By Dr. Balfour Mount and Dr. Serge Daneault
Editor’s note. The following letter to the editor was reprinted at alexschadenberg.blogspot.com. It ran in the Montreal Gazette under the headline, “Disappointed that Couillard plans to reintroduce ‘medical aid in dying’ law.” Phillippe Couillard is the premier of Quebec. His Liberal party won 70 seats in the National Assembly in the April 7 general election
Dr. Mount is the father of palliative care in Canada, and Dr. Daneault is the chief of palliative care at University Hospital in Montreal.
We congratulate Philippe Couillard on his victory in the April 7 election. Nonetheless we feel compelled to express our deep disappointment, and that of many medical colleagues and other Quebec citizens, at his announcement the day after the election that he intends to reintroduce Bill 52, including medical aid in dying.
Knowing that in October 2013 he expressed serious reservations about the “medical aid in dying” component of Bill 52, we are mystified by his about-face on this very grave question. It is impossible to legalize euthanasia without putting vulnerable patients at risk, as the experience in Belgium and other countries shows clearly. Bill 52, with or without the amendments, goes even farther than the Belgian law; it defines medical homicide as health care and requires that it be available to all patients who meet the exceedingly broad criteria set out in the bill. As a physician [Couillard is a former neurosurgeon], he is conscious of the power imbalance between physicians and their patients, and how patients can be manipulated to consent even by well-meaning health professionals.
The majority of the citizens and health professionals who made submissions to the Select Committee on Dying with Dignity in 2010-11 opposed legalization of euthanasia, but the report recommended it. The fact that the vast majority of palliative care physicians oppose euthanasia was systematically ignored by the commission and the preceding government. The public, which seems to be clamoring for so-called death with dignity, is largely unaware that what is being proposed to them is a homicidal act and that skilled palliative care and wise management of end-of-life decisions are sufficient to address the fears leading to their request.
From the legal and political point of view, it is clear that the Quebec government lacks jurisdiction to legalize euthanasia, which is contrary to the Criminal Code of Canada, and that this component of the bill will be challenged in court, cause a confrontation with the federal government and ultimately be found illegal. We urge Couillard to examine the legal opinions of the ministry of Justice on this aspect and to publish them as he has promised to do with those regarding the validity of the Secularism Charter (Bill 60).
Balfour Mount MD
Emeritus Eric M. Flanders Professor of Medicine, McGill University
Serge Daneault MD
Chief, Palliative Care Service, Centre hospitalier de l’Université de Montréal (CHUM)