With great caution, the Quebec College of Physicians is prepared to cross the line on the controversial debate over euthanasia and propose that it be included "as part of the appropriate care in certain particular circumstances."
After examining the issue for three years, the College's task force on ethics concluded that Quebec society has evolved to the point where it could tolerate euthanasia in specific circumstances. The task force's recommendation will likely be part of a "reflection" document the College will release next fall, hoping that a public debate on the issue will pressure the federal government to eventually amend the criminal code.
"We are being very cautious in our approach," said the College's secretary, Yves Robert. "Avoiding the debate contributes to the general hypocrisy around this issue. To say that it doesn't happen because it is illegal is completely stupid. … We have to stop hiding our head in the sand," Dr. Robert said.
It is common knowledge that physicians often have no choice but to constantly increase medication such as morphine to alleviate the pain and suffering of terminally ill patients.
Sometimes, the pain is so unbearable that the amount of painkillers or analgesics used to control it can be fatal. And this, according to the Quebec College of Physicians, can be viewed as a form of euthanasia.
"The question here is to decide whether a drop in dosage or an increase in dosage constitutes a criminal act," Dr. Robert said. "We may go as far as to recommend that in certain cases, where the pain is unbearable, the amount of analgesic required could correspond to a form of euthanasia."
The College wants to avoid a divisive confrontation between those who are for or against euthanasia, saying such a debate would solve nothing. Instead, the debate should be about the doctor's role in accompanying a terminally ill patient toward the inevitability of death, offering as much dignity and medical assistance as possible. "There's not a politician or a lawyer that can tell me what that entails," Dr. Robert said.
The College says there are three conditions required in order to amend the criminal code, which currently defines euthanasia as a criminal act. The first would require that the decision be made in accordance with the patient's will. A physician alone could not decide, Dr. Robert said. The second condition would require that clear rules be established to protect society from abuses. And thirdly, the doctor has to be part of the decision-making process and not someone who simply carries out orders.
Quebec physicians are adamant in stating their position excludes assisted suicides, which is practised in Switzerland and in some parts of the United States. There have been a few rare cases where Canadians have died at the assisted-suicide clinic Dignitas in Switzerland, but the College opposes the practice.
Right-to-die groups in Quebec believe the province's College of Physicians has taken a "bold, cautious and realistic" approach that will have considerable impact on the rest of the country.
Social worker Yvon Bureau, who has spent 25 years promoting the right to euthanasia, called the College's proposal a major step forward.
"I believe this is huge," Mr. Bureau said. "We need to avoid having people commit suicide or die under terrible circumstances. About 80 per cent of the Quebec population supports the right to medical assistance in dying. All of this would take place in the course of the relationship between the doctor and the patient, as well as the family."
Mr. Bureau hopes the debate will persuade the Quebec government to adopt an "end of life" policy that will recognize each individual's right to die with dignity. However, he anticipates strong opposition from groups that fear that such a policy may lead to abuses.
The College of Physicians is expected to table its final proposal in November.
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