Thaddeus Baklinski


Euthanasia is inevitable, time to move on: Canadian Medical Association Journal article

Thaddeus Baklinski

OTTAWA, April 10, 2014 ( – Debate over euthanasia and assisted suicide in Canada is “obsolete” and the deadly practices are inevitable, so it’s time to move on, argues a commentary this week in the Canadian Medical Association Journal.

“Physician-assisted death is going to become legal in Canada in the very near future by one means or another and crucial questions need to be answered,” wrote Dr. James Downar, an assistant professor in the division of critical care and palliative care medicine at the University of Toronto, in a piece titled, "Physician-assisted death: time to move beyond Yes or No." 

Downar argues that the debate over euthanasia and assisted suicide has become irrelevant and that physicians could soon be left in a legal vacuum if the Supreme Court of Canada rules later this year that laws banning doctor-assisted suicide violate the Canadian Charter of Rights and Freedoms.

The case before the high court is an appeal of the recent British Columbia Court of Appeal ruling in Carter v. Canada that upheld the nation’s ban on assisted suicide.

The case was launched by the family of Kay Carter, who died by assisted suicide in Switzerland in 2010. The family claims Carter was denied the "right" to die with dignity in Canada and her family was forced to break the law by assisting her travel to Switzerland for suicide. The BC Civil Liberties Association represented the Carters.

Downar said Canada could end up in a similar position on euthanasia as it has been on abortion since the 1988 Morgentaler ruling.

“Abortion was never legalized by statute in Canada — the laws limiting it or restricting it were simply struck down,” Downar stated. “That left physicians in a legal vacuum. Physicians were left scrambling to come up with rules, policies and guidelines to follow.”

“There is a very distinct possibility that could happen” with physician-assisted death, Downar wrote.

Downar also noted that legalizing doctor-assisted killing may come about by legislation, citing the assisted suicide private member’s bill recently introduced by Manitoba Conservative MP Steven Fletcher.

“Through either route, physician assisted-death may become legal in Canada, and our well-rehearsed debates about whether sanctity of life is more valuable than personal autonomy or whether people can experience intolerable suffering despite receiving optimal palliative care may become obsolete,” Dr. Downar wrote in the CMAJ.

However, the Canadian Medical Association, which has no editorial control over the opinions expressed in the Canadian Medical Association Journal, was quick to state that Dr. Downar put “the cart well before the horse” by focusing his commentary on doctor-assisted death over better access to palliative care.

In a letter to the CMAJ editor, CMA President Dr. Louis Hugo Francescutti said that while Downar's commentary presents "a very detailed examination of many of the issues involved in our growing national examination of how Canadians expect to manage their care at the end-of-life they unfortunately get the cart well before the horse by focusing solely on physician-assisted death.”

"Addressing the dire need for improved access to palliative care services … and Canada's lack of a national pain strategy would be much better places to start," Francescutti wrote.

Dr. Francescutti noted that "contrary to the author's assertion" there is little support for doctor-assisted death among Canadian physicians, as shown  by the vote at the CMA annual general meeting last August where delegates made it clear the doctors' association will not change its formal position against euthanasia and assisted suicide.

Dr. Francescutti added that the CMA is gathering input from Canadians online and is holding public town-hall meetings on end-of-life care to sound out society's position on the issue.

"While physicians may indeed need to be prepared for the challenges of physician-assisted death, we are hearing from Canadians that there is an even greater need for our society to ensure we provide high quality palliative care to everyone who would need it as well as a better understanding among the public about advance care directives," Dr. Francescutti wrote.

In his commentary, Dr. Downar argued that data from other jurisdictions where doctor-assisted death is legal show that vulnerable groups, including the institutionalized, “are actually less likely than non-vulnerable groups to receive assisted death.”

However, Alex Schadenberg, president of the Euthanasia Prevention Coalition, points out that abuses that contravene the law and put vulnerable people at risk are rampant in countries with legal assisted death.

"In Belgium, where euthanasia was legalized in 2002, studies published in the CMAJ and the British Medical Journal (BMJ) indicate that as many as 32% of the assisted deaths are done without request and many of the assisted deaths are not reported," Schadenberg said.

"In January, Belgian euthanasia doctor, Marc Cosyns admitted that he does not report the euthanasia deaths that he does, even though reporting is a requirement of the euthanasia law. Recently Belgium extended euthanasia to children," he said. "The former leader of the euthanasia lobby in the Netherlands stated in January that the Netherlands euthanasia law has derailed and doctor-assisted death is out of control."

"The fact is that legalizing euthanasia or assisted suicide is lethal and not safe," Schadenberg concluded.

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