Ontario Call for Conscience 2018
Dr. Frank Ewert wants protection from having to help a patient die — but Dying with Dignity Canada doesn’t want that to happen at the cost of patients receiving full access to end-of-life options.
“When I started back a number of years ago and vowed to follow the Hippocratic oath, I meant it. It was very profound to me, it resonated with my core beliefs, that I would always respect life, that I would do nothing to harm a patient,” Ewert told a legislative committee on Monday evening. . . [Full text]
A policy on handling requests for medically assisted dying is being prepared for the John Noble Home.
The home’s committee of management this week got a staff report on the drafting of a formal policy on managing medical assistance in dying, or MAID, requests, which is now required in long-term care homes by federal law.
The draft could be presented to the committee for review as early as next month and will be referred to the city’s legal department for comment.
Jennifer Miller, administrator for the home for the aged on Mount Pleasant Street, said that, so far, there have been no MAID requests from residents. . . [Full text]
As euthanasia rates increase in the Canadian province of Ontario, pressure is mounting on Catholic Healthcare providers to abandon their blanket opposition to Medical Assistance in Dying (MAiD).
Over 630 Ontarians have received MAiD since the procedure was legalised in Canada in 2015, according to data from the provincial coroner, yet none of these cases has taken place in a Catholic healthcare facility.
Lobby groups are now calling for sanctions on Catholic healthcare providers, particularly in light of the public funding these providers receive.
Dying With Dignity Canada CEO Shanaaz Gokool told CBA News that her organisation is considering a legal challenge of Catholic hospitals’ right to conscientiously object to participation in euthanasia.
Gokool says that the Catholic healthcare policy of transferring MAiD patients to secular facilities places an undue burden on patients. “It really depends on how precarious their physical medical condition is,” she said. “And if they are in a precarious state physically, then that can cause them more trauma.”
Ontario health minister Eric Hoskins said that access to MAiD was not currently a problem. “We’re obviously monitoring it very, very closely and currently don’t have those concerns in terms of access,” he told CBA News. “And about half of medical assistance in dying happens at home”.
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While more than 630 Ontarians to date have legally ended their lives with the help of a nurse or doctor, none have been able to do so within the walls of a hospital that has historic ties to the Catholic Church.
But advocates for medically assisted dying argue that since these are public-funded health-care centres, they are bound to offer the option — even though Ontario law currently exempts any person or institution that objects.
It’s legislation that Dying With Dignity Canada may challenge in court, according to the group’s CEO. . . [Full text]
The agency responsible for expanding Ontario’s network of hospice care wants hospice patients to have the option of assisted suicide, even if most hospices and the majority of doctors oppose it.
“The OPCN (Ontario Palliative Care Network) promotes early and equitable access to hospice palliative care for all patients with a life-limiting illness, including individuals who have requested medical assistance in dying,” a spokesperson for the Ontario Palliative Care Network told The Catholic Register in an email.
The provincially-funded OPCN, a sub-agency of Cancer Care Ontario, “recognizes that there may be an intersection between palliative care and medical assistance in dying (MAID). Both medical assistance in dying and palliative care are health care services that exist within the health care system,” wrote Cancer Care Ontario communications advisor Jayani Perera. “However, the focus and mandate of the Ontario Palliative Care Network is advancing palliative care in the province.”
A year into legalized killing in Canada, the big question is how palliative care and hospice beds will be expanded, said bioethicist Bob Parke. Will governments fund hospices that refuse to perform or refer for assisted dying? . . [Full text]
Outline of the programme
03:00 Dr. Sephora Tang, psychiatrist (objecting physician). Discussion points include potential problem of access to euthanasia/assisted suicide faced by frail and isolated patients, those in rural areas or “negative elements” in families, central referral service alternative, issue of complicity, physician-patient relationship.
12:16 Caller Dr. Terry, primary care (objecting physician). Discussion points include erosion of medical ethics, erosion of trust in physician-patient relationship, relationship between law and ethics, distinction in skill sets needed for euthanasia/assisted suicide vs. abortion.
19:25 Interviewer outlines points in position of the Canadian Medical Association
20:19 Caller Vivi. Favours compulsory referral because access to euthanasia/assisted suicide should be considered from patient perspective, not doctor’s.
22:32 Dr. Sephora Tang responds to points made by caller.
24:34 Caller Dr. Ramona Coelho (objecting physician). Explains why she will not make effective referral.
25:42 Caller Dr. David Roussell, President, College of Physicians & Surgeons of Ontario (CPSO). Interviewer puts to him opposition to effective referral by the Canadian Medical Association, more liberal policies in other provinces. Dr. Roussell discusses College policy requiring effective referral. Asserts that the College is primarily concerned with access to euthanasia/assisted suicide etc. by patients who might have difficulty doing do if their physician does not assist. Notes that both Nova Scotia and Quebec have similar requirements, so Ontario is not alone. Notes that referral does not always result in procedure being obtained. Characterizes objections to effective referral as oversensitive. Acknowledges that loss of licence to practice is one possible outcome of complaint against a physician for refusing to refer.
35:12 Caller Dr. Christine (objecting physician). Emphasizes central care coordinating system and self-referral by patients would be more efficient and avoid conflicts of conscience.
37:20 Caller Dr. Roussell agrees that central coordination system and self-referral is promising, but asserts that this can “fall apart” in some cases.
38:25 Caller David. Opposed to compulsory referral. Believes it is safer to ensure diversity of views in society, especially in life and death matters, by protecting freedom of conscience.
41:30 Interviewer asks Dr. Roussell to respond to concerns about freedom of conscience.
42:00 Caller Dr. Roussell notes “private beliefs, religious or otherwise, are not the purview, shouldn’t be the purview of the College or the government . . . What we’re talking about here is from the public’s point of view. There’s a legally available service to, in most people’s minds, alleviate suffering, which is what medicine is supposed to be about. And the battle’s been fought, the war’s been won, the law has been passed. Why are we throwing up obstacles to a legally accessible service? Especially throwing up obstacles at the last moment to people who are in some sense suffering.”
43:04 Caller Joel (medical student). Supports compulsory referral. “Doctors in Canada should not be practising medicine in Canada if they feel that their moral code supersedes what is law.” He adds, “It is great for doctors to unite and object on some things” and refers to the Alberta system (which has proved acceptable to objecting physicians). He believes that effective referral for euthanasia or assisted suicide does not make a physician a “conduit of death,” but means that the patient can access a specialist with appropriate training. He characterizes acceptance of conscientious objection as a “slippery slope.”
44:45 Caller Erica. Supports compulsory referral. Her mother (whom she identified as a Christian) was suffering from multiple sclerosis. She was joyful when euthanasia was legalized [Criminal Code amendments given Royal Assent in June, 2016; Administrator]. She was not euthanized/assisted with suicide until the end of December, 2016 because her physician (whom Erica also identified as a Christian) refused, and refused to refer her. Erica stated that this “absolutely shattered her. It took her days to pick herself up and decide she was going to keep trying to find somebody.” Asserts that denying such people access to a medical procedure is unfair.
46:31 Interviewer notes that less than 75 physicians in Ontario are actually providing euthanasia/assisted suicide. Erica explains that a doctor was found after a CBC interview made her situation public.
47:28 Dr. Sephora Tang responds. Notes that patients want access, and she does not wish to impede. The system set up by the government made it impossible for patients to access euthanasia/assisted suicide on their own. If society wants people to have access, there are alternative ways to ensure access that should be considered.
48:07 Interviewer asks about patients being fearful of the “judgement” of their physicians.
48:27 Dr. Sephora Tang emphasizes importance of trust in physician-patient relationship. It is better for the patient to know where she stands on some issues, so there “no guessing around that.” It is possible to agree to disagree.
49:16 Dr. Chantal (euthanasia/assisted suicide provider). Supports compulsory referral, because “patients need access.” Abortion clinics are not an appropriate comparison. Referral must include all relevant medical information. “No medical information is necessary for a physician to do an abortion,” but is needed prior to performing euthanasia/assisted suicide. To expect patients to go to hospitals and doctors to gather all of the relevant medical information is “completely unreasonable.” Patients would be “significantly compromised” if objecting physicians refused to provide the relevant information.
Postscript from Dr. Christine (Reproduced with permission)
Just because a physician may conscientiously object to formal participation by the administrative/legal/ethical agreement implied by a documentation-based referral (re: linking billing numbers between 2 practitioners for review +/- enactment of a desired procedure),this does NOT mean that an objecting physician would ever dare to obstruct the subsequently requested movement of health file information (which is first and foremost a property that emanates from the patient!) to the clinician to whom the patient wishes to receive lethal injections from.
Furthermore: If a patient seeks a care pathway that may end in MAiD, through a care coordination service in the ideal case, then there are administrative health professionals in all the offices who can and do link with each other to physically get the records moving.
(Again, a physician is not the one pulling the files in a Norman Rockwell/1950’s-style office; we now have digital spigots to move information, and physicians are not required to unlock the content in our current collaborative environment of ConnectingOntario/PRO/OLIS).
My original point in the call is that forcing a physician to fill out referrals (and limiting the power/responsibility to do this, to physicians) is ironically creating (rather than removing) a barrier to care.
(Incidentally – and not all people know this – it is also quite typical and not an exception for most referrals to come with inadequate background case information, even in non-controversial indications; doctors know how to probe for what’s missing [and often have to ask for information in several iterations and from multiple parties], and gaps from healthcare fragmentation are not so much a product of malfeasance as simply laziness…)
Bill 84 has been passed into law in Ontario and outlines the legal issues surrounding medical aid in dying (MAID), which has been legal in Canada since last year. The patient’s death must be “reasonably foreseeable” and their suffering “grievous and irremediable” to qualify for the service. Groups such as those with advance directives, mental illness, and minors are left out, and whether they should be allowed access to this service in the future is an issue for another time.
One of the most contentious aspects of Bill 84 is the requirement for the treating physician in Ontario to provide a referral for a patient who has requested MAID to a physician who provides it. . . [Full text]
Waterloo Region Record
Last week five doctors and several rights groups were in Ontario’s Divisional Court challenging rules imposed by the College of Physicians and Surgeons of Ontario to punish doctors who refuse to help arrange assisted suicide. The Court reserved its ruling, which will be released at a later date.
Ontario’s new assisted suicide law amended various Acts in response to the federal legislation on assisted suicide. Pleas to guarantee freedom of conscientious objection for doctors who defy orders to provide “effective referral” were ignored by the legislature, so penalties imposed by the College of Physicians and Surgeons of Ontario against conscientious objectors remain in force.
Remarkably, in just two short years Canadians have gone from punishing those who helped arrange assisted suicide to punishing those who refuse to arrange assisted suicide. . . [Full text]
“Martha” was stunned when her 78-year-old father told her he wanted a medically assisted death, after battling lung cancer for almost two years.
“It’s something you’ve never contemplated before in your family,” she said. “How do you prepare for this? This date that somebody’s going to pass away. It’s really hard.”
Martha has asked CBC News to use only her middle name, because children in her family don’t know that their grandfather’s death was medically assisted. A year after Canada’s Medical Assistance in Dying law passed on June 17, 2016, the issue remains highly controversial. . . [Full text]