Another bioethical quandary for doctors as they face either complying with euthanasia or shutting down their practices.
Canadian members of parliament are attempting to pass a law that would protect the conscience rights of doctors, as government leaders look to expand access to euthanasia in the country.
Conservative MP David Anderson (Cypress Hills—Grasslands, Saskatchewan) introduced bill C-418 in October as a private member’s bill, seeking to protect medical practitioners unwilling to euthanize their patients or provide referrals for medically induced deaths.
Anderson told CNA that he was inspired to submit the bill after hearing complaints from doctors that Canada’s “medical assistance in dying” (MAID) policies were a violation of the Hippocratic Oath.
“One [part] of that oath is ‘we will not administer poison,’” Anderson told CNA in an interview. “So it’s clear, right? And yet, now the medical system is expected to be the ones who actually administer these drugs that terminate people’s lives.”
The legislation would make it illegal to “intimidate a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of medical assistance in dying.”
The bill would also make it an offence to fire someone for refusing to take part in MAID. Canada’s healthcare system is government-run, tying doctors’ working conditions and practice closely to ministerial policy.
Last year, MAID accounted for 1.12 percent of all deaths in Canada. Although Canadians have an option to self-administer the drugs to end their lives, only a single person chose this option.
Anderson told CNA that he is concerned that MAID, coupled with Canada’s aging population and increasingly expensive healthcare system, could result in dehumanization.
Presently in Canada, women who receive a prenatal diagnosis of disability are “encouraged to abort [their preborn child] so they’re not part of our medical system beyond that one event,” Anderson said.
The MP is worried that this attitude could be expanded to view the elderly and persons with disabilities as unnecessarily expensive costs to the healthcare system.
“Certainly, seniors, disabled people cost the system more than the healthy people do,” Anderson said.
“You can see people justifying assisted suicide, euthanasia in the future in order to save money, and we don’t want to get to that point.”
Anderson said there are currently posters in hospitals that explain MAID, and also explain who can request that their doctor end their life.
He told CNA that he thinks this is “entirely inappropriate,” and that people “shouldn’t go into the hospital in order to facilitate (their) death.”
Currently, only people who are over the age of 18, have been deemed to be “mentally competent,” and have been diagnosed with a terminal physical illness by two doctors or two nurse practitioners are eligible to receive MAID.
But these restrictions could be changed, Conservative MP Michael Cooper of St. Albert-Edmonton warned CNA.
The existing MAID policy that was passed into law is “far more limited” than the version originally recommended by the joint legislative committee, Cooper said.
“My concern at this point in time is that the limited safeguards that have been put in place…All of that now is potentially on the table to be opened up, whereby there would be virtually no safeguards in place,” Cooper said.
Potential changes being considered, Cooper explained, include allowing those with mental illnesses as well as “mature minors” to request MAID, and the creation of an “advanced directive” whereby a person can give instructs for their own death as a contingency plan.
“At this point, there has been no indication that further changes to the law are going to be made,” said Cooper.
“But I’m not optimistic that over the long term that won’t be the case.”
Both Cooper and Anderson expressed concern about the state of palliative care in Canada as a result of the MAID law and a lack of clear conscience rights for doctors.
“We do have a strong palliative care community in Canada, who have been encouraging governments to really commit to that,” Anderson said.
“One of the things that concerns me is that I’m hearing about doctors who have been involved in palliative care in the past who are shutting down their practices because of the threat of being forced to participate in assisted suicide.”
This results in fewer palliative care doctors in Canada, “in a time when we probably should be encouraging it and strengthening it.”
“This government has basically window-dressed when it comes to palliative care,” said Cooper, the Albertan MP.
“There’s very little movement on the palliative care front.”
Cooper told CNA that he thinks it “essential” that palliative care be expanded in Canada and that it is not currently available to most Canadians, a problem he said predates the passage of MAID.
“Absent palliative care, many individuals may feel there is no other choice but to go down the road of physician assisted dying, or may even feel pressure from family members or friends who may be otherwise in a position of looking after them,” Cooper said.