Quebec doctors' support for euthanasia raises ethical questions

Originally published in the National Post November 3rd 2009. To go to the National Post website, please click here

A decision by the medical regulatory body of Quebec to support legalized euthanasia in “exceptional situations” raises grave concern about crossing ethical boundaries that violate the fundamental duty of physicians, critics say.

“I am concerned that a physicians’ group would come out so unequivocally and say they are in favour of it,” said Dr. Jeff Blackmer, head of the Canadian Medical Association’s office of ethics. “It’s a group of physicians that are regulators who set the moral and ethical standards for practicing physicians. So they carry a certain amount of weight that could sway public opinion.”

On Tuesday, the Quebec College of Physicians and Surgeons, the province’s regulator, said the Criminal Code should be changed to allow doctors to take the life of certain patients facing imminent death.

“We are saying death can be an appropriate type of care in certain circumstances,” said Dr. Yves Robert, a college official, at a news conference in Montreal on Tuesday. (Read their full release)

“This is a major breakthrough.”

This is the first time in Canada that a regulatory body has openly supported euthanasia.

Opinion polls have consistently shown that a majority of Canadians support some form of legalized euthanasia, with the strongest support typically in Quebec.

The document from the college argues it is impossible to have one law that covers an array of complex end-of-life issues — and that the current law impinges on the rights of doctors and patients to make their own decisions for situations that cannot be helped by palliative care.

“In effect, there are certain exceptional situations — uncontrollable pain or interminable suffering, for example — in which euthanasia could be considered a final step required to assure the provision of quality care,” the document said. “[We must] stop denying the existence of these difficult situations and we openly discuss the various options facing us …” the report said.

The college rejects a private member’s bill that would legalize euthanasia and is now going through second reading in Parliament, calling it far too broad. Bill C-384 would allow patients to request euthanasia for physical or mental distress, even if they refuse to seek medical treatment.

“[It] is understandable for a doctor or anyone else to be reluctant to shorten the life of a patient who is depressed or to help a patient to die who refuses appropriate care,” the report said.

Senator Sharon Carstairs, a proponent of improved end-of-life care in Canada, said if euthanasia was made legal now it could stop the improvements made to palliative care access.

However, she said she commended the Quebec college for at least airing the issue.

“Euthanasia is going on in Canada; we know that,” she said. “So they’re saying ‘bring it out of the closet and make it legal.’ ”

She said the college’s position is “premature” because we still do not have adequate palliative care.

But even with the best palliative care in the world, she added, there will be those who will want the right to end their life legally, so the debate would continue.