Redefining the Practice of Medicine
Euthanasia in Quebec
An Act Respecting End-of-Life Care (June, 2014)
An Act Respecting End-of-Life Care ("ARELC") is intended to
legalize euthanasia by physicians in the province of Quebec, a legally
contentious project because of Canadian constitutional law. This paper does
not take a position on the desirability of euthanasia or assisted suicide,
but reviews ARELC in detail from the perspective of physicians who do not
wish to be involved with such procedures for reasons of conscience. The
Table of Contents following this summary outlines the paper, which consists
of nine parts and three appendices. Each part opens with an abstract.
Part 1 offers an overview of ARELC and
closes with a review of the long term prospects for the implementation of
the law. Part 2 discusses the law in detail,
including definitions of key terms and procedural requirements. It also
explains how a revision of the original text authorizes two different kinds
of euthanasia: a regulated process for competent patients, and an
unregulated process for incompetent patients. This aspect of the new law has
not received attention.
The issue of slippery slopes is addressed in
Part 3, with particular reference to the guidelines provided in the law.
Part 4 considers the tension among health
care workers generated by the killing of patients, and closes with an
overview of the institutional and legal mechanisms available to implement
the law. Appendices "A" and
"B" provide detailed information about these
Most physicians do not personally kill patients even in jurisdictions
where euthanasia or assisted suicide are legal. This fact collides with
ARELC’s declaration that access to euthanasia is a right.
Part 5 discusses the implications of this
collision in Quebec. Appendix "C" provides
statistics on physician participation in euthanasia and assisted suicide.
Since most physicians will not actually kill patients, and most euthanasia
proponents do not insist that objecting physicians should do so, attacks on
freedom of conscience are more likely to take the form of demands that
physicians facilitate the procedure by referral or other means. Accordingly,
Part 6 uses the criminal law and examples of
capital punishment, torture and female genital mutilation to explore the
concept of morally significant participation in what is believed to be
Physicians may have reasons other than conscientious objection for
refusing to kill a patient. The various reasons for refusal and ARELC’s
provision for conscientious objection are noted in
Part 7, including the continuing criminal
prohibition of euthanasia by Canadian criminal law. Of particular interest
is the extent of immunity from prosecution being sought by physicians, and
the degree of immunity that the government is actually willing to grant.
ARELC exempts palliative care hospices from the requirement to provide
euthanasia, but the exemption has been challenged and hospice administrators
are concerned that the legalization of the procedure will eventually
compromise their operations. Part 8
offers an overview of the challenges and their concerns.
As a general rule, it fundamentally unjust and offensive to human dignity
to require people to support, facilitate or participate in what they
perceive to be wrongful acts; the more serious the wrongdoing, the graver
the injustice and offence. Thus, it was a serious error to include this a
requirement in Code of Ethics for Quebec physicians and
pharmacists. Part 9 uses the concept of
"examined emotions" to demonstrate that this error became intuitively
obvious to the Collège des médecins and College of Pharmacists when the
subject shifted from facilitating access to birth control to facilitating
the killing of patients.