GESTIÓN EN SALUD PÚBLICA: BioEdge: A judge loosens Canada’s euthanasia belt another notch or two

domingo, 15 de septiembre de 2019

BioEdge: A judge loosens Canada’s euthanasia belt another notch or two

BioEdge: A judge loosens Canada’s euthanasia belt another notch or two

Bioedge

A judge loosens Canada’s euthanasia belt another notch or two

by Michael Cook | 15 Sep 2019 |

Something north of 8,000 people have died in Canada after its Medical Aid in Dying legislation came into effect in 2016. And now it will probably become easier after a decision by a Québec judge.

This week Superior Court Justice Christine Baudouin struck down as unconstitutional a provision in the federal legislation which restricts euthanasia to terminally ill patients. The clause says that a patient’s natural death had to be “reasonably foreseeable". This meant that some patients who wanted to die had to face the prospect of seemingly endless pain.

Denying them access to assisted dying is “forcing them to endure harsh physical and psychological suffering,” Justice Baudouin wrote. “The court has no hesitation in concluding that the requirement that their death has to be reasonably foreseeable is violating the rights to liberty and security of [the plaintiffs.]”

Euthanasia supporters were delighted.

“Three years ago, when the [federal] law was being debated, we raised concerns about the reasonably foreseeable criterion, arguing that it does not comply with the [Supreme Court’s] Carter decision," said Cory Ruf, of Dying with Dignity Canada. He had heard stories of Canadians who travelled to Switzerland for assisted suicide, starved themselves, or committed suicide because they were unable to obtain relief under the current law.

However, for Dr Michel Racicot, who represents the le Collectif des médecins contre l’euthanasie (Collective of Physicians against Euthanasia), the judgement sends a bad message.

"If we remove this criterion (to be terminally ill), we do not transform medical aid in dying into help for the dying person; rather, it becomes almost death on demand for people who are suffering, but who may still have to a long life ahead of them.”

Furthermore, at a time when the Canadian government is promoting suicide prevention, removing the “reasonably foreseeable” clause creates a two-tier system of suicide, he observed.

"We're going to have two kinds of suicides: good suicides, which are going to be medical aid in dying for people who are not at the end of life -- because it's a form of suicide, no doubt about it -- and bad suicides, the ones we are trying to prevent. "

Michael Cook is editor of BioEdge

Conscientious objection to procedures like abortion and euthanasia often features in BioEdge. There is a growing consensus that CO has no place in modern medicine. It’s often argued nowadays that a doctor’s duty is to carry out the wishes of patients, regardless of whether they agree with them or not.

I stumbled across an interesting hypothetical on the American Medical Association Journal of Ethics which makes me question this consensus. In it, three bioethicists analyse a situation involving a difficult patient with deep Christian convictions. He is refusing post-operative pain medication because he believes that he needs to suffer in order to atone for his life as an alcoholic. What should the physician do?

The bioethicists conclude that he should neither acquiesce nor refer the patient to another doctor who will acquiesce. Instead, the physician should “refuse to offer this course of action, regardless of the religious rationale for such a request”.

They go on to assert that “Indeed, as part of their professional commitment to the patient’s health, physicians have some obligation to respectfully challenge patients' refusals of medical care that the physician believes is needed. A sincere discussion—even a respectful debate—in no way denigrates [his] religious beliefs.”

Indeed, this makes good sense. But, viewed from another angle, the bioethicists are advising the physician to conscientiously object to a course of action determined by a lucid patient after serious consideration. They even counsel him to argue (respectfully) with the patient to convince him that he is wrong.

If this is so obviously the case, why is it wrong for a doctor to refuse to perform an abortion? I’m having trouble reconciling the ethical reasoning of the two situations. Can anyone help?