“If reflection and discussion do not reconcile the conflicts between the physician’s and patient’s values, the physician should discuss transferring the patient’s care to another physician in a way that neither compromises the physician’s moral integrity nor affects the patient’s quality of care,” reads “A Guide for Reflection on Ethical Issues Concerning Assisted Suicide and Voluntary Euthanasia,” quietly released by the College of Family Physicians of Canada in September.
In trying to strike a balance between the freedom of conscience of doctors and the Supreme Court of Canada’s ruling that struck down criminal law against assisted suicide, the College of Family Physicians’ new guide does as good a job as possible of protecting doctors who believe killing is beyond their mandate as doctors, said Redemptorist bioethicist Fr. Mark Miller.
“They’re trying to make the best out of a bad situation,” said Miller.
The principle author of the new guide is physician, researcher and ethicist Dr. Bill Sullivan, who was the founding executive director of the Canadian Catholic Bioethics Institute and a current member of the Pontifical Academy for Life.
Miller supports Catholics working inside the system to try to shape the law and practice around physician-assisted suicide.
“This is a political reality, not an ethical reality,” said Miller. “From that point of view, you have to get in there and prevent as much damage as you can.”
The new guide for family doctors criticizes the Supreme Court of Canada for confusing the difference between intentionally killing patients and withdrawing or withholding unwanted treatment.
“The (court’s) ruling does not differentiate ethically between physician-assisted dying and currently accepted practices of physicians withholding or withdrawing life-sustaining interventions at a patient’s request and of palliative sedation that is administered for symptom control,” reads the guide. “There is a significant difference in terms of the physician’s intention.”
Overall, the guide leads doctors through a careful and thorough process for determining the underlying reasons behind a request for assisted suicide — “to discern whether depression or suicidal ideation, which compromise patient autonomy, is present and can be addressed therapeutically.”
While the process outlined in the guide is excellent, Miller doubts that the average family doctor, who may see 20 to 40 patients a day, is likely to follow such a rigorous protocol.
“Basically, my experience of family physicians is that they write a prescription and they move on,” Miller said. “If it’s something serious, they send you to a specialist.”
But most family doctors are spending more of their time diagnosing and treating mental health issues, and this will prepare them for more careful assessment of requests for euthanasia, said Miller.
“There are some family physicians who have really gone out of their way to be good palliative physicians. I think that’s going to be a real trial for them if they don’t believe in killing people. What do they do in terms of options?” asked Miller.
“Physicians have to be adept at discussing feelings and interpreting behaviours,” says the new College of Family Physicians ethics guide.
The change in the law shifts the common ground upon which most people base their ethical reasoning, said Miller.
“We assume that the law provides us with the ethics of these things,” Miller said. “It’s legal therefore you can do it, therefore... Unless we put really strict limits on doctors, it’s wide open.”
An imbalance has entered into society’s thinking about issues of life where the only value to be considered is personal, individual autonomy, said Miller. The idea that life is shared and not merely personal property to be disposed of as one chooses gets no traction, he said.
“From a Catholic ethics point of view, this isn’t about the principle of autonomy,” said Miller. “It’s not about what people want. It’s about whether it’s good to do these things. Somebody argues, ‘This is good for me because I don’t want to live any longer.’ For the rest of us to agree with that is going to mean that it’s good to kill you. It means that your life isn’t worth living any more. I really disagree with that way of approaching things.”