Monday, June 19, 2017

We are a nation of laws and conscience

This article was published in The National Post online on June 15 2017

By: Dr. Ramona Coelho (London, ON), Dr. Lucas Vivas (Toronto, ON), Catherine Ferrier, MD (Montreal, QC), Ricardo Di Cecca (Burlington, ON)


Dr. Ramona Coelho
Re: When religion must yield to the law, Derek Smith, June 12. Derek Smith claims that rules are essential to prevent religious physicians from harming others. A physician not willing to arrange the killing (MAiD—Medical Assistance in Dying) of a patient is now seen by some as causing harm. While that is debatable in our pluralistic society, what is clear is that the protection of the patient’s life has always been the foundation for the trust in the patient-physician relationship.

Groups representing Jews, Muslims, Christians, Sikhs and secular humanists have all said that effective referral isn’t a workable solution for patient access. The College of Physicians and Surgeons of Ontario has helpfully suggested that physicians who cannot adopt their pro-MAiD ethical framework should leave or retrain. Is that a compassionate or creative response to this conundrum? We all are paying for our health system and therefore we all belong.

These doctors have been vocal about their willingness to give information and not obstruct patient wishes. Everywhere else has a more respectful system. Why would coercion be part of the equation here in Ontario?

Derek Smith mentions frail patients, unable to use a phone to self-refer. I am a doctor with years of home care experience of the most vulnerable. I have met new patients who were isolated, poor, malnourished, in pain, and some suicidal. One can imagine that helping that patient access MAiD would not be anyone’s priority nor would that patient be in a state to choose such a service.

For frail and vulnerable patients to live in the community, they need a full care team. Anyone on the care team could help make the phone call.

There are many ways to accommodate both physician and patient in these tricky situations. Coercion need not be one of them and is not a creative nor a Canadian solution. Derek Smith is concerned that religious physicians may impede access to assisted death in “frail patient(s) who cannot make a MAiD phone call.”

A patient so isolated that they cannot make a phone call is not in need of killing: they are in need of social supports and care so that they may not be alone in their final illness.

It is impossible that a patient in such isolation would really have received “adequate palliative care”, and facilitating their death will only result in less motivation to fund and provide the high-quality palliation that our most vulnerable so desperately need.

Rather than spending time and resources trying to compel good doctors to lose their integrity or leave the profession, the College of Physicians and Surgeons and the Ministry of Health should be focusing on providing better end-of-life care to all Ontarians. Derek Smith opposes the lawsuit against the College of Physicians and Surgeons of Ontario by doctors who are not willing to send patients to be euthanized. To support his arguments, he creates an imaginary world in which a medical need is being denied to frail people in emergency situations by religious zealots who refuse to do their duty.

Medicine is an ancient and universal profession whose purpose is to diagnose, treat and prevent disease, and to relieve symptoms where cure is not possible.

Canada is one of a tiny minority of countries that permit doctors to kill patients, an act that remains anathema to the worldwide medical community. Even among supporters of euthanasia there are some who now question the role of medicine in its administration.

Consider his imaginary frail patient, wanting euthanasia (as a now-legal personal choice, not a medical need), but unable to use a telephone or a computer to access a centralized referral system.

Does that person exist? How does he get groceries or do his banking? If hospitalized, is she not surrounded by a host of other people to whom the request can be made? Is there anyone so isolated they cannot find one person to help them get what they want? What is Dying with Dignity for, if not for that?

What “emergency” need for death does he have in mind?


His comparison between refusing euthanasia and a religious denial of urgent blood transfusion for a child is ludicrous and pathetic. The latter has to do with saving life, the former with ending it.

If the “emergency” is uncontrolled pain, he should be screaming about the real problem of access to palliative care, not access to death.

And what about this being all about religion? The eligibility criteria in the law have nothing to do with religion and every thing to do with protecting patients from choosing death with out having a chance at life preserving options. Many objecting doctors have no religious affiliation: they just want the freedom to keep caring for patients in stead of sending them to their death.

We can’t have a debate unless we’re living in the same world. At the heart of freedom is the right of conscience. When it is under cut or coerced by the state, it be comes totalitarian and dangerous.

To paraphrase C. S. Lewis: the road to perdition is a gradual one—a gentle slope, soft under foot, without sudden curves, without mile markers, without signage.

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