Diane Kelsall is Deputy Editor at CMAJ, and Editor of CMAJ Open.
In June 1993 I attended my first international research meeting. WONCA (World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) was having its annual meeting in The Hague and I had gotten funding from my fellowship program to attend.
It was all very exciting for someone new to the research world to see the hustle and bustle, and feel the energy, that accompanies such a large meeting. Even Queen Beatrix attended.
But that’s not what I remember most about the meeting.
One of the sessions put on by the local organizers focused on euthanasia (that was the term used at the conference). At the time, the Netherlands was the only jurisdiction in the world where this practice was legalized. Many attended out of curiosity—and the collective response was interesting. Numerous attendees filed out of the session in silence, clutching handouts that described euthanasia protocols:
Administer this. If the patient is still breathing, administer that. If the patient’s heart is still beating, do this.
We stood in small groups, hardly able to grasp what we were reading. This was so contrary to everything we had been taught and everything we believed. How could physicians have crossed this line? When did “above all do no harm” turn into an algorithm for death?
When I returned home, I put the protocols away in my desk. Every few years, I would stumble across them—and each time, I felt chilled as I read them.
Fast forward to February 2, 2016,,,
I received an email outlining interim guidance from the College of Physicians and Surgeons of Ontario on physician-assisted death. As I read through the guidance, I came across this statement: “College members may wish to consult resources on drug protocols used in other jurisdictions. Examples of such protocols are available in the Members’ section of the College’s website.”
More than twenty years after my trip to The Hague, I was again being given access to protocols to end patients’ lives.
Only, this time, it was in my own country. In my province. From my College.
I never thought this day would come. And I am still chilled.