Submission to the College of Physicians and Surgeons of Manitoba Re: Draft Statement on Physician Assisted Dying

Abstract

The Project finds the proposed policy concerning the exercise of physician freedom of conscience generally satisfactory. Unfortunately, in its current form, the proposed policy could be understood to mean that objecting physicians cannot or should not discuss euthanasia and assisted suicide with patients. This is inconsistent with recent advice from the College of Family Physicians, and it inadvertently introduces bias against objecting physicians. However, this can easily be corrected by rewording the draft to bring it more closely into line with existing College policy on moral or religious beliefs.The draft does not clearly indicate that patients must be advised about the possibility that the drugs may not cause death as expected. The patient should be asked to provide direction as to what the physician should do in the event of incapacitation by failed physician-assisted suicide or euthanasia. This situation would be particularly problematic for physicians willing to assist with suicide but not provide euthanasia. The killing of an incapacitated patient in such circumstances may be legally questionable even within the terms of the Carter ruling. At a minimum, the Project suggests that physicians should not undertake to provide assisted suicide unless they are also willing to provide euthanasia.The proposed policy seems to envisage the possibility of delegation of aspects of the lethal act to other physicians or health care workers. This increases the likelihood of conflicts of conscience, particularly in urgent situations. While it seems unlikely that physicians will be expected to provide euthanasia and assisted suicide on an urgent basis, there is evidence that this expectation could develop when there is a delay between final approval and the provision of the procedures. Among other things, the Project recommends that the responsible physician should personally administer the lethal drug or be personally present when it is ingested, remain with the patient until death ensues, and be continuously available for this purpose once the procedure has been approved.This submission also recommends that the policy should include provisions to protect physicians, applicants for medical school and medical students from discrimination. The Project's view is that if the draft policy is revised in accordance with its recommendations, the result will be entirely satisfactory from the perspective of ensuring protection of conscience for physicians, without impeding patient access to euthanasia and assisted suicide.Finally, it is unlikely that the College will encounter procedures more contentious than euthanasia and assisted suicide. If the revisions proposed in this submission are accepted, the Project suggests that the part of the policy dealing with physician freedom of conscience could be adopted as a standard policy applicable to all morally contested procedures and services. This would very likely make it unnecessary for the College to revisit the issue of physician freedom of conscience every time social and technological developments give rise to new morally contested procedures.