December 7, 2015

MONTREAL - After 30 years in palliative care medicine, Dr. Bernard Lapointe is adamant that regardless of what the law says he will never euthanize a patient.

He is among thousands of law-abiding Quebec doctors who are facing some of the most difficult days of their careers as the province hurtles towards the Dec. 10 legalization of euthanasia.

"Doctors have the right to be conscientious objectors, and I for one will not do it," he said. "There is not a tribunal in the country that can force me to do it."

Quebec's controversial right-to-die legislation, Bill 52, makes it mandatory for physicians to either accommodate a patient's request to die or refer that patient to an obliging doctor in the same institution.

With few exceptions, all Quebec health care institutions, including hospitals, hospices and palliative care facilities, are required to provide assisted-death services for patients who ask to die and qualify under government guidelines for assisted death.

"No institution has the right to conscientiously object," said Lapointe, director of the palliative care division of Montréal's Jewish General Hospital. "Even faith-based hospitals with a religious attachment to them cannot ignore the law."

Yet the medical staff at Université de Montréal health centre have voted unanimously to reject doctor-assisted death and at least two of 29 hospices in the province have announced they will not participate. Another will limit medical aid in dying to patients suffering from terminal cancer.

Quebec will become the first province in Canada to allow physician-assisted death even though euthanasia and assisted suicide remain illegal under the Canadian Criminal Code.

But Quebec lawmakers are skirting the federal law by insisting they are implementing medical aid in dying, which is a health-care matter that falls outside the Criminal Code and is under provincial jurisdiction.


The legislation allows terminally ill patients "who are of sound mind" and "in a state of unbearable physical and psychological pain" to request "palliative sedation." Each request must be approved by an attending physician and approved by a hospital medical team.

Dr. Manuel Boyard, chair of the McGill University Health Centre, says you can read the language of the bill any way you want. What it offers, in his view, is "not assisted suicide, but euthanasia."

Quebec's health minister, Gaetan Barrette, a doctor, insists that even medical institutions which disdain the law must comply with it.

"Doctors do not own Quebec hospitals," he has said. He has threatened to deny hospital privileges to physicians who refuse to comply.

A recent poll found that at least two-thirds of Quebec doctors say they want no part of euthanasia.

Boyard believes proper palliative care would alleviate the need for euthanasia and Bill 52 is unnecessary. "Palliative care in the right setting with the right resources and the right pain control is sufficient," he said.

But the man regarded as the father of Canadian palliative care is unimpressed.

"It is a tremendously important mistake to think you can improve palliative care by throwing money at it," said Dr. Balfour Mount, a cancer surgeon who started the Royal Victoria Hospital's Palliative Care Service, the first in North America, in 1975.


He calls Bill 52 "a phenomenally bad idea, a catastrophic idea" but says the battle is lost and "any attempt to fight it is going to be useless."

Church leaders in Quebec opposed the new law but seem to be resigned to it.

Cardinal Gerald Lacroix has said whatever terminology you use, the notion that assisted suicide and euthanasia are medical solutions to pain and suffering is repugnant.