When and how to die

In their editorial in CMAJ, Flegel and Fletcher asked, “Are we ready to perform therapeutic homicide?”1

As the professional body representing more than 300 physicians practising palliative medicine, the Canadian Society of Palliative Care Physicians answers with an emphatic, “No!” Physician-assisted dying is not part of the continuum of end-of-life care, nor has it been part of 2500 years of Hippocratic tradition.

We were encouraged by the CMAJ authors’ 2 important observations about palliative care, specifically that it “has come of age and is adequate to meet the needs of most dying people,” and more important, that “it is underprovided, particularly in remote and rural areas.” The Canadian Hospice Palliative Care Association has determined that only 30% of Canadians have access to palliative care.2^,3

Regarding the call to “speak up now, and with conviction,” our 2011 member survey found 83.3% of respondents were against legalization or decriminalization of euthanasia, and 90.6% would not participate in it; 80.6% opposed physician-assisted suicide, and 83.6% would not aid in it.4 We also applaud the Conservative government’s appeal of the British Columbia decision allowing physician-assisted suicide.

We are concerned that liberalizing euthanasia laws in other countries has led to its being performed without appropriate consent — and not always for terminal illness. We oppose any suggestion that these acts become part of standard end-of-life care. As a nation with a proud tradition of caring for the vulnerable, let us instead choose to ensure that the dying have the choice of palliative care.