Dr. David Amies: Trudeau's choices after Harper's departure

In his latest post to DWD Canada's blog, Dr. David Amies tells of his introduction to DWD Canada and shares his views on the political landscape following the general election.

One year ago, I attended a rally in downtown Lethbridge held by supporters of Dying with Dignity Canada. Several people spoke in support of the notion of physician assisted dying. There was also a motley crew of protesters standing a little way off, some of whom were carrying banners. As this was taking place in Canada, it was all very orderly and polite. 

But one of the banners carried a disturbing message. In its top left hand corner, the word Canada was written. In the bottom right hand corner were the words Nazi Germany. A bold red arrow joined the two with the words assisted suicide written alongside the arrow. The implication was that once PAD was introduced in Canada, it was then just a short step to adopting all the practices of Hitler’s Germany.

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DWD Canada supporters in Lethbridge on our first-ever National Day of Action in October 2014.

I wandered over to the fellow displaying this odious banner and pointed out to him that he was drawing rather a long bow. He disagreed and informed me that Germans had all been very nice people until Hitler came along and then look what happened! He was a proud member of a very fundamentalist and rather obscure little church and felt that his faith obliged him to point out what a perilous route Canada might be taking. 

The following day a picture on the front page of the local paper showed me apparently schmoozing with the banner holder. Pat, my wife, suggested that I had to write to the editor of the paper to disassociate myself from the views so graphically displayed on the banner. I did so and the members of the local chapter of DWD noted that I could put together coherent sentences and invited to me to be on a panel discussion to be held shortly thereafter.  They also pointed out that not one single Alberta physician was on the national board of the organization. I was duly invited to join and sit on DWD Canada’s Physicians Advisory Board. My fervent pleas that I no longer considered myself to be a physician were ignored. So, one year later, I am taking part in monthly tele-conferences, writing regular pieces for the organization’s blog and generally making myself useful.

The Current Political Landscape

In February of this year, the Supreme Court of Canada struck down the existing law which made aiding or abetting another to commit suicide a criminal offence, punishable by a long spell in the pokey. The Court did, however, stay its decision for one year in order to allow the government to write new legislation. The then prime minister of Canada, Stephen Harper, sat on his hands for several months before setting up a panel in July to conduct interviews and carry out soundings across the country. It was noticeable that two of the three members in that panel were persons who had appeared before the Supreme Court as witnesses in favour of retaining the old rules. The court’s unanimous ruling suggests that it did not pay much heed to the views of that pair of appointees. Almost immediately after the creation of the panel, Mr. Harper called for a general election and set off one of the longest campaigns in the country’s history. Consequently, the panel’s work was more or less put on hold for eleven more weeks.

In the meantime, the various provincial colleges of physicians and surgeons have been issuing advisories to practising doctors to outline how they envisage legalized assisted dying might work. A couple of provinces have drafted their own laws. That from Quebec comes into force in December. Technically, these laws are irregular but it is most unlikely that the Federal Government is going to seek a quarrel with the rather fractious francophone province because it could be considered to have jumped the gun by a few weeks.

It does look as if new rules, be they federal or provincial, will insist that applicants for assisted dying have the consent of two doctors, with an additional psychiatric consultation if mental illness is suspected. Mandatory waiting periods look to be likely. Patients will have to show that they are mentally competent, not acting under coercion, aged at least eighteen years and suffering from terminal illness and intolerable pain and distress. 

Some colleges have taken a positive patient-centred approach — Saskatchewan, for example. Others have been much more cautious and concerned about the feelings of doctors rather than the patients’, e.g. Alberta. Faith groups are marching into action and columnists in major papers are sounding warning notes. I attended a sort of lecture last night at which a Catholic activist led off by letting us all know that life was sacred, that God alone could determine its length and that the scriptures told us all that, "Thou shalt not kill." Unfortunately, I did not get the chance to ask who or what was God, what does sacred mean and why should I take any notice of scripture?

Palliative care specialists are against PAD for they maintain that their special skills can remove from everyone the need to contemplate taking matters into one’s own hands. Pain relief has now become pretty good and there ought to be little excuse for anyone to continue to suffer it. These specialists are not so good in dealing with the kind of anguish that a young quadriplegic might experience when it dawns on him or her that they will be trapped and helpless for years on end. Brian Clark’s play Whose Life Is It Anyway? provides a telling insight into that situation and is well worth reading.

My Views and The Views of the Canadian Public 

My own feelings are that I am all in favour of the rights of all to determine the time of their death when and if they are placed in an intolerable position because of illness, infirmity or accident. I agree that more than one physician’s approval is a good idea. I also consider that anyone who appears to be suffering from a depressive illness deserves an attempt to ameliorate it before going ahead with PAD. The person asking for help to die should be mentally competent to make such a request. I am 100 percent against the idea that there should be arbitrary waiting periods before death can occur. 

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Dr. David Amies.

The Canadian public has been extensively polled on the matter of physician assisted dying and has shown itself to be very much in favour. The numbers demonstrating approval have been consistent across the country and have come in at around 78-84%. Polling among disability groups has reflected the feelings of the population as a whole. On the other hand, medical practitioners have demonstrated greater reluctance. A recent Canadian Medical Association survey showed that about two thirds of all physicians were opposed but that general practitioners were not nearly so reluctant. I can understand the sentiments of the medical profession. After all, they have been taught that their job is to preserve life and to regard death as a failure of skill and technology. Most have little idea how to discuss death with their patients and find it much easier and quicker to order yet another round of chemotherapy, say, than to have an uncomfortable talk about death. Palliative care as a specialty is relatively recent and is not yet widely available in Canada. Happily, today’s medical students now receive training in the discipline as well better teachings on how to communicate with their patients. 

Now What For Trudeau's Government?

So where are we? The Supreme Court’s decision ensures that assisted dying is a right under the Charter. We have a new government led by Justin Trudeau, who has already announced that he is favour of the concept. Due to the foot dragging of the previous government, it may well be that the new government will seek an application to the court for a six-month extension. After all, Mr. Trudeau’s Liberals have been out of power for a decade and they will have much to do in order to get up and running. Doctors and their organizations are inherently disputatious and they will almost certainly be unable to agree on the precise rules under which PAD should be run and so there is bound to be variation from province to province. However, it is most unlikely that there will be serious differences and that Canadian citizens wishing to end their lives on medical grounds will have to jump through different hoops, depending upon where they live.

Let us hope that the medical and surgical colleges in any province do not use their regulations as a sneaky way to deny citizens their rights. The last thing anyone faced with a desire to quit a life that has become intolerable will need is to quarterback a parcel of competing laws and regulations. That possibility will need careful watching. 

I am sure that there will be objections raised and opposition mounted by religious bodies who will hold that all life’s end is solely a matter for God. For my part, those who adhere to such ideas are welcome to them, and also should feel under no obligation to turn to assisted dying if they find themselves in desperate medical circumstances. They are most certainly not entitled to consider that I and other like-minded people should be bound by their particular worldview.

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

*Photos by 

Alex Guibord — Flickr (Trudeau)

Presidencia de la República Mexicana — Flickr (Harper) 

Gustavo Vieira — DWD Canada (Montage)


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