Mr. Speaker, please remind me when I have two minutes left.
I would like to announce to my colleagues in the House of Commons that the Liberal critic will not be voting in favour of this private member's bill by the hon. member for La Pointe-de-l'Île. I would like to thank her for raising this important issue. I personally think it is such an important and complex matter that a private member's bill is not the right vehicle to engage the public debate that this issue deserves. I would like to read a letter that the Canadian Medical Association addressed to my colleague, the hon. member for La Pointe-de-l'Île. A copy of this letter was sent to all hon. members. It sums up my concerns about this issue. The letter reads,
Madame,
The Canadian Medical Association (CMA) has been very interested in and concerned about the progress of Bill C-384 in the House of Commons. The House is at third reading of a bill that would, in some circumstances, allow a physician to aid a person to die with dignity if that person has provided free and informed consent. The CMA's policy is clear. “Canadian physicians should not participate in euthanasia or assisted suicide.”
As the attached policy notes, euthanasia and assisted suicide must be distinguished from the withholding or withdrawal of inappropriate, futile or unwanted medical treatment or the provision of compassionate palliative care, even when these practices shorten life. The CMA does not support euthanasia or assisted suicide and urges its members to uphold the principles of palliative care. Euthanasia and assisted suicide are opposed by almost every national medical association and prohibited by the law codes of almost all countries.
Our policies also clearly state that “the CMA recognizes that it is the prerogative of society to decide whether the laws dealing with euthanasia and assisted suicide should be changed”, but that there are some concerns that must be addressed before any changes are made. These include:
1. Adequate palliative-care services must be made available to all Canadians. In 1994, our members approved a motion that Canadian physicians should uphold the principles of palliative care. The public has clearly demonstrated its concern with our care of the dying. The provision of palliative care for all who are in need is a mandatory precondition to the contemplation of permissive legislative change. Efforts to broaden the availability of palliative care in Canada should be intensified.
2. Suicide-prevention programs should be maintained and strengthened where necessary. Although attempted suicide is not illegal, it is often the result of temporary depression or unhappiness. Society rightly supports efforts to prevent suicide, and physicians are expected to provide life-support measures to people who have attempted suicide. In any debate about providing assistance in suicide to relieve the suffering of persons with incurable diseases, the interests of those at risk of attempting suicide for other reasons must be safeguarded.
3. A Canadian study of medical decision-making during dying should be undertaken. We know relatively little about the frequency of various medical decisions made near the end of life, how these decisions are made and the satisfaction of patients, families, physicians and other caregivers with the decision-making process and outcomes.
Hence, a study of medical decision making during dying is needed to evaluate the current state of Canadian practice. This evaluation would help determine the possible need for change and identify what those changes should be. If physicians participating in such a study were offered immunity from prosecution based on information collected, as was done during the Remmelink commission in the Netherlands, the study could substantiate or refute the repeated allegations that euthanasia and assisted suicide take place.
4. Consideration should be given to whether any proposed legislation can restrict euthanasia and assisted suicide to the indications intended. Research from the Netherlands and Oregon demonstrate that a large percentage of patients who request aid in dying do so in order to maintain their dignity and autonomy.
If euthanasia or assisted suicide or both are permitted for competent, suffering, terminally ill patients, there may be legal challenges, based on the Canadian Charter of Rights and Freedoms, to extend these practices to others who are not competent, suffering or terminally ill. Such extension is the “slippery slope” that many fear.
This statement has been developed to help physicians, the public and politicians participate in any re-examination of the current legal prohibition of euthanasia and assisted suicide and arrive at a solution in the best interests of Canadians. The CMA is in favour of improving access to palliative care and suicide prevention programs, undertaking a study on how medical decisions are made near the end of life and having a comprehensive public debate on the matter, but we cannot support Bill C-384.
Sincerely,
Anne Doig, MD, CCFP, FCFP,
President
As I indicated at the beginning of my speech, I understand and deeply respect the desire of the hon. member for La Pointe-de-l'Île to bring this matter forth in the House of Commons, and I sympathize with her. I think this is a debate that we should have, but it should be initiated by the government.
I am critical, however, of this government and previous governments of my political stripe for not having had the moral fortitude to take the necessary steps to allow such a debate to take place and not undertaking such a study, as suggested and recommended by the Canadian Medical Association.
I truly believe that it is an issue that many Canadians, many families are grappling with and an idea that they are finding very painful to think about. Government has a responsibility to help Canadians deal with this issue, to see what the actual state is and whether or not this issue can be dealt with in a way that provides dignity and serenity, and also to provide a sense of security that there will not be mistakes made if legislative measures are in fact taken.
As I have said, I blame the government but I also blame my own political party, which formed government for several terms, for not having had the moral courage to deal with this.