Assisted suicide debate needs constructive dialogue, doctors say

Physician-assisted suicide could become legal in Canada, which raises a host of questions that we need to start answering now, a medical journal editorial argues.

"Whether or not physicians individually or collectively agree with physician-assisted death, it is clear that our profession must be prepared for the challenges to be faced if physician-assisted death is legalized in Canada," Dr. James Downar of the division of critical care and palliative care at the University of Toronto and his co-authors concluded in a commentary published in Monday’s Canadian Medical Association Journal.

"It is time for the ‘yes’ or ‘no’ debate to give way to a constructive dialogue about policies and guidelines for legal physician-assisted death. We may need them very soon."

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If the Supreme Court of Canada strikes down the laws prohibiting physician-assisted death when it hears an appeal by the B.C. Civil Liberties Association, then doctors across the country will be left in a legal vacuum. The case was launched in 2011 by the BCCLA and two women, Kay Carter and Gloria Taylor. Taylor died in 2012, without assistance, from Lou Gehrig's disease, a degenerative neurological illness.

MP Steven Fletcher’s private member’s bill in the House of Commons would also allow physician-assisted suicide under specific circumstances.

Downar and his team of palliative care doctors raised several questions to answer, including:

• What sort of suffering is "intolerable?" Can psychological suffering be an indication for physician-assisted suicide?
• How can we protect the vulnerable?
• How can we ensure that all Canadians have access to a palliative care consultation when appropriate?
• How can we protect professionals who participate in delivering physician-assisted death from societal repercussions?
• Will physicians who are conscientious objectors be obliged to present the option and facilitate transfers to colleagues?

In a statement responding to the commentary, Dr. Louis Hugo Francescutti, president of the Canadian Medical Association, said the focus should be on "addressing the dire need for improved access to palliative-care services … and Canada's lack of a national pain strategy." 

The authors said Canada could borrow from guidelines and policies from other jurisdictions such as the Netherlands, Belgium and five U.S. states that legally permit euthanasia and assisted suicide, but these would need to be adapted to the Canadian context.