Patients need protection from unwanted euthanasia discussions, ethicists say 

Two Canadian medical ethicists are calling on the federal government to prohibit health-care personnel from raising the subject of doctor-assisted suicide when discussing treatment options with patients.

The need to protect patients from unsolicited information on assisted suicide follows The B.C. Catholic’s publication of the results of an investigation that found medical personnel in the Fraser Health Authority exert pro-euthanasia pressure on patients despite policies against it. 

The policies, which The B.C. Catholic obtained through a Freedom of Information application, specify that “medical assistance in dying “is supposed to be an “entirely patient-driven” process.

The revelation comes as the House of Commons is debating Bill C-7 which would expand euthanasia to those who request it for reasons of mental illness.

Dr. Margaret Somerville, professor of bioethics at the University of Notre Dame in Australia, said the practice of health-care professionals suggesting assisted suicide “is extremely worrying and unethical.”

In an email exchange, Somerville said the Australian state of Victoria’s assisted-suicide legislation, called the Voluntary Assisted Dying Act, contains the sort of patient-first declaration Canada’s euthanasia law needs.

A patient fact sheet accompanying the Australian legislation explains: “Only you can start a discussion with your doctor or health practitioner about voluntary assisted dying. Your doctor or health practitioner cannot start the discussion […] This helps to make sure your decision to seek voluntary assisted dying is voluntary.”

“Patients to whom it is proposed are necessarily extremely vulnerable,” said Somerville, founding director of the McGill Centre for Medicine, Ethics and Law.

“We know that a principal reason for requesting euthanasia is fear of being a burden on others. A suggestion of euthanasia is a clear message that the health-care professional is telling the patient, ‘Your life is not worth living. You would be better off dead.’”

Natalie Sonnen, executive director of Life Canada, agreed patients need protection from unwanted discussions about euthanasia as they’re in a vulnerable position and often don’t want to be a burden on others.

Sonnen recounted being on an airline flight where an elderly passenger suffered a medical emergency that caused her to lapse in and out of consciousness. Throughout the incident the woman never asked for help or expressed fear of dying. Her only concern was that she was being an inconvenience, for which she apologized.

Prohibiting physicians from suggesting assisted suicide would also bolster doctors’ conscience rights, said Sonnen. “By not having to broach the subject at all, it protects them and also protects the vulnerable patient.”

Despite B.C. Catholic requests for more detailed information on doctor-patient interactions involving assisted suicide, Fraser Health and the B.C. College of Physicians and Surgeons responded only with emails pointing to general MAiD guidelines, which do not address the subject.

Father Robert Spitzer, president of the Magis Center of Reason and Faith in the U.S., addressed the issue of patient vulnerability in a 2015 video. Those with depression or self-esteem issues may interpret a discussion of the right to die as indifference about their death. Other patients, such as the “stoically responsible,” may think that it is their “duty” to die so they don’t inconvenience others.

Dutch physician Joke Goren-Evers, quoted in the book Do You Call This a Life?, noted that when she began discussions with terminally ill patients by referring to euthanasia, 90 per cent ultimately chose assisted suicide. After becoming increasingly uncomfortable with euthanasia, Goren-Evers began directing the conversations toward palliative care.

“And what do you know: Almost no one asks for [euthanasia] anymore,” Goren-Evers said. “If you mention euthanasia, they will ask for it. If you mention palliative care, then that is what they will choose.”

The Commons has until March 26 to bring in a new euthanasia law to comply with a 2019 Quebec court ruling that said the existing law is discriminatory because it limits doctor-assisted death to those whose natural deaths are “reasonably foreseeable.”