Canadian physicians who oppose eu/pas

The College of Family Physicians of Canada (CFPC) Statement concerning euthanasia and physician-assisted suicide

ďOnce you accept killing as a solution for a single problem, you will find tomorrow hundreds of problems for which killing can be seen as a solution.Ē Dr. Karl Gunning, Dutch physician

Statement concerning euthanasia and physician-assisted suicide

The College of Family Physicians of Canada (CFPC) distinguishes palliative care and appropriate decisions to forgo life-sustaining treatment from acts of assisted suicide and active euthanasia. Specifically:

  1. The goals of medicine are not only to cure disease and  minimize suffering but also to provide the best possible end-of-life care, when cure is no longer possible.
  2. Acts intentionally causing a patientís death either by a physician (active euthanasia) or with a physicianís help (assisted suicide) are to be distinguished from the appropriate practice of withholding or withdrawing life-sustaining care.  Even if done out of best possible compassionate motives, euthanasia and assisted suicide are ethically controversial and illegal under the Criminal Code of Canada.
  3. A physician should not agree to a patientís request for the deliberate infliction of death.  Such requests are often calls for urgent attention by the physician and are often prompted by depression, poor palliation, isolation, and fear of abandonment.  Input and consultation might be required from other health care professionals (such as a palliative care specialist, a social worker, an ethicist, a psychiatrist, a spiritual care provider or representative) for help in clarifying the patientís needs and exploring alternative ways of helping the patient.
  4. Patients and families are due effective, comprehensive, and competent palliative care. Such care strives to meet the physical, psychological, social, and spiritual expectations and needs of those living with illness.4   
  5. Patients have the right to participate in decisions about their care. This includes the right to appropriate medical careÜ as well as the right to forgo life-sustaining measures.
  6. A decision to withhold or withdraw certain treatments might result in the earlier death of a patient, but this consequence can be ethically acceptable and legally permissible if carefully and thoughtfully made in consultation with the patient.á
  7. All care aimed at alleviating symptoms due to advanced, terminal disease should be provided.  Even if the care might unintentionally hasten a patientís death, it is ethically acceptable and legally permissible if it is not a deliberate infliction of death.
  8. Where a patientís wishes regarding their care run counter to the physicianís own values and an impasse is reached, the physician must not abandon care but seek to transfer the patient to another physician.
  9. Substitute decision makers for an incapableß patient should make decisions for the patient in accordance with the patientís prior expressed wishes or, if such wishes are unknown or not applicable, shall act in the incapable personís best interests (taking into consideration the patientís prior wishes, beliefs, and values, and the treatmentís effect upon the patientís well-being and its balance of benefits and harms).
  10. Physicians ought to seek clarification of a patientís views about care at the end of life by providing counseling and assistance in the area of advance directives (living wills, mandates for health care, powers of attorney for personal care, proxy decision making). The goal of advance care planning is to encourage physicians, patients, and their significant others to discuss issues concerning death and dying; such discussions can better prepare patients for serious illness and encourage realistic end-of-life care.

ÜAppropriate care means the care that a reasonable practitioner would provide. Patients or families might, at times, ask for treatment that, in the eyes of health care providers, is futile or inappropriate. Such differences in perspective ought to be subject to negotiation and discussion among patients, families, and health care professionals.

áSuch treatment decisions must be made by a capable patient and accord with the principles of informed choice, that is, the consent must relate to the treatment being declined, be informed, be voluntary, and not be obtained through misrepresentation.

ß"Incapacity" means that the person, as regards treatment, is unable to understand the relevant information, appreciate the consequences of a decision or lack thereof, or express his or her wishes. All people are presumed competent unless there are reasonable grounds to the contrary. Incapable patients must have treatment decisions made for them by appropriate substitute decision makers. 

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100 Doctors and Lawyers Warn Canada's Parliament Against Assisted Suicide Bill
Doctors: 'We do not want to become the executioners of our patients.'


OTTAWA, October 26, 2005 ( - A group of 100 physicians and lawyers has issued a strong warning not to legalize physician assisted suicide or euthanasia in Canada.  This statement has been issued in advance of the second reading of private members Bill C-407 scheduled for October 31st.  The Bill seeks to legalize physician assisted suicide.

The document was signed by 61 physicians (comprising essentially all medical specialties including several professors, practicing in such diverse fields as family and internal medicine, oncology, surgery, anaesthesiology, psychiatry, neurology, radiology, medical ethics and palliative care) and is being sent to all MPs to alert them to the dangers of altering existing legislation.  The document has also been endorsed by 39 lawyers.

The statement warns that 'while euthanasia and physician-assisted suicide may superficially appear attractive, they have profound adverse effects on the social fabric of society, on attitudes towards death and illness and on attitudes towards those who are ill or have disabilities.'

The brief warns that in the Netherlands, where euthanasia and physician-assisted suicide have been legalized, at least 1,000 patients including children and newborn babies are being killed every year without their consent by doctors.  Nearly one in ten deaths of newborn babies in Holland occurs after doctors administer medication to babies with the explicit purpose of hastening death. 

The statement quotes UK palliative care specialists who warn that 'Euthanasia, once accepted, is uncontrollable for philosophical, logical and practical reasons.  Patients will certainly die without and against their wishes if any such legislation is introduced.'

The doctors state: "It is easier and cheaper to kill a patient than to treat." The brief warns that once euthanasia or physician- assisted suicide has been legalized, it would put immense pressure on those who, due to illness or disability, consider themselves to be a burden to relatives or society.  Patients or individuals with disabilities will be pressured, warns the letter, into euthanasia or physician assisted suicide. 

In Oregon, where physician assisted suicide has been legalized, almost two-thirds of all those who died through physician assisted suicide were at least to some extent motivated by the belief that they had become a burden to others.  The letter notes that the desire to die and the will to live frequently changes over time, especially if pain and depression have been treated.  The 'wish to die' is rarely a truly autonomous decision.

Rather than assisted suicide leading to a 'good death', the brief notes that medical evidence from Holland shows that nearly one in five patients who attempted physician-assisted suicide were killed by their doctors, because the procedure failed.  Some patients took many hours to several days to die, when they eventually succumbed to the poison they took - certainly not a 'death with dignity'. 

The document warns that legalizing euthanasia and physician assisted suicide will have a very negative effect on the doctor-patient relationship. Patients will wonder whether the physician is wearing 'the white coat of the healer or the black hood of the executioner'.  The doctors state categorically: "'As physicians, we ever (sic) want to become the executioners of our patients."

The document warns that it is impossible to legislate without this legislation being abused.  A change in the legislation, it suggests, will only lead to further devaluing of human life, especially for the vulnerable members of society.

See the complete document
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PDF version -


Source Wednesday October 26, 2005

Institute of Marriage and Family Canada, an initiative of Focus on the Family Canada The Spring 2006 edition contains an excellent article on palliative care A NATURAL DEATH AN INTERVIEW WITH DR. MARGARET COTTLE by Frank Stirk; also Connecting the dots Understanding the history of euthanasia building a disturbing picture we cannot ignore, by Ian Dowbiggin, Ph.D

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