A new draft policy on providing care at the end of life clearly warns doctors that both euthanasia and assisted suicide are against the law.
“None of this is to suggest that physicians should refrain from the aggressive management of a patient’s pain and symptoms, as appropriate,” reads the draft policy, which has been posted for public comment at the college’s web site, cpso.on.ca.
The new policy on “Decision-making for the End of Life” lays a heavy emphasis on planning well before critical decisions must be made. It also updates physicians’ legal obligations in light of the Cuthbertson v. Rasouli Supreme Court of Canada decision in 2013.
“We want this to be a positive change,” Ontario College president Dr. Carol Leet told The Catholic Register. “We want to encourage people to have more discussion about end-of-life issues before they get to that point.”
Whether it’s a wedding, a baby or diagnosis of a life-limiting illness, there are critical junctures in any patient’s life when it is wise to speak openly about dying and the decisions which must be made, said Leet.
“Not just would I want to be on life support, but would I want to be on a feeding tube,” she said.
The new policy encourages, though it does not force, doctors to open up the conversation with their patients.
“These are delicate conversations. We also had to acknowledge that some patients may not be ready to have that conversation,” Leet said. “So it needs to be done with sensitivity.”
Having an end-of-life plan, including power of attorney for personal care, is a very good idea but not something you can force patients into, said Moira McQueen, executive director of the Canadian Catholic Bioethics Institute.
“To make it into an obligation is another one of those nanny state type of things,” she said. “On the other hand, I think they’re very useful.”
Even without the formal legal document, having had frank discussions with a spouse, children or others about what limits you would put on end-of-life care saves everybody a lot of agonizing guess work, McQueen said.
“Even just to say to my husband or my daughter, ‘You will speak for me,’ ” she said.
The draft policy is aimed at avoiding the kind of doctor versus family conflict that led to the Rasouli court case, Leet said. Hassan Rasouli of London, Ont., was severely brain damaged in anaccident and his family, devout Muslims, insisted that all efforts must be undertaken to sustain his life. The doctors argued that further treatment had no medical benefit and that he should be allowed to die.
The Supreme Court ruled the doctors could not unilaterally make that decision and ordered them to apply to Ontario’s Consent and Capacity Board and abide by its decision.
Rather than seeing every difficult case go to the Consent and Capacity Board, better and earlier communication between doctors and patients and their families should lessen the potential for conflict, said Leet.
“Withdrawal of treatment is certainly something that requires consent,” she said.
The new College of Physicians and Surgeons policy is open for comment until Feb. 20, with a final policy likely to be adopted in May or June.