"I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect."

So goes the medical profession's Hippocratic Oath.

And yet, it does seem "hypocritical" to compare that oath with the stark reality of medical practice in geriatric, cancer, AIDS or incurable disease wards of modern hospitals.

One American doctor made a name for himself (and got a 10-year prison sentence) by having designed a death machine whereby the patient is administered a lethal dose of drugs, drop-by-drop, to induce a slow but peaceful death. Dr. Kevorkian was released from jail on June 1, 2007 after serving 8 years of his sentence.

Dr. Jack Kevorkian actions, and the prevalence of the fatal HIV virus, have brought the euthanasia debate to the forefront.

Euthanasia is the putting to death, by painless method, of a terminally-ill or severely debilitated person through the omission (intentionally withholding a life-saving medical procedure, also known as passive euthanasia) or the commission of an act (active euthanasia).

image of morphine vialTwo sections of Canada's Criminal Code are relevant:

"14. No person is entitled to consent to have death inflicted on him, and such consent does not affect the criminal responsibility of any person by whom death may be inflicted on the person by whom consent is given.

"241. Everyone who counsels a person to commit suicide or aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years."

The reality of modern medicine is that doctors do practice passive euthanasia; not all of them, but rare is the doctor that has not, at the request of the patient, the patient's family, or on his or her own accord, decided to discontinue life-support.

Consider §58 of Quebec's Code of Ethics for Physicians (2011) for doctors:

"A physician must, when the death of a patient appears to him to be inevitable, act so that the death occurs with dignity. He must also ensure that the patient obtains the appropriate support and relief."1

Studies also show that many doctors have acquiesced to life-ending drug doses in cases of advanced terminal conditions - assisted suicide; aka active euthanasia. But try finding one to admit it.

Assisting suicide or intentional killing, even to reduce suffering, is criminal conduct.

More interesting is the situation where a doctor decides to withhold or withdraw medical care for euthanasia reasons. Section 215 of the Criminal Code says that:

"... every one is under a legal duty to provide necessaries of life to a person under his charge if that person is unable, by reason of (...) illness, mental disorder or other cause, to withdraw himself from that charge and is unable to provide himself with the necessaries of life."

The Courts have captured medical treatment under this section, essentially preventing doctors from withholding or withdrawing life-sustaining procedures.

Doctors are also under legal obligation to ensure that patients, for whom a risk of suicide exists, are prevented from harming themselves.

On the other side of the coin, Canadian citizens have a basic right to refuse medical care and treatment and they have a right to decide what medical treatment they accept or reject, even if the rejection of a life-saving procedures leads to their death. This is part of the Canadian Charter of Rights and Freedoms : "every one has the right to (...) security of the person and the right not to be deprived thereof." Quebec's Civil Code reiterates this principle. This would include, for example, Jehovah Witnesses refusing blood transfusions.

Living wills present another legal dilemma. They are documents which set out guidelines for dealing with life-sustaining medical procedures in the eventuality of the signatory's sudden debilitation. Living wills would, for example, inform medical staff not to provide extraordinary life-preserving procedures on their bodies if they are incapable of expressing themselves and suffering from an incurable and terminal condition.

The value of a living will is debatable. One of the most serious problems is the common occurrence that nobody on the medical staff is made aware of the living will. Medical staff must also consider other factors:

  • Has the "will" ever been revoked?
  • Are there competing living wills?
  • Were there capacity issues with the person at the time she or he signed the living will?
  • What if a surviving relative wants the hospital to overlook the living will?
  • How far will the living will go in preventing the doctor from subsequent criminal charges under 215 of the Criminal Code?
  • What if the living will is on audio-tape?

Some provinces have been toying with legislation to allow living wills under certain circumstances. In British Columbia, representation agreements can be drafted which allow a person to pre-determine what happens if they are ever in need of life-sustaining medical treatments.