Dr. David Amies: Manitoba's new assisted dying law fails to put patients first

In this blog post, Dr. David Amies comments on the recent passage of Manitoba's Bill 34, which prioritizes the view of objecting clinicians over the rights of patients. This, Dr. Amies writes, is akin to doing harm to the province's most vulnerable people.

The Manitoba legislature recently passed Bill 34, which gives health care professionals in that province, who object to medical assistance in dying (MAID) on conscientious grounds, the right to refuse to play any part in the process. It also seems to prevent health care regulatory bodies from censuring their members if they walk away from patients who wish to access MAID.

No one can reasonably expect a physician or nurse practitioner to be part of a MAID team if they hold sincere religious or other ethical or moral views that cause them to believe that helping a patient to die is wrong. Dr. Frank Ewart, a senior medical practitioner in Manitoba told a legislative committee recently that he wants protection from being obliged to help a patient die. He added, “When I started back a number of years ago and vowed to follow the Hippocratic Oath, I meant it. It was very profound to me, it resonated with my core beliefs, that I would always respect life, that I would do nothing to harm a patient." These are noble sentiments, but I would question his use of the word “harm.”

There are many ways in which a physician can harm a patient: ignoring red flags, overlooking significant physical signs and symptoms, mis-prescribing and acting clumsily during surgery are some of the more obvious ones. Does not great harm occur when a terminally sick patient under great duress, unrelieved by the best possible palliative care, asks for help to die and is flatly refused that mercy by the attending physician?

I fully understand and sympathize with the physician who decides that conscience prevents him or her from taking part in MAID, but I have nothing but disdain for those who will not even make a referral or provide pertinent information. The argument that doing so equates to actually carrying out the process is, in my view, both feeble and Pharisaical.

John Savulescu, ethics professor at Oxford University, holds that patients’ access to legal treatment or management should not depend upon the conscience of the physician they happen to have chosen. It does seem that Bill 34 provides physicians in Manitoba with that very escape route. Consider the circumstances where a patient has attended the same doctor for many years and feels that a sound and firm relationship has been built. Then, consider also the shock and pain that would occur, when in the hour of greatest need, the doctor feels entitled to walk away from that relationship because of conscientious objection to MAID.

My wife recently discussed MAID with her family doctor. He told her that he could not carry it out were it to become necessary, but he stressed that he would do all he could to put her in touch with a practitioner who could and would. He added that he would actually attend her death if she so wished. How much more kindly and patient-centred is such an attitude than the one expressed by Dr. Ewart and those of a like mind?

The hard-line conscientious objectors seek official protection from being obliged to assist, in any way, patients who wish to end their lives. Dying With Dignity Canada (DWDC) does not want that to be the case if it will deny patients their legal right to have full and untrammelled access to all end-of-life options.

While in no way demanding that anyone act against their own consciences, DWDC argues that any doctor or nurse practitioner faced with a request for MAID from a qualified patient is under a moral obligation to, at the very least, provide that patient with pertinent information that will allow him or her to obtain help and information elsewhere. Bill 34 allows health practitioners to escape from this minimum obligation.

In his presentation to Manitoba’s Standing Committee on Legislative Affairs on November 6, DWDC Communications Officer Cory Ruf said it eloquently: “Bill 34, if passed in its present form, means that it would be okay to tell desperately ill Manitobans that they are on their own.”

Now, that really looks like harm to me!

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.


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