Journal Correspondence Archives - Protection of Conscience Project Library

(Correspondence) MAID, social determinants and the slippery slope

Tom Koch

Rapid Response: extract
Jocelyn Downie and Udo Schuklenk conclude, first, that the Canadian experience denies the existence of a ‘slippery slope’ expanding medical termination from a limited to a broader medical constituency. Second, they argue a failure to provide social constituents of health and support is a significant factor in the increased requests for ‘medical aide in dying.’ (1) It is hard to credit their conclusions on either point. . . .

. . . As a Canadian long engaged in this debate–legal and social–as well as in the care of those with chronic conditions I thus find their arguments incomplete and their conclusions inaccurate. . .

Koch T. (Rapid Response) MAID, social determinants and the slippery slope. J Med Ethics. 2021 Aug 04;47(10).

(Correspondence) Organ Donation after Medical Assistance in Dying — Canada’s First Cases

Ian M. Ball, Andrew Healey, Sean Keenan, Fran Priestap, John Basmaji, ,Kimia Honarmand, ,Jeanna Parsons Leigh, ,Sam Shemie, ,Prosanto Chaudhury,,Jeffrey M Singh, Jeffrey Zaltzman,Stephen Beed, Matthew Weiss

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
The provision of organ donation after medically assisted euthanasia involves unusual challenges, including first-person direct consent, navigation of a new legislative landscape, and incorporation of the legislated requirements of euthanasia into the donation process. Ethical issues involving the well-being of health care workers and conscientious objection have also been raised.

Medical assistance in dying followed by organ donation is new to North America. It is evolving, and if offered to potential donors it provides them with the opportunity to fulfill their dying wishes. Secondarily, this process may make more organs available to patients on transplant waiting lists. There is substantial room for enhanced education of both the public and health care workers and for the evolution of clinical practice. National level, prospective data will be necessary to assess this evolving area of care.

Ball IM, Healey A, Keenan S, Priestap F, Basmaji J, Honarmand K et al. Organ Donation after Medical Assistance in Dying — Canada’s First Cases. N Engl J Med. 2020;382(6):576-577.

(Correspondence) CMA’s “third way” may be a third rail

Responding to articles by CMA officials (BMJ 2019; 364)

Sean Murphy

British Medical Journal, BMJ — British Medical Journal

Extract
It is disconcerting to find that the CMA’s President-Elect thinks that Canadian law “does not compel any physician to be involved in an act or procedure that would violate their values or faith.” The state medical regulator in Canada’s largest province has enacted policies that do just that, requiring physicians who refuse to kill their patients to find a colleague who will. These policies do have the force of law, and objecting physicians were forced to launch an expensive constitutional challenge to defend themselves. The Protection of Conscience Project and others have intervened in the case to support them; the CMA has not.

Further, the Canadian Medical Association’s assertion that it has successfully adopted a “neutral” position on euthanasia and assisted suicide (EAS) is challenged in a World Medical Journal article by seven Canadian physicians. “For refusing to collaborate in killing our patients,” they write, “many of us now risk discipline and expulsion from the medical profession,” are accused of human rights violations and “even called bigots.” . . .

Murphy S. CMA’s “third way” may be a third rail. Rapid Response to articles by CMA officials (BMJ 2019; 364).

(Correspondence) Losing doctors with integrity will harm patients and profession

Karol F Boschung

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
I am responding to a letter by Dr. Eric Brown about semantics in referring for medical assistance in dying (MAiD). . . The intended implication, it seems, is that any conscientious objectors should simply leave the practice of medicine.

Boschung KF. (Correspondence) Losing doctors with integrity will harm patients and profession. Can Med Assoc. J. 2018;7.

(Correspondence) An effective referral is still a referral

Sanasi Jayawardena, Alexandra A Majerski

Extract
We are writing to respond to Dr. Steven Bodley’s letter: “Just the Facts on Effective Referral.” . . . The College of Physicians and Surgeons of Ontario’s (CPSO’s) effective referral policy for MAiD does not go far enough in protecting the religious freedom of physicians. . . It is unfortunate that the CPSO does not acknowledge that the provision of an “indirect” referral still renders the referring physician complicit. . . . medical students training in Ontario must now seriously consider taking their skills and talents to another province or jurisdiction in which they can practice their vocation in a manner that upholds their integrity. . .

Jayawardena S, Majerski AA. An effective referral is still a referral. CMAJ [Internet]. 2018 Feb 28; 190(7).

(Correspondence) Conscientious Objection in Health Care

Lester Liao, Ewan Goligher

Extract
Stahl and Emanuel (April 6 issue)1 rightly differentiate between conscripts and physicians. Nonetheless, they state, “the profession . . . uses reflective equilibrium to self-correct. This dynamic process establishes professional obligations . . . regardless of . . . personal beliefs.”1 This point fails to recognize that conscientious objectors are engaging in the dynamic process from within the profession to counter problematic professional obligations and to correct mistakes. . .

Liao L,Goligher E. Conscientious Objection in Health Care, N Engl J Med 2017; 377:96-98 July 6, 2017 DOI: 10.1056/NEJMc1706233

Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium

Kenneth Chambaere, Robert Vander Stichele, Freddy Mortier, Joachim Cohen, Luc Deliens

Extract
We found an increased demand for euthanasia in Belgium between 2007 and 2013, as well as growing willingness among physicians to meet those requests, mostly after the involvement of palliative care services. This finding indicates that, after 11 years of experience, euthanasia is increasingly considered as a valid option at the end of life in Belgium.

Chambaere K, Stichele RV, Mortier F, Cohen J, Deliens L. Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium. N Engl J Med. 2015 Mar 19;372(12):1179-1181.

(Correspondence) Redefining Physicians’ Role in Assisted Dying

Edward Lowenstein, Marcia Angell

Extract
To the Editor: As two of the original petitioners to bring a Death with Dignity Act before Massachusetts voters, we are pleased that Prokopetz and Lehmann believe “there is a compelling case for legalizing assisted dying,” as they state in their Perspective article (July 12 issue).¹ However, we oppose their idea that physicians who agree that assisted dying is sometimes indicated might outsource the actual writing of the prescription to a government agency, presumably because they find that final step “incompatible with the physician’s role as healer” (in the words of the statement on the subject by the American Medical . . .

Angell M., Lowenstein E. Letter re: Redefining Physicians’ Role in Assisted Dying. N Engl J Med 2013; 368:485-486 January 31, 2013 DOI: 10.1056/NEJMc1209798

(Correspondence) Female feticide

Susan J Woolhouse

Extract
Rajendra Kale. . .advocates for physician regulatory agencies to undertake a recommendation to ban the disclosure of the sex of a fetus before 30 weeks gestation. This advocacy is misguided at best and dangerous at worst. . . . Blaming women for the scourge of gender-based violence is also not a solution. This is why limiting access to abortion based on this specific reason is dangerous health policy. Does this mean that some women will decide to abort female fetuses preferentially? Sadly, yes.

Woolhouse SJ. (Correspondence) Female feticide. Can Med Assoc J. 2012 Jun 12;184(9):1064.

(Correspondence) Female feticide (Dr. Kale responds)

Rajendra Kale

Extract
I referred to a 2010 study in which Asians were defined, for the purposes of that study, as “people from India, China, Korea, Vietnam and Philippines.”3 I did not intend to suggest that . . . evidence of sex selection, disparity of infant sex. . . applied to all those groups; indeed, the results were varied. I apologize for the ambiguity.

Kale R. (Correspondence) Female feticide (Dr. Kale responds). Can Med Assoc J. 2012 Jun 12;184(9):1065.