Redefining the Practice of Medicine: Euthanasia in Quebec

Abstract

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 mechanisms.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 wrong.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 College des medecins and College of Pharmacists when the subject shifted from facilitating access to birth control to facilitating the killing of patients.