Getting the facts right about euthanasia

How can Quebec doctors ask for the legalisation of euthanasia? They don't even know what it is.
Margaret Somerville | Mar 2 2010 | comment  



The Quebec College of Physicians and Surgeons has “tentatively proposed” legalized euthanasia. The college says that it could be seen “as part of appropriate care in certain particular circumstances.” As a result, the Quebec Legislative Assembly has established a multi-party committee, “La commission de la santé et des services sociaux” (the Health and Social Services commission) consisting of 20 members of the Assembly.  

Recently, Dr Gaétan Barrette, the president of the federation of Quebec medical specialists, Dr Yves Lamontagne of the Quebec College of Physicians and Yves Robert, secretary of the College gave evidence before the commission. The first two men are clearly on the public record as supporting euthanasia, and the third appears to hold the same view.

There is a saying in ethics that "good facts are essential to good ethics."

But if Dr Barrette, Dr Lamontagne and Yves Robert, secretary of the College, are accurately reported, none of them had  his facts straight in giving evidence before the commission.

Dr Barrette said that in caring for terminally ill people, "doctors are aware they can be charged with murder if they administer a 'palliative sedative' before a patient is on his or her last breath." This is not euthanasia, although, like Dr Barrette, 49 percent of Quebec physicians recently polled mistakenly thought it was.

Palliative means the sedative was necessary to relieve pain and suffering and was not given with an intention of killing the patient. That cannot result in a murder charge, or any other legal charge, unless the patient refused it.

Indeed, unreasonably failing to provide necessary treatment for pain and suffering could constitute unprofessional conduct with resultant disciplinary measures, medical malpractice and legal liability for damages, and, in extreme cases, criminal negligence. It is now also widely recognized that for a healthcare professional to negligently leave a patient in serious pain is a breach of fundamental human rights.

Dr Barrette also said, "We want legislation in tune with the wishes of the public." But just because the public wants something or a majority votes for it doesn't mean it is ethical - or even wise. Democratic decisions and ethical ones are not necessarily the same.

The Montreal Gazette reported that Dr Barrette and Dr Lamontagne "told the committee that doctors do not want to perform assisted suicides."

"We are not there to execute people," Lamontagne said.

This boggles the mind. They are recommending that euthanasia be legalized. What do they think euthanasia involves? And if, as they are proposing, killing patients is acceptable, why is helping those patients to kill themselves not acceptable? At least accepting both would have the virtue of consistency.

Finally, the statement of Yves Robert, "that Quebec is the only jurisdiction in Canada where patients can refuse medical treatment, which can lead to death," is simply wrong.

All adult Canadians have the right to refuse all medical treatment, either at the time, if competent, or, if incompetent, through prior advance directives. The only exceptions are if the person must be treated to avoid a danger to public health or the person is mentally ill and, as a result, constitutes a serious danger to himself or others.

In the latter case, very stringent requirements must be fulfilled to override the patient's refusal of treatment.

These witnesses seem to be confusing euthanasia and necessary pain or physical suffering relief treatment. The distinction between them hinges on the physician’s primary intention in giving the treatment. Pain or physical suffering relief treatment, including sedation, given with a primary intention to relieve pain and physical suffering and reasonably necessary to achieve that outcome is not euthanasia, even if it did shorten the patient’s life (a rare occurrence). Any intervention, including the use of sedation, carried out with a primary intention of causing the patient’s death and resulting in that outcome, is euthanasia.

Another source of confusion

I also gave evidence before the commission and encountered yet another confusion. I was asked on more than one occasion to explain what the ethical and legal differences between withdrawal of treatment that results in death and euthanasia are, and why I agree that the former can be ethically and legally acceptable, provided certain conditions are fulfilled, and the latter cannot be. This is a central and important question in the euthanasia debate.

Primary intention...

First, the primary intention is different in the two cases: In withdrawing life-support treatment it is to respect the patient’s right to refuse all treatment; in euthanasia it is to kill the patient. The former intention is ethically and legally acceptable; the latter is not.

Rights...

Patients have a right to refuse treatment, even if that means they will die. This is an exercise of their right to autonomy and self-determination. But the content of that right is a right not to be touched without their consent – a right to inviolability – which is a “negative content” right, a right against something being done to the person with the right. It is not a right to die and does not establish any such right (as pro-euthanasia advocates argue it does), although death results from respecting the right to inviolability.

In other words, pro-euthanasia advocates use this recognition of a right to refuse treatment even when it results in death, to argue that, likewise, patients should be allowed to exercise their right to autonomy and self-determination to choose death through lethal injection. They say that there is no morally or ethically significant difference between these situations, and there ought to be no legal difference.

But the content of the right they want to see recognized is a right to be killed, often confusingly referred to as a “right to die”. There is a “right to be allowed to die” by refusing treatment, which is not a right to be killed, euthanasia. Such a right would be a “positive content” right, a right to something.  There is no such right, at present, in Canadian law and the law is very much more reluctant to recognize positive content rights – that is, “rights to” something – than negative content rights - that is, “rights against” something.

Causation...

Which brings me to the issue of causation, which also differentiates refusals of treatment that result in death from euthanasia. In refusals of treatment that result in death, the person dies from their underlying disease – a natural death. The withdrawal of treatment is the occasion on which death occurs, but not its cause. If the person had no fatal illness, they would not die. In contrast in euthanasia, the cause of death is the lethal injection. Without that, the person would not die at that time from that cause.

Confusion as to the issue...

The fact that the patient dies in both refusing treatment that results in death and in euthanasia is one of the causes of the confusion between the two situations. If we focus just on that outcome of death, as one of the honourable members of the committee did in questioning me, we miss what the real point of the distinction between the two situations is.

The issue in the euthanasia debate is not if we die - we all eventually die. The issue is how we die and whether some means of dying, such as euthanasia and physician-assisted suicide, should remain prohibited. I believe they should.

Margaret Somerville is director of the Centre for Medicine, Ethics and Law at McGill University, and author of The Ethical Imagination: Journeys of the Human Spirit.



Copyright © Margaret Somerville . Published by MercatorNet.com. You may download and print extracts from this article for your own personal and non-commercial use only. Contact us if you wish to discuss republication.

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