Comment: B.C. off to a bad start with assisted dying

Unfortunately, so far, B.C. has performed poorly in furthering physician-assisted dying.

The multiparty subcommittee on end-of-life issues recommended availability of assisted dying; astonishingly, the B.C. government rejected its own report without explanation.

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In the absence of any other logical reason, this suggests the possibility that Premier Christy Clark’s statement that the Bible helps her make difficult decisions should be taken at face value.

B.C. was the only province not to participate in the Ontario-led multi-provincial expert advisory group. It maintained “observer status.” No explanation was given. And now, the B.C. College of Physicians and Surgeons has made recommendations that actually impede the implementation of the Supreme Court of Canada ruling.

Physician-assisted dying has to be available across Canada by June 6. All publicly funded hospitals should provide access to assisted dying or appropriate referral for competent patients who request it who are suffering from a “grievous and irremediable medical condition that causes enduring suffering that is intolerable to the patient.”

Surprisingly, the advisory group’s report included allowing advanced consent when a diagnosis is made of a condition that inevitably will produce future, severe dementia. It is recognized that some physicians will refuse assisted death for personal, usually religious, grounds. But most reports state that then the physician should initiate referral elsewhere or with another doctor.

The B.C. College of Physicians and Surgeons is seriously out of step with these recommendations. It states that the patient must be able to give informed consent at “the time of physician-assisted dying.” That absolutely precludes advance consent. Furthermore, it can impose an impossible burden on a patient.

Take the case of a near-terminal patient, who has been approved and given consent for assisted dying. Suppose the planned procedure is five days hence in order to gather family and friends. The day arrives but she has developed some confusion (common in patients who are dying and on large doses of medication). By BCCPS guidelines, the physician cannot carry out the procedure as scheduled. If the confusion persists until death, perhaps several weeks later, then undue suffering is guaranteed to the patient (and the family).

The college has significantly erred in another vital area. Contrary to all the other recommendations (and practices in countries that allow assisted dying), B.C. physicians are not required to make a referral if they refuse to consider assisted dying as a matter of conscience. The physician should “suggest the patient visits an alternative.”

As a physician, I strongly condemn this as cruel and impractical. Suppose a severely ill, suffering and dying patient requests assisted dying to relieve suffering. The physician says: “No, go find an alternative.” How on earth could the patient manage this? This is an insult to medical ethics.

The Canadian Medical Association, which represents the vast majority of Canadian doctors, has stated that “physicians should follow their own conscience,” giving support to those physicians who hold that even referring a patient for assisted dying would be unacceptable. The Catholic Hospital Association has stated that physician-assisted dying cannot take place in its scores of hospitals. And now our own college joins in this crusade.

Conscientious objectors clearly place their own interests above those of the patient. This conflicts with the major role of a physician, which is to act in the patients’ best interest. Declining to consider assisted dying or referral breaks that contract. It also increases stress and suffering. From the patients’ perspective, it is arrogant and paternalistic.

Ironically, the palliative-care physicians who specialize in the care of dying patients are the most vocal opponents of assisted dying, claiming that palliative care obviates the need for assisted dying.

Experience elsewhere has shown this not to be the case. More than 90 per cent of physician-assisted deaths in Oregon are carried out on patients registered in hospice programs. Canadian palliative-care physicians claim that none of their patients would choose this option. But this is disingenuous and paternalistic. None will ask for it when it is not available. As in other countries, a very small number of palliative-care patients will request it if available. That should be their choice.

Seventy-five to 90 per cent of all Canadians, physicians and Catholics are in favour of physician-assisted dying and advance consent. I hope better sense and compassion will prevail, and politicians and physicians will respect the wishes of their constituents and patients.

We must actively challenge our politicians and physicians to ensure that religious dogma and misguided medical ethics do not impede compassionate care to the tiny fraction of patients requesting physician-assisted dying so that that their autonomy is maintained.

Dr. Adrian Fine is a retired medical specialist. He works on the physician advisory committee of Dying With Dignity Canada and is a member of the DWD Victoria chapter.

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