, “Quebec physicians are free to act according to their conscience,” and recommends Quebec legislation that is purported to accommodate freedom of conscience and religion.  The Quebec model has been rejected by many objecting physicians because it requires them to become parties to homicide by referring a patient to an administrator, who will arrange for euthanasia.

A supplementary opinion filed by two New Democrat (NDP) Members of Parliament states that legislation “must ensure that every eligible patient’s right to access medical aid in dying is upheld, and protect any healthcare professional who objects for reasons of conscience from disciplinary action.”  However, the authors of the supplementary opinion do not dissent from the main report, so they must mean that objecting physicians should be disciplined if they refuse to arrange for someone to kill patients or help them commit suicide.

In Canada, the federal government has no jurisdiction over the regulation of medical practice or the operation of hospitals.  In effect, then, the committee wants the federal government to pressure provincial governments to force unwilling physicians, health care workers and institutions to become parties to homicide and suicide.  This is arguably more contentious than the legalization of assisted suicide and euthanasia, so it is politically advantageous for the federal government to pass this particular buck to the provinces.

The federal government has full jurisdiction to prevent people from being forced to become parties to homicide and suicide, and this was recommended to the Committee by the Protection of Conscience Project and others.  Instead, the Committee has taken the opposite tack, insisting that the state should impose and enforce an obligation to kill, even upon those who believe that killing people or helping them to commit suicide is gravely wrong.

Contact:

Sean Murphy, Administrator (protection@consciencelaws.org)

 

Alberta Catholic bishops reject coerced participation in euthanasia and assisted suicide

Sean Murphy*

Following a first reading of the report of the Special Joint Committee on Physician Assisted Dying, the six Catholic bishops of Alberta welcomed recommendations advocating enhanced palliative care, but expressed deep disappointment about others.  “Killing is not medicine,” they state. “This has no place in a just and ethical society.” (Alberta Bishops ‘deeply disappointed’ in federal report on assisted suicide)

Among the recommendations they criticized were two involving freedom of conscience and religion.

  • “That the government of Canada work with the provinces and territories to ensure that all publicly funded health care institutions provide medical assistance in dying.” This is unacceptable at Catholic hospitals, which are committed to the compassionate care of patients to the natural end of life. Canadians have a right to be served by doctors and institutions that practice only medicine and are not involved in state-sponsored killing. They must not be deprived of access to such just because there are other citizens who desire assistance in committing suicide.
  • “At a minimum, the objecting practitioner must provide an effective referral for the patient.” A physician who conscientiously objects to these practices must not be coerced into referring a patient to another professional for assisted suicide or to be euthanized. This would, in fact, be complicity and thus a violation of the person’s right to freedom of conscience. Furthermore, medical professionals who refuse for reasons of conscience direct or indirect participation must also be protected from intimidation and discrimination.

Report on physician-assisted dying gives attention to key issues; critical matters still to be addressed with federal legislation

A Statement from Dr. Cindy Forbes, President of the Canadian Medical Association

News Release

Canadian Medical Association

OTTAWA, Feb. 25, 2016 /CNW/ – The Canadian Medical Association (CMA) is pleased to see physician input reflected in a number of recommendations released today in the report of the Special Joint Committee on Physician-Assisted Dying.

In particular, the CMA welcomes the recommendation to re-establish a secretariat on palliative and end-of-life care and to implement a pan-Canadian palliative care strategy with dedicated funding. We are also pleased to see the recommendation for the development of a pan-Canadian strategy to improve quality of care and services received by individuals living with dementia.

While there is much to praise in this report, it does fall short on the issue of respecting a physician’s right to conscientious objection. As the government moves forward in drafting legislation, we must focus on ensuring effective access while also respecting different views of conscientious objection. Both can be achieved. While not addressed by this report, a central mechanism to coordinate access must be a key part of the solution.

The doctors of Canada hope that the recommendations outlined in today’s report will result in a consistent approach across provinces, including federally-coordinated reporting and oversight. In particular, we are dedicated to finding a solution, in partnership with legislators and regulators, that ensures patients have effective access to the service should they need it, no matter where they live.

–Dr. Cindy Forbes, President of the Canadian Medical Association

For further information: mediainquiries@cma.ca, 613-806-1865


The Canadian Medical Association (CMA) is the national voice of Canadian physicians. Founded in 1867, the CMA is a voluntary professional organization representing more than 83,000 of Canada’s physicians and comprising 12 provincial and territorial medical associations and over 60 national medical organizations. CMA’s mission is helping physicians care for patients. The CMA will be the leader in engaging and serving physicians and be the national voice for the highest standards for health and health care.

 

SOURCE Canadian Medical Association

 

Archbishop alarmed at erosion of respect for life

Report fails to reflect witnesses’ call for palliative care, conscience rights

News Release

Roman Catholic Archdiocese of Vancouver

VANCOUVER (Feb. 25, 2016) – The leader of the Catholic community in the Lower Mainland called the joint Senate-Commons committee report on assisted-suicide “deeply disappointing.”

Archbishop J. Michael Miller said “Canadians, especially those dying or suffering from illness, deserve better. It’s alarming how easily suicide is being offered and respect for life eroded.”

Miller pointed out a serious omission in the report. “Where is the plan for protecting the Charter rights of Canadians who don’t want to participate in causing patients to die?” he asked. “Many health-care workers believe strongly in saving lives and ending suffering—but not in ending lives. Canadians from many ethical traditions just won’t be able to go along with this. Where is there room for them in medical care? No one can ethically be forced to take part in causing their patient to die. New laws need to ensure their Charter rights are protected as well.”

The Archbishop said he was troubled that the committee disregarded the testimony of so many witnesses who had called for conscience protection for health-care workers and institutions.

The report also fails to make palliative care the high priority many witnesses called for. “Unfortunately the report treats palliative care almost as an afterthought. It’s dismaying that a committee would propose assisted suicide as a ‘choice’ to people who are suffering. Without a real, effective, alternative, what kind of free choice is that?”

He said the committee appeared to have made its preference for assisted suicide clear from the start by choosing the euphemism “medical assistance in dying.” “Doctors have always assisted people who are dying,” he said. “What we are talking about here is medically causing the patient to die.”

He urged Justice Minister Jody Wilson-Raybould to reject the report, to acknowledge the numerous sincere objections in the dissenting portion of the report, and to draft legislation taking into account the testimony of the many witnesses who brought forward concerns about implementing assisted suicide in Canada.

-30-

Paul Schratz Communications Director
communications@rcav.org
604-683-0281

Special Joint Committee on Physician Assisted Dying

Parliament of Canada (January-February, 2016)

Overview

Contents


Introduction

In February, 2015, in the case of Carter v. Canada (Attorney General), the Supreme Court of Canada struck down the criminal prohibition of physician assisted suicide and physician administered euthanasia, but suspended the ruling for one year to give federal and provincial governments an opportunity to draft new laws that conform to the decision.  In January, 2016, the Court granted an extension of the suspension to 6 June, 2016.  In the interim, ith it allowed euthanasia to proceed in Quebec under provincial legislation in force there, and allowed individuals seeking physician assisted suicide or euthanasia elsewhere to apply to a superior court to obtain authorization.  A special joint committee of the Canadian House of Commons and Senate began work in January to produce a report for the federal government about proposed federal legislation.

Committee Pages

Proceedings

Transcripts

Committee proceedings have not been transcribed verbatim.  On important points, transcripts should be checked against the video to ensure accuracy.

French language materials

French language videos and transcripts can be found by using the links below to access the parliamentary English language page, and then clicking on the French language icon or link at the upper right corner of the parliamentary page.


Meetings

Groups and individuals were heard during 10 Committee meetings, which are listed and outlined below.  The outline of each meeting includes:

  • Meeting number and date
  • Links to full videos and transcripts of the meeting
  • Witness list
  • Links to videos edited to show exchanges relevant to freedom of conscience
  • Links to briefs submitted by the groups/individuals
  • Links to extracts from group/individual briefs relevant to freedom of conscience (+)

Meeting No. 2
18 January, 2016  |  VideoTranscript

  • Department of Justice
    • Joanne Klineberg, Senior Counsel, Criminal Law Policy Section
    • Jeanette Ettel, Counsel, Human Rights Law Section

Meeting No. 3
25 January, 2016 | Video | Transcript

  • Department of Health
    • Abby Hoffman, Assistant Deputy Minister, Strategic Policy
    • Sharon Harper, Manager, Chronic and Continuing Care Division
  • As an individual
    • Peter Hogg, Scholar in Residence, Blake, Cassels & Graydon LLP
  • Barreau du Québec
    • Marc Sauvé, Director, Research and Legislation Services
    • Jean-Pierre Ménard, Lawyer

Meeting No. 5
26 January, 2016 | Video | Transcript

  • External Panel on Options for a Legislative Response to Carter v. Canada
    • Benoît Pelletier, Member, External Panel
    • Stephen Mihorean, Executive Director, Secretariat
  • Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying
    • Jennifer Gibson, Co-Chair
    • Maureen Taylor, Co-Chair

Meeting No. 6
27 January, 2016 | Video | Transcript

  • Canadian Medical Association
    • Dr. Cindy Forbes, President
    • Dr. Jeff Blackmer, Vice-President, Medical Professionalism
  • Canadian Nurses Association
    • Anne Sutherland Boal, Chief Executive Officer
    • Josette Roussel, Senior Nurse Advisor
  • Canadian Society of Palliative Care Physicians
  • Canadian Pharmacists Association
  • Canadian Psychiatric Association
    • Dr. K. Sonu Gaind, President
    • Katie Hardy, Director, Professional and Member Affairs

Meeting No. 7
28 January, 2016  | Video | Transcript

  • As an individual
    • Hon. Steven Fletcher
  • Council of Canadians with Disabilities
    • Dean Richert, Co-Chair, Ending of Life Ethics Committee
    • Rhonda Wiebe, Co-Chair, Ending of Life Ethics Committee
  • Dying With Dignity Canada
  • As individuals
    • Jocelyn Downie, Professor, Faculties of Law and Medicine, Dalhousie University
    • David Baker, Lawyer, Bakerlaw
    • Trudo Lemmens, Professor, Faculty of Law & Dalla Lana School of Public Health, University of Toronto

Meeting No. 8
1 February, 2016  | Video | Transcript

  • British Columbia Civil Liberties Association
    • Josh Paterson, Executive Director
    • Grace Pastine, Litigation Director
  • Justice Centre for Constitutional Freedoms
  • Dying With Dignity Canada
    • Wanda Morris, Chief Executive Officer
    • Shanaaz Gokool, Chief Operating Officer and National Campaigns Director
  • College of Family Physicians of Canada
    • Dr. Francine Lemire, Executive Director and Chief Executive Officer
  • Alzheimer Society of Canada
    • Mimi Lowi-Young, Chief Executive Officer
    • Debbie Benczkowski, Chief Operating Officer

Meeting No. 9
1 February, 2016  | Video | Transcript

  • Canadian Cancer Society
    • Gabriel Miller, Director, Public Issues
    • Kelly Masotti, Assistant Director, Public Issues
  • First Nations University of Canada
    • Carrie Bourassa, Professor, Indigenous Health Studies

Meeting No. 10
2 February, 2016 | Video | Transcript

  • As an individual
    • Carolyn Ells, Associate Professor, Medicine, Biomedical Ethics Unit, McGill University
  • Canadian Hospice Palliative Care Association
  • Dying With Dignity Canada
    • Derryck Smith, Chair of Physicians Advisory Council
  • College of Physicians and Surgeons of Nova Scotia
    • Dr. Douglas Grant, Registrar and Chief Executive Officer
    • Marjorie Hickey, Legal Counsel
  • Criminal Lawyers’ Association
    • Leo Russomanno, Member and Criminal Defence Counsel
  • Indigenous Physicians Association of Canada
    • Dr. Alika Lafontaine, President

Meeting No. 11
3 February, 2016 | Video | Transcript

  • Coalition for HealthCARE and Conscience
    • Cardinal Thomas Collins, Archbishop, Archdiocese of Toronto
    • Laurence Worthen, Executive Director, Christian Medical and Dental Society of Canada
  • Canadian Unitarian Council
  • Centre for Addiction and Mental Health
    • Dr. Tarek Rajji, Chief, Geriatric Psychiatry
    • Kristin Taylor, Vice-President, Legal Services
  • Canadian Paediatric Society
    • Dr. Dawn Davies, Chair, Bioethics Committee
    • Mary J Shariff, Associate Professor of Law and Associate Dean Academic, University of Manitoba
  • Canadian Council of Imams

Meeting No 12
4 February, 2016  | Video | Transcript

  • DisAbled Women’s Network of Canada
    • Carmela Hutchison, President
  • Alliance of People with Disabilities Who Are Supportive of Legal Assisted Dying Society
    • Margaret Birrell, President
    • Angus M. Gunn, Counsel
  • As an individual
    • Margaret Somerville, Professor, McGill University
  • The Canadian Medical Protective Association
  • Canadian Association for Community Living
    • Michael Bach, Executive Vice-President
  • As an individual
    • Gerald Chipeur, Lawyer
  • Society of Rural Physicians of Canada

Edited Videos

The edited videos provided here focus on

  • terminology,
  • the continuing effects of the criminal law,
  • the exemptions to criminal prosecution required to allow euthanasia and physician assisted suicide under the terms of the Carter ruling,
  • jursidiction of the federal and provincial governments in relation to criminal law and freedom of conscience and religion,
  • freedom of conscience and religion for individual and institutional health care providers who object to providing or becoming parties to euthanasia or assisted suicide.
List of Edited Videos

Group/individual presentations

Multiple participant discussions


Briefs submitted

Links to the full briefs are provided below.  Click on (+) to see statements from a brief relevant to freedom of conscience and religion for healthcare providers.

By groups/ indivduals appearing as witnesses

By groups/individuals not appearing

Quebec’s new assisted-dying law leaves doctors struggling to adapt

Fear of legal reprisal still widespread among health professionals

CBC News

Two months after Quebec’s assisted-dying law came into effect, about 10 patients have chosen to end their lives with the help of a doctor.

Health Minister Gaétan Barrette says this is a sign that things are going well and there are no systematic obstacles.

“The information that I have from the ground and from the College of Physicians is that teams are in place and that access is there,” Barrette said.

“Problems, if there were any, were resolved quickly.”

Doctors and patient advocates tell a different story.

Jean-Pierre Ménard, a lawyer specializing in health law, says his clients have reported trouble obtaining medical assistance to die. . . [Full text]

 

 

Journalist: shut down Catholic health care facilities that refuse euthanasia, assisted suicide

Sean Murphy*

Doctor Examining an Elderly PatientFollowing a strong statement from the Catholic Bishops of Alberta that Catholic health care facilities will not provide euthanasia or assisted suicide, a columnist at the Edmonton Journal has accused them of defying the Supreme Court of Canada, breaking the law, and denying patients their “legal rights”.

Paula Simons wants to deny public funding to Catholic hospitals, hospices and nursing homes that refuse to allow patients to be killed or helped to commit suicide, which would force them to close, or (more  likely) to be seized by the state through expropriation or other means.

Simons’ column was published the day after statements issued by Covenant Health and Alberta’s Catholic bishops affirmed the traditional opposition of the Catholic Church to euthanasia and assisted suicide, despite the Supreme Court of Canada ruling that ordered legalization of the procedures.

Covenant Health’s Dr. Gordon Self emphasized that the organization was confident that it would “find a way to respond respectfully and compassionately to requests for physician assisted death that does not abandon the person in our care nor compromise the values of care providers or our organization.”

Throughout this process we are committed to upholding the right of both personal and institutional conscience. This will be important for all organizations as they grapple with the same issues of safe and timely co-ordination of care between institutions without abandoning the person in care when their own medical staff conscientiously object. Together we can all learn at this time and benefit from mutual dialogue and thoughtful, ethical reflection.

Alberta’s six Catholic bishops noted that “from a Catholic perspective, the intentional, wilful act of killing oneself or another human being is morally wrong,” so that “no Catholic may advocate for, or participate in any way, whether by act or omission, in the intentional killing of another human being either by assisted suicide or euthanasia.”

The following passage is taken from the bishops’ full statement:

Upholding Conscience Rights

Third, other provincial jurisdictions in Canada have proposed regulations that undermine the conscience rights of physicians and other healthcare workers. This must not be allowed to happen here. Physicians, other medical professionals, and our institutions have to be allowed the freedom that is theirs by right to exercise their conscience, not only to accord with our Charter of Rights and Freedoms, but also as a matter of good medical practice. Morally wrong in itself, the attempt to force a physician to assist in a suicide or to kill another by euthanasia would also fundamentally redefine what it means to be a doctor. Killing is not medicine. Likewise, from an ethical perspective, and certainly from that of Catholic moral teaching, a physician who conscientiously objects to these practices must not be coerced into referring a patient to another professional for assisted suicide or to be euthanized. This would, in fact, be complicity and thus a violation of the person’s right to freedom of conscience. Furthermore, medical professionals who refuse for reasons of conscience direct or indirect participation must also be protected from intimidation and discrimination.

Patient rights and the rights of family members must also be respected – that is, their civil right to access medical care for themselves and their loved ones in which there is no pressure to request or to submit to assisted suicide or euthanasia, and indeed their natural right to be served by doctors and institutions that practice only medicine and are not involved in state-sponsored killing. This is essential to maintaining the relationship of trust between patients and doctors or other care-givers. A great many citizens still intend that their doctors, and the institutions to which they entrust themselves at need, be committed to the Hippocratic oath. They must not be deprived of access to such just because there are other citizens who desire assistance in committing suicide. If they are so deprived, this will have far-reaching consequences, disrupting the relationship of trust with the state as well as with the medical community.

The decision of the Supreme Court of Canada makes legally permissible in some circumstances what is morally wrong in every circumstance: the taking of innocent human life. This is unacceptable in a truly just and ethical society.

Most Reverend Richard W. Smith
Archbishop of Edmonton

Most Reverend Frederick Henry
Bishop of Calgary

Most Reverend Gregory J. Bittman
Auxiliary Bishop of Edmonton

Most Reverend Daniel Motiuk
Bishop of the Ukrainian Eparchy of Edmonton

Most Reverend Girard Pettipas,CSsR
Archbishop of Grouard-McLennon

Most Reverend Paul Terrio,
Bishop of St. Paul

Médecins: la « solution » du Québec est une collaboration au meurtre, pas un compromis « élégant »

 

quebec-001Les médecins rejettent le « compromis ultime » qui oblige à référer les demandes d’euthanasie 

Ne forcez personne à agir contre sa  volonté : ni les médecins, ni qui que ce soit d’autre.

Introduction (par l’Administrateur de Projet

En juin 2014, le Québec a adopté une loi autorisant l’euthanasie dans la province, en dépit de l’interdiction pénale de cette procédure encore en vigueur. La province a fait valoir que l’euthanasie administrée par un médecin est une forme de soin de santé et que, à ce titre, elle est exempte de la juridiction du gouvernement fédéral en matière criminelle. La loi du Québec est donc entrée en vigueur en décembre 2015, soit 10 mois après que la Cour suprême du Canada ait invalidé l’interdiction pénale de l’euthanasie et du suicide avec l’assistance d’un médecin dans Carter c. Canada (Procureur général).  La Cour suprême avait toutefois suspendu sa décision pour un an afin de permettre au gouvernement fédéral de développer une loi, de sorte que l’interdiction pénale contre l’euthanasie était toujours officiellement applicable lorsque la loi provinciale autorisant sa pratique est entrée en vigueur au Québec.

En réponse à une poursuite intentée par des médecins qui s’y opposaient, une injonction contre la loi a été appliquée par la Cour supérieure du Québec le 1er décembre, 2015, mais a été annulée par la Cour d’appel du Québec trois semaines plus tard. La décision de la Cour d’appel a été basée sur le fait que la loi québécoise était conforme à la décision Carter, bien qu’elle doive être soumise à une révision une fois que le gouvernement fédéral aura modifié le Code criminel.

Le Dr Yves Robert est le secrétaire du Collège des médecins du Québec, organisme gouvernemental de réglementation de la pratique médicale dans la province. Il y a trois ans, le Dr Robert a témoigné devant un comité législatif chargé d’étudier le projet de loi – qui est par la suite devenu la loi sur l’euthanasie au Québec – aux côtés du Dr Charles Bernard, président du Collège des médecins. À cette époque, le Dr Bernard avait dit:

Parce que, si on a une objection de conscience puis c’est nous qui doive faire la démarche pour trouver la personne qui va le faire, à ce moment-là , notre objection de conscience ne s’applique plus. C’est comme si on le faisait quand meme.[Consultations]

Toutefois, en novembre 2015, juste avant l’entrée en vigueur de la loi sur l’euthanasie au Québec, le Dr Robert a écrit un editorial affirmant que forcer les médecins qui s’objectent à référer les demandes d’euthanasie est un compromis qui concilie les droits et libertés des patients et des médecins.

La position du Dr Robert a été rejetée dans la réponse ci-dessous, une lettre très articulée cosignée par plus de 80 médecins du Québec, auxquels près de 350 autres médecins ont ajouté leur nom par la suite. Ce rejet est particulièrement important parce que le président de l’Association canadienne de protection médicale (ACPM) a récemment recommandé le modèle québécois comme une solution «élégante» qui concilie la liberté de conscience et de religion des médecins avec le droit des patients à accéder à l’euthanasie et au suicide assisté.

De toute évidence, les personnes les plus directement touchées par la « solution » du Québec ne partagent pas cette opinion.


Préambule :

La présente lettre a été écrite en réaction de l’éditorial du Dr. Robert paru dans LE COLLÈGE (novembre 2015) au sujet de l’objection de conscience des médecins sous la Loi concernant les soins de fin de vie dont l’entrée en vigueur était prévue le 10 décembre 2015.

Débattue en Cour supérieure du Québec suite à une demande d’injonction déposée par une coalition de médecins, le jugement rendu s’est appuyé sur la doctrine de la prépondérance fédérale sur les lois provinciales pour empêcher les articles concernant l’aide médicale à mourir d’entrer en vigueur comme prévu à cause de leur incompatibilité avec le Code criminel canadien.

La présente lettre a donc été rédigée à la lumière des conclusions du jugement de la Cour supérieure du Québec rendu le 2 décembre 2015, et elle est appuyée par 84 médecins cosignataires.

Objection scientifique à l’éditorial du Dr Yves Robert

La transmission de la demande d’un patient à une autorité du réseau de la santé qui pourra y donner suite apparaît donc comme l’ultime compromis pour respecter les droits du patient et ceux du médecin » Dr Yves Robert, LE COLLÈGE, 10 novembre 2015

Dr Robert,

Cette déclaration que vous avez faite à titre de secrétaire du Collège des Médecins du Québec est complètement fausse.

Pour commencer, retenons d’abord cet extrait, tiré du jugement de la Cour supérieure (paragraphe 97) : « L’avocate de la PGC a également manifesté son inquiétude face aux dispositions de l’article 31 de la Loi qui impose aux médecins qui ne voudraient pas accéder à une demande d’ de participer, malgré leur objection, au processus visant à trouver un autre médecin volontaire et consentant. Elle y voit par le fait même une indication que même un médecin, objecteur de conscience, sera forcément impliqué dans un processus allant mener à la commission d’un acte criminel dans l’état du droit actuel ».

Voilà qui résume sans ambiguïté le fond de la pensée de la procureure générale du Canada et de la Cour supérieure du Québec concernant votre « ultime compromis » au sujet de l’objection de conscience, opinion également partagée par le Collège des Médecins du Québec.

Cette forme de collaboration à la mise à mort de son patient, n’en déplaise au secrétaire, n’est pas l’ultime compromis. C’est une contrainte de collaboration – qui peut être vécue par un médecin comme une complicité pour un geste qu’il considère comme dommageable pour son patient et ce, peu importe que ce geste soit reconnu comme criminel ou non (la criminalité évoquée ici n’est qu’un facteur amplifiant la violence de l’obligation).

Moi, je veux continuer d’offrir des soins à mon patient, je ne romps pas la relation. Je refuse uniquement de causer sa mort. Qu’allez-vous faire contre mon jugement médical?

Si vous me suspendez, c’est vous qui brisez la relation de soin en privant le patient de son médecin alors que moi je suis disposé à continuer de le soigner. Mais je considère qu’envoyer mon patient se faire tuer n’est pas un soin parce que… se faire tuer n’est pas un soin, ni pour

moi, ni pour l’écrasante majorité des médecins et des associations médicales partout dans le monde. C’est donc d’une objection médicale qu’il est question ici, car moi j’applique la norme internationale, tandis que le Collège a décidé de façon unilatérale d’y faire dissidence.

Il s’agit donc beaucoup plus ici d’une objection scientifique que d’une objection de conscience puisque le but est de continuer à appliquer les standards et les normes internationales auxquels le Collège avait décidé de faire dissidence.

Étant donné que la plupart des médecins ne seront jamais d’accord pour cesser de prévenir le suicide de leurs patients, on ne pourra pas les contraindre à cesser cette prévention car leur jugement médical et leur expertise – qu’ils appliquent depuis des années – leur dit de ne pas le faire. Prévenir le suicide reste de la bonne médecine.

De façon analogue, un directeur d’hôpital ne peut m’obliger à pratiquer une chirurgie pour mon patient si mon opinion médicale m’indique que cette chirurgie lui sera néfaste. Ça ne veut pas dire que je brise la relation d’aide avec mon patient, seulement que j’exerce ma profession avec mon jugement et ma compétence, ce qui revient à dire que je ne suis pas un simple technicien qui ne serait que « les mains de quelqu’un d’autre ».

De la même façon, aucun patient ne peut me forcer à pratiquer une chirurgie que je considère mauvaise ou néfaste, et il va de soi que le minimum de cohérence professionnelle m’empêcherait de le référer à quelqu’un qui la pratiquerait à ma place. Je lui dirais simplement que ce n’est pas la chose à faire, et il sera libre d’aller voir ailleurs. Mais si j’organisais ce transfert vers un collègue ou une autorité du réseau de la santé sachant que le geste que je considère néfaste sera posé, ce serait comme si je le pratiquais moi-même par mains interposées.

C’est cette logique terre-à-terre que le Collège doit comprendre dans la réaction des médecins (palliativistes ou autres) qui ne veulent pas collaborer au cheminement vers la mort médicalement provoquée de leurs patients. Ces médecins, qui ne sont pas des illuminés ou des fanatiques, voient cette intention de l’État (et du Collège) de leur imposer la collaboration forcée comme un abus d’autorité. L’utilisation du terme « ultime compromis », dans ce contexte, résonne beaucoup plus comme « c’est ma dernière offre ». Et pour continuer de bien nommer les choses, on appelle plutôt ça un ultimatum – et la procureure général du Canada a bien fait de noter l’intention réelle derrière les mots.

En conclusion, si le Collège veut éviter une confrontation injuste et inutile avec des médecins qualifiés, attentionnés et intègres, qu’il trouve une façon de ne pas les contraindre à participer à la mort de leurs patients contre leur jugement médical et leur conscience professionnelle.

Même si les nouvelles mesures d’exception (ne pas lire « règle ») qui seront établies prochainement dans le Code criminel canadien en viennent à permettre l’euthanasie humaine ou le suicide assisté dans certaines conditions, il est impératif de rappeler que de forcer les médecins à référer – en les menaçant de surcroît – constituera toujours une recette assurée pour créer des batailles inutiles et dommageables pour tous, en semant la division et en générant un environnement pourri dans nos hôpitaux.

Le vrai compromis qui respecte l’autonomie de tout le monde serait plutôt celui-ci: si, un jour, il y a dépénalisation de l’euthanasie humaine ou du suicide assisté, laissez les patients faire leurs démarches eux-mêmes par l’entremise d’un système fait de volontaires, sans forcer leurs médecins traitants ni aucun autre intervenant à y participer contre leur gré.

Marc Beauchamp, MD, FRCSC, chirurgien orthopédiste, Montréal

Avec l’appui des cosignataires suivants :

1. Renata Sava, MD, médecin de famille, Montréal

2. Louis Morissette, MD, FRCPC., surspécialiste en psychiatrie légale, Montréal

3. Yousri Hanna, MD, chef de l’Unité des Soins Palliatifs de Santa Cabrini, Montréal

4. Yvan Roy, MD, médecin de famille, L’Assomption

5. Bernard H. Doray, MD, pédiatre, Montréal

6. Antonio Tongué, MD, radiologiste, Gatineau

7. Stephen Martin, MD, médecin de famille, Montréal

8. François Belzile, M.D, FRCPC, radiologiste, Sherbrooke

9. Roy Eappen, MD, endocrinologue, Montréal

10. Annik Dupras, MD, FRCPC, interniste-gériatre, Terrebonne

11. René Pouliot, MD, néphrologue, Québec

12. Francine Gaba, MD, gériatre, Montréal

13. Jacques R. Rouleau, MD, CSPQ, FRCPC, FACC (Institut universitaire de cardiologie et de pneumologie de Québec, Professeur titulaire de médecine, Université Laval)

14. Roger Roberge, MD, gériatre, Montréal

15. Elisabeth Fuvel-Girodias, MD, Kirkland

16. Louis Béland, MD, chirurgien, Québec

17. Nathalie de Grandpré, MD, médecin de famille, Montréal

18. Michelle Bergeron, MD retraitée, Québec

19. Mark Basik MDCM, FRCS(C), chirurgien oncologue, Montréal

20. Guy Bouchard, MD, médecin de famille, Québec

21. Valérie J. Brousseau, BScH, MDCM, FRCSC, oto-rhino-laryngologue, Victoriaville

22. Claude Morin, MD, médecin de famille, Québec

23. Nicholas Newman, MD, FRCSC, chirurgien orthopédiste, Montréal

24. Michel Brouillard, MD, médecin de famille, Rouyn-Noranda

25. Mance Luneau, MD, médecin de famille, Blainville

26. Suzanne Labelle, MD, médecin de famille, Laval

27. Jean-Bernard Girodias, MD, pédiatre, Montréal

28. Juan Francisco Asenjo, MD, anesthésiologiste, Montréal

29. Paul Barré, MD, nephrologue, Montréal

30. Michel Copti, MD, neurologue, Saint-Lambert

31. Liette Pilon, MD, médecin de famille, Montréal

32. André Rochon, MD, médecin de famille, Montréal

33. Douglass Dalton, MD, médecin de famille, Montréal

34. Marie-Chantal Piché, MD, médecin de famille, Vaudreuil-Dorion

35. Odile Michaud, MD, médecin de famille, Otterburn Park

36. Catherine Ferrier, MD, médecin de famille, Montréal

37. Michel de Maupeou, MD, médecin de famille, La Sarre

38. Vijayabalan Balasingam, MD, neurochirurgien, Pointe-Claire

39. Pierrette Girard, MD, chirurgienne orthopédiste, Pointe-Claire

40. Jacques Beaudoin, MD, cardiologue, Québec

41. Marc Bergeron, MD, hémato-oncologue, Québec

42. Rosaire Vaillancourt, MD, FRCPC, chirurgien thoracique, Québec

43. Louis Dionne, MD, chirurgien général, Québec

44. Juan Rivera, MD, endocrinologue, Montréal

45. Lyette St-Hilaire, MD, médecin de famille, Laval

46. Matthieu Tittley, MD, FRCPC, psychiatre, Sherbrooke

47. Luc Chaussé, MD, médecin de famille, L’Assomption

48. Gilles Gaudreau MD, médecin de famille, Sorel-Tracy

49. Evelyne Huglo, MD, médecin de famille, Montréal

50. Hong Phuc Tran-Le, MD, FCMF, médecin de famille, Val d’Or

51. Laurence Normand-Rivest, MD, médecin de famille, Châteauguay

52. Daniel Boulet, MD, FRCP(C), physiatre, Qu.bec

53. Anne-Louise Boucher, MD, responsable médical GMF du Carmel, Trois-Rivières

54. Mathieu Brouillet, MD, médecin de famille, Rimouski

55. David Bacon, MD, CM, CCFP-EM, médecin de famille, Pointe-Claire

56. Marcel D’Amours, MD, anesthésiologiste, Québec

57. Anne Marie Uhlir, MD, médecin de famille, Sainte-Croix

58. Mélanie Laberge, MD, omnipraticienne, Québec

59. Heather Coombs, MD, urgentologue, Montréal

60. Svetlana Ninkovic, MD, pédiatre, neurologue, Greenfield Park

61. Roland Leclerc, MD, pédiatre, Québec

62. Jean-Pierre Beauchef, MD, endocrinologue, Greenfield Park

63. Serge Daneault, MD, soins palliatifs, Montréal

64. Patricia Marchand, MD, médecin de famille, Trois-Rivières

65. Louis Martel, MD, médecin de famille, Trois-Rivières

66. Daniel Viens, MD, FRCPC, interniste, Drummondville

67. Roseline LeBel, MD, médecin de famille, Laval

68. Sonia Calouche, MD, psychiatre, Saint-Eustache

69. Cecile Hendrickx, MD

70. Marie-France Raynault, MD, santé publique, Montréal

71. Julie Gauthier, MD, médecin de famille, Montréal

72. Olivier Yaccarini, MD, médecin de famille, Québec

73. Caroline Girouard, MD, oncologue médicale, Hôpital Sacré-Coeur, Montréal

74. Pierre Duclos, MD, endocrinologue, Québec

75. Normand Lussier, MD, médecin de famille, Montréal

76. Paola Diadori, MD, neurologue, Montréal

77. Bruno Gagnon MD, MSc, Soins Palliatifs, Université Laval, Québec

78. Judith Trudeau, MD, rhumatologue, Hôtel-Dieu de Lévis

79. Yves Bacher, MD, gériatre, Montréal

80. Tommy Aumond-Beaupré, MD, médecin de famille, Montréal

81. Joseph Ayoub, MD, oncologie et soins palliatifs, Montréal

82. Xavier Coll, MD, cardiologue, Lachenaie

83. Léonard Langlois, MD, pédiatre, Sherbrooke

84. Anne Larkin, MD, généraliste depuis plus de 36 ans, Waterloo