My letter to the College of Physicians and Surgeons of Ontario concerning MAiD
The College of Physicians and Surgeons of Ontario (CPSO) is presently engaged in a consultation concerning Medical Assistance in Dying (MAiD) and has invited Canadian physicians, organizations, and the public to send them feedback (deadline is April 12, 2021). Below is a copy of my letter which I sent to the CPSO on March 30, 2021.
Dear College of Physicians and Surgeons of Ontario (CPSO),
Thanks for giving the Canadian public an opportunity to provide you with feedback about Medical Assistance in Dying (MAiD). Here is my feedback.
In my personal and professional opinion (note: I am a retired philosophy professor who has studied and taught ethics) I recommend the following: (a) medical personnel who conscientiously object to MAiD and “effective” referrals for MAiD should not be required to participate in or facilitate MAiD; and (b) they should be provided workplace protection from harassment and discrimination because of their conscientious objection.
Here are my reasons for the above recommendations.
MAiD is a euphemism for physician-assisted suicide. But, according to the World Medical Association, good medical practice should neither ask nor require any doctor or nurse to help patients with suicide. After all, suicide is wrong and tragic (that is why Canadians work hard at suicide prevention).
Moreover, turning physician-assisted suicide into “health care” is seriously problematic in other ways.
History teaches us that medically administered death is dangerous for the vulnerable as well as all of us. This can be seen in recent years in the abuses of MAiD in Belgium and The Netherlands (for evidence see, for starters, the documentaries Euthanasia Deception and Fatal Flaws). In not-as-recent history, we should note Dr. Leo Alexander’s observation at the Nuremberg Trials (1945-1946). Dr. Alexander attributed the beginnings of the horrors of the Holocaust to the attitude of physicians, i.e., that they accepted “life not worthy of life” as a justification of killing patients (for evidence, see Dr. Alexander’s essay in New England Journal of Medicine, 1949). The notion of “life not worthy of life”—German: lebensunwertes leben—was at the heart of the Holocaust and is at the heart of MAiD.
Yes, in Canada there are patients who choose physician-assisted suicide as their best option. But this “choice” is often due to a lack of real options, especially a lack of top-notch palliative and hospice care. In fact, top-notch palliative and hospice care is not available for the vast majority of Canadians. A basic understanding of ethics requires that assistance in living should be provided for all BEFORE medical assistance in suicide is offered at all.
Also, I am troubled that if the CPSO does not provide protections to physicians who object to performing MAiD or making effective referrals to MAiD, then, as time passes, the medical profession will be staffed primarily by doctors who are morally callous. I fear that in the future those doctors who object to MAiD will not or will not be allowed to practice medicine, and I fear that most or all doctors who do practice medicine will have no moral qualm about killing patients as a regular part of “health care.” What is worse, I suspect they also will have no moral qualm about falsely reporting any misdeeds they commit.
The fact is that doctors in Ontario who are now practicing MAiD are falsely reporting cause of death on death certificates. Indeed, blatant lying is promoted—required—by the CPSO.
My evidence: According to CPSO on MAiD: “When completing the death certificate physicians: a. must list the illness, disease, or disability leading to the request for MAID as the cause of death; and b. must not make any reference to MAID or the drugs administered on the death certificate.” (Bold in original. Reference: See #22of CPSO on MAiD.)
Again: Blatant lying is promoted—required—by the CPSO. Alarmingly, when it comes to MAiD, lying has become a norm of practice for the CPSO. A reasonable question for Canadians to ask is this: What else are doctors lying about?
If my studies (and personal experience) in ethics have taught me anything, it’s this: little ethical lapses pave the way to big ethical lapses. It seems that with regards to MAiD, the CPSO—with its institutionalized lying—is well on its way to engaging in big ethical lapses. For the sake of moral integrity (and for the sake of regaining public trust), the CPSO needs its conscientious objectors.
Therefore, I recommend the following to the College of Physicians and Surgeons of Ontario: (a) medical personnel who conscientiously object to MAiD and “effective” referrals for MAiD should not be required to participate in or facilitate MAiD; and (b) they should be provided workplace protection from harassment and discrimination because of their conscientious objection.
Thanks again for the opportunity to provide you with feedback. I hope my feedback is helpful.
Hendrik van der Breggen, PhD
(Retired Associate Professor of Philosophy, formerly at Providence University College, Manitoba)
For additional thought: