Physician-assisted dying in Canada: the gavel has fallen


Kirsten Patrick is Deputy Editor at CMAJ


Today is a momentous day for physicians in Canada. No matter what your opinion about whether or not physician assisted dying is morally right, it will be a human right henceforth under certain circumstances.

We have aired a broad spectrum of views on this forum in the lead up to the Supreme Court of Canada’s unanimous decision on Carter vs. the Attorney General, released this morning. Even CMAJ’s editors are divided in their personal opinions. We have discussed our personal views in many an editorial meeting, and CMAJ’s Editor-In-Chief, John Fletcher, put me on the spot to declare my position publicly when we were recording the podcast for the November 18th issue of the journal.

Many Canadian physicians will feel unhappy about the decision, perhaps even angry or betrayed. CMAJ posted a link to the ruling on its Facebook page this morning along with remarks made today by the CMA’s president, Dr Chris Simpson. There have already been negative comments, one suggesting that the CMA has let physicians down.

The CMA did change its stance on the issue of PAD recently, which resulted in both harsh criticism and expressions of respect. This followed a series of town halls, which the CMA conducted across the country in partnership with Macleans magazine to consult members of the public on end-of-life issues, and a fulsome report on the findings of this process.

I think it is safe to say that we are seeing a disconnect between wider public opinion on the issue and how physicians feel about PAD. Public opinion has shifted substantially since the SCC issued a different verdict on a similar case 20 years ago, but the stance of the medical profession has perhaps shifted much less. I think that this has to do, in part, with physicians being the ones who will have to prescribe life ending medication (for the express purpose of terminating a life). For a profession charged with protecting health and saving lives there is, understandably, a difficult moral dilemma.

That said, I am in favour of allowing physician assisted death, with careful regulation and under the clear circumstances outlined in today’s ruling, which are as follows.

The Court concluded that any new law must include safeguards …To allow for PAD to go ahead an indvidual would need to:

  • Be a competent adult;
  • clearly consent to the hastening of life;
  • have a grievous and irremediable medical condition (including an illness, disease or disability), and
  • be suffering intolerably

The Supreme Court has allowed Parliament and the provincial legislatures 12 months to enact new legislation that upholds these fundamental human rights.

I feel that today’s SC decision is a victory for compassion, and also an opportunity for displaying humility. We have enough evidence from other jurisdictions to allay any fears I may have had regarding ‘the slippery slope’. I support freedom of the person and the right to choose, as I have done in other difficult debates. I would like the freedom to be able to make this choice for myself one day, should I wish to make it in some unimaginable and un-hoped-for future. I would like my children and any other loved-ones to have the freedom to support my wishes. This is what I told Dr Fletcher when he asked my view back in November.

Let’s face it. The majority who are healthy of body do not wish to die. No physician really wants to prescribe life-ending medication or participate in deliberate termination of life. But we are not omnipotent, we cannot prevent death and we are not able to relieve the terrible physical suffering of some patients. While the right of physicians to ‘conscientiously object’ to being party to PAD should not be questioned, I hope that objectors will be compassionate enough not to make it difficult for patients who make this choice to receive the assistance to which they are now entitled.



5 thoughts on “Physician-assisted dying in Canada: the gavel has fallen

  1. Barry McMahon

    I am deeply disappointed in today's decision regarding physician assisted suicide. Wouldn't a veterinarian be more qualified to do the job? They are highly trained in euthanasia. I certainly don't feel my physician should be asked to quicken my death. Palliative care is much more sophisticated now versus 20 years ago when the case of assisted suicide first went to the Supreme Court. I want to have full confidence that the medical profession is focused on my quality of life regardless of where I am in Canada.

  2. Kristina Joyal

    From a CMAJ article in 2010: Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey
    "208 deaths involving the use of life-ending drugs were reported:... 66 (weighted prevalence 1.8%) were without an explicit request"

    I do NOT find that reassuring the euthanasia/assisted suicide can be implemented with enough safeguards in place to prevent abuse!

  3. Gerald Ashe

    Thank you for this. It is well written and really captures the issue for physicians. What really matters is that it is not about the is about the patient. I am proud of the CMA.

  4. Alison Froese

    I am afraid you are missing some substantial evidence when you conclude that no slippery slope has been evident to date. One early proponent of euthanasia in the Netherlands, Professor Theo Boer, an ethicist, recently wrote an article for the British media saying 'Don't Go There'. Between 2001 and 2007 the number of assisted deaths remained stable. Since then it has risen by 15% of all deaths each year. Assisted death now includes babies born with potential disabilities, depressed adolescents, people just lonely or tired of living and couple suicides where the healthy spouse is euthanized along with the ill spouse. You can get a mobile van to come to your house an euthanize your demented parent. Boer says it is currently our of control. Safeguards are always assumed to be an adequate protection. the have proven not to be. Since the major argument used for the current legalization has always been personal autonomy, how can any doctor argue against a person's 'indications for assisted death' is either totally subjective (grievous condition/suffering intolerably) with these being determined solely by the patient, or at risk of coercion, which of course cannot be 'proven' without subjecting the patient and family members to lie-detector tests! One dutch physician simply states openly that he never fallows the legal requirement to report his euthanasia deaths. The only dutch doctor who did report simply had his case dismissed.

  5. Few die by assisted-death.
    Many say that they have peace of mind just knowing that the option is theirs.

    Allow Me To Die: Euthanasia in Belgium


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