Physician-assisted suicide begins in Quebec on December 10. One of the overlooked consequences of this radical change to the law is how doctors will fill out death certificates. Although the immediate cause of death will be a lethal drug, doctors have been advised to list the cause of death as an underlying medical condition.
The Collège des médecins du Québec and pharmacy and nursing regulators have issued a Practice Guide directing Quebec physicians to falsify death certificates in euthanasia cases.
The physician must write as the immediate cause of death the disease or morbid condition which justified [the medical aid in dying] and caused the death. It is not a question of the manner of death (cardiac arrest), but of the disease, accident or complication that led to the death. The term medical aid in dying should not appear on this document.2
Since untruths are not normally part of medical practice, how does the practice guide justify this? It gives two reasons: first, that some patients may not want their families to know how they died, and second, that it protects families who don't know that their loved ones have been killed by physicians from some unspecified "harm."
Writing in the Protection of Conscience blog, Sean Murphy comments that this is bound to upset both Quebec physicians and families.
Many physicians, coroners and other health care workers may share these concerns, even if they don't have moral reservations about euthanasia. Indeed, euthanasia supporters may worry that mandating deceptive practices is counterproductive and inconsistent with the Practice Guide's expectation that physicians will apply "moral rigour" in processing euthanasia requests.
Others may be uncomfortable lying or dissembling to families about how their loved ones died, which would seem to be unavoidably associated with falsifying causes of death. They may be concerned that falsifying records and lying to families is likely to undermine the trust essential to the practice of medicine. And many people simply have moral or religious objections to falsifying documents, lying, dissembling and other forms of deception under any circumstances.
In addition, a good number of those who object to euthanasia who are not directly involved in lethally injecting a patient will almost certainly consider participation in deception to involve unacceptable complicity in killing, even if it occurs after the fact.
This is not an unreasonable position. The killing of thousands of hospital patients in Nazi Germany involved extensive falsification of death certificates by physicians, supervised and assisted by state functionaries. Their goal was to convince families that loved ones who had been lethally injected or gassed had died from natural causes. Few would now say that those involved in what Robert J. Lifton called a "bureaucracy of medical deception" were not morally implicated in the deaths of those patients.
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