World Medical Association to consider policy changes on abortion, euthanasia, assisted suicide

Debate planned for ethics conference in October in Iceland

Sean Murphy*

Following a meeting of the WMA Council in Riga, Latvia, the WMA issued a statement noting that a revised version of the WMA abortion policy would be presented for approval at the WMA annual General Assembly in Reykjavik, Iceland.

In addition, the WMA has announced that there will be a further “open debate” on changing the Association’s policy against physician participation in euthasnasia and assisted suicide.  The debate will occur during a WMA conference on medical ethics taking place at the same time and place.  Formal presentations on euthanasia and assisted suicide will be given on 4 October, 2018, but informal discussions among delegates are likely to be important.  The debate appears to be a consequence of lobbying by the Canadian and Royal Dutch Medical Associations to convince the WMA to drop its condemnation of the practices

It is not clear whether or not WMA members appreciate the relationship between abortion policy and euthanasia policy.  Compulsory referral for abortion is essentially a dress rehearsal for compulsory referral for euthanasia and assisted suicide, something clearly demonstrated in Canada.  Accusations of “patient abandonment” formerly aimed at those refusing to refer for abortion1 are now, in addition, being levelled at those who refuse to refer patients to someone willing to kill them or help them commit suicide.2

In 2011, a Royal Society of Canada panel of experts chaired by Udo Schuklenk  recommended legalization of assisted suicide and euthanasia.3  The experts insisted that health care professionals unwilling to provide euthanasia help patients commit suicide must refer them to someone willing to do so.4 This was justified, they said, because it was agreed that objectors are obliged to refer for “reproductive health services.”5  It really was not agreed: the Canadian Medical Association had, in fact, rejected this claim five years earlier6 after it was made by Jocelyn Downie,7 one of Schuklenk’s colleagues on the Royal Society Panel.

By 2015 Schuklenk was arguing that objecting physicians should not be accommodated at all. Among his arguments was that referring for abortion or euthanasia is not a compromise because it involves moral complicity in the act, “barely reduced” by the act of referral.8  This implied that physicians should be forced to provide abortion and euthanasia, notwithstanding religious or conscientious convictions to the contrary, a position Schuklenk explicitly adopted over the next two years.9, 10

At the same time, Ottawa law professor Amir Attaran was insisting that physicians should be forced to kill eligible patients themselves.11 He claimed that this was required by human rights law,12 describing effective referral as an unacceptable form of illicit discrimination.13

In considering changes to euthanasia, assisted suicide and abortion policies in October, WMA delegates will have to take great care to consider not only the most obvious ethical issues of life and death, but less obvious yet important issues like the distinction between acceptable cooperation and unacceptable collaboration, which play out in disputes about mandatory referral for abortion and euthanasia.


Notes
1.  “According to the prevailing norm of beneficence therefore, as well as those of trust, patient autonomy, and not abandoning patients, physicians should refer patients for abortions.”  McLeod C. Referral in the Wake of Conscientious Objection to Abortion. Hypatia, Vol. 23, No. 4 (October-December, 2008) at p. 36 (Accessed 2018-08-022).

2.  Cook M. Canadian court tells doctors they must refer for euthanasia. Mercatornet, 2 February, 2018

3. Schuklenk U, van Delden JJM, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel on End-of-Life Decision Making (November, 2011)[“Royal Society“] p. 96 (Accessed 2014-02-23).

4.  Royal Society, p. 69, 101.

5.  Royal Society, p. 62.

6.  Blackmer J. Clarification of the CMA’s position on induced abortion. CMAJ April 24, 2007 vol. 176 no. 9 doi: 10.1503/cmaj.1070035 (Accessed 2017-12-12).

7.  Rodgers S. Downie J. Abortion: Ensuring Access. CMAJ July 4, 2006 vol. 175 no. 1 doi: 10.1503/cmaj.060548 (Accessed 2017-12-12).

8.  Schuklenk, U. Conscientious objection in medicine: private ideological convictions must not supercede public service obligations (2015) 29:5 Bioethics ii, DOI: 10.1111/bioe.12167

9.  Schuklenk U, Smalling R. Why medical professionals have no claim to conscientious objection accommodation in liberal democracies (2016) 43:4 J Med Ethics 234, DOI: http://dx.doi.org/10.1136/medethics-2016-103560.

10. Savulescu J, Schuklenk U. Doctors have no right to refuse medical assistance in dying, abortion or contraception (2017) 31:3 Bioethics 162, DOI: 10.1111/bioe.12288

11.  Though conceding that a lethal drug might be administered in the physician’s presence by a delegate, and that referral might be necessitated by technical incompetence. Attaran A. The Limits of Conscientious and Religious Objection to Physician-Assisted Dying after the Supreme Court’s Decision in Carter v Canada (2016 ) 36:3 Health L Can 86 [“Attaran“], p. 87-88, 96.

12.  “[W]hen a doctor refuses to assist a patient who is disabled by a ‘grievous and irremediable medical condition’, just because the patient wants death rather than something else, that arguably discriminates against the disabled patient.” Attaran, p. 89.

13.  Attaran, p. 91–93.

Podcast: Amir Attaran and the elves: A law professor makes much ado

A response to   “Doctors can’t refuse to help a patient die – no matter what they say”, a column by University of Ottawa law professor Amir Attaran.  He refers to  the alleged “corrosive hostility” of the Canadian Medical Association to “physician-assisted dying” and its “cowardly and stupid” position on the procedure, including support for physician freedom of conscience. [Full text – Amir Attaran and the elves]

Podcast Contents

Introduction (00 – 01:40)

Attaran: CMA siding with “bigots”  (02:11 –  4:50  )

Attaran: “they cannot refuse”  (05:23 – 06:33)

What Professor Attaran left out  (06:34 – 08:15 )

Professor  Attaran then and now  (08:50 – 09:56)

Law on abortion vs. law on homicide  (09:57 – 11:32)

A difference in perspective  (11:33  – 13:12)

What else Professor Attaran left out  (13:13 – 18:38)

Getting the facts backwards  (19:11 – 20:50 )

Amir Attaran and the elves

 

A law professor makes much ado

Sean Murphy*

In a column in the on-line magazine iPolitics,1 University of Ottawa law professor Amir Attaran asserts that the “corrosive hostility” of the Canadian Medical Association to “physician-assisted dying” is evident in its “cowardly and stupid” position on the procedure. He claims that the Association “all but threatened” the Supreme Court of Canada that “doctors would rise up” to block it.

In his telling, ever since the Court ignored the threat and struck down the law, the CMA has been acting like a “sore loser,” trying to persuade physicians not to participate. As evidence, he quotes a CMA policy recommendation: “Physicians are not obligated to fulfil requests for assisted dying.” And he complains that the CMA won’t force physicians unwilling to kill patients or help them commit suicide to find someone who will.

Now, the CMA also states that all eligible people should have access to the services without undue delay, and physicians will work with others to ensure access to them,2 but Professor Attaran ignores this. His analysis of CMA policy is simple and scathing. Some physicians, he says, are “bigots,” and the CMA is siding with “those bigots” rather than with patients.

Professor Attaran identifies the bigots: physicians who believe that killing patients or helping them commit suicide is gravely wrong, or at least a bad idea, even in the circumstances defined by the Supreme Court. Those whom Professor Attaran denounces as bigots include physicians who believe they are ethically obliged to compassionately accompany and support dying patients, but not to kill them.

On the contrary, says Professor Attaran, they are “duty-bound” to kill patients or help them commit suicide precisely because the Supreme Court “pointedly” approved “physician-assisted suicide.”*  If physicians won’t help patients commit suicide, he rages, “then who does the CMA think should be obliged to help – elves, maybe?”

To which any number of physicians have already replied, “Not elves, but lawyers.”

[Full text]

[iPolitics version- Doctors aren’t obliged — legally or otherwise — to help people die]

 

A bureaucracy of medical deception

 Quebec physicians told to falsify euthanasia death certificates

Regulators support coverup of euthanasia from families

Sean Murphy*

In the first week of September, the Canadian Medical Association (CMA) was reported to be “seeking ‘clarity'” about whether or not physicians who perform euthanasia should misrepresent the medical cause of death, classifying death by lethal injection or infusion as death by natural causes. The question arose because the Quebec College of Physicians was said to be “considering recommending” that Quebec physicians who provide euthanasia should declare the immediate cause of death to be an underlying medical condition, not the administration of the drugs that actually kill the patient.1 In fact, the Collège des médecins du Québec and pharmacy and nursing regulators in the province had already made the decision. In August, the three regulators issued a Practice Guide directing Quebec physicians to falsify death certificates in euthanasia cases.

The physician must write as the immediate cause of death the disease or morbid condition which justified [the medical aid in dying] and caused the death. It is not a question of the manner of death (cardiac arrest), but of the disease, accident or complication that led to the death. The term medical aid in dying should not appear on this document.2

Lawyer Jean Pierre Ménard correctly observed that Quebec’s euthanasia law does not require physicians to report euthanasia on death certificates.1  M. Ménard is an expert on euthanasia law consulted by the Quebec government and the CMA,3  but he seems unaware of guidelines relevant to the classification of deaths and medico-legal death investigations. . . [Full text]