Webcast archive: Ontario College of Physicians’ “end of life” policy

Today, we discuss the new euthanasia policy from the Ontario College of Physicians.

In this episode of Euthanasia & Disability, Amy Hasbrouck and Christian Debray discuss:

  • Ontario College of Physicians’ “end of life” policy
  • News Briefs

Please note that this text is only a script and that our webcast contains additional commentary.


  • In December the Ontario College of Physicians issued a draft policy on end-of-life care, and asked for pubic comments.
  • The policy is available at: http://policyconsult.cpso.on.ca/?page_id=4943
  • The document is not very complete. It seems more like an exercise in public relations.  It’s not directed at doctors or administrators to help them make decisions.  If the College wants to publish a flyer for the public, that would be one thing, but don’t call it a policy statement.
  • From the disability perspective, the policy presents many problems.
  • Like the majority of documents that discuss, “end of life” the policy doesn’t distinguish between people who are in the process of dying and those who have severe functional limitations.
  • The policy neither recognizes nor resolves the double bind in which doctors must defend the interest of their patients at the same time they are pressured to keep costs down.
  • In our comments, TVNDY listed several principles that should be included in a real policy to guide doctors and administrators providing health care.
    • A bias toward life should govern all decisions
    • “End of life” should not mean “ending of life.”
    • The word “person” should be used instead of “patient.”
    • Discrimination is not acceptable, especially in life or death judgments.
  • To prevent requests to terminate treatment, each person must have access to services and supports to allow a true choice in where and how to live.
  • A request for euthanasia, assisted suicide or to withhold or withdraw medical treatment should trigger suicide prevention intervention.
  • Every person who needs it should have access to services and devices to allow for effective communications
  • Every person will have access to necessary services and adaptive equipment to allow for timely and effective medical care.
  • “Self-regulation” is insufficient to prevent conflicts of interest and failure of accountability.
    • Many essential terms are not defined in the policy, such as “end of life”, “clinical benefit”, “capacity” and “futile care.”
    • The policy lacks an explanation of standards of quality care; the list of “what is important to patients and their families” is not a policy. Some examples of standards for care doctors should provide:
  • Provide (or coordinate and oversee the provision of) state-of-the-art medical care to ensure the maximum level of functioning and quality of life.
  • Provide (or coordinate and oversee the provision of) state-of-the-art pain and symptom management to relieve physical and psychological and symptoms.
  • Advocate on the person’s behalf to obtain necessary authorization for medical treatment.
  • Provide clear, honest, information to the person receiving treatment and his/her family. Communicate on a timely and consistent basis in language and by whatever means to ensure understanding and participation (including using language or sign interpreters, technology or facilitators).  Inform the person of her diagnosis, prognosis, available treatments (their potential efficacy and drawbacks), and the consequences of any decision.
  • Be honest, forthright and compassionate in all dealings with the individual, his/her family and other providers.
  • Work with social service and rehabilitation professionals to ensure that each person obtains services to support the maximum level of independence and integration.
  • Along with mental health providers, social service and chaplaincy staff, promote positive family participation in decision-making, achieving a sense of control and meaning, satisfying spiritual needs, completing important tasks, and preparing for the end of life by resolving conflicts, saying goodbye, and preparing for death.
  • Ensure that all medical services, equipment and facilities are accessible and available to persons with disabilities in a timely fashion.
  • Ensure that the person is free from abuse, exploitation and mistreatment.
  • Care for the whole person, treating her with respect at all times. Affirm her/his inherent dignity by empowering the person to control his/her circumstance.
    • The section on “advance care planning” looks more like “death planning.” As such, the policy excludes important decisions, such as arranging long-term care (at home) and how to obtain, use and adapt to life-saving equipment and medical services.
    • This section suggests that doctors frequently encourage people to prepare “advance care planning” documents. On the ground, this means people with disabilities are often harassed to sign “do not resuscitate” orders, or such orders are placed on people’s medical without their knowledge or consent.
    • Documents used for “advance care planning” are usually biased against life-sustaining treatment. They describe feeding tubes and respirators in negative terms, rather than as the life-saving aides they are.
    • The section on refusing medical treatment doesn’t mention that such requests are suicidal gestures (and should be treated as such).
    • The policy should require doctors to consult palliative care and pain management specialists. Most physicians receive only eight hours of training in pain management during their medical education; this is not enough to offer effective, state-of-the-art care.
    • The paragraph that talks about “aggressive pain management” gives the impression that this practice and the use of opiates should be limited to the end of life, which is not the case.
    • The policy does not explain how bias and prejudice regarding people with disabilities will be excluded from doctors’ decision about what is the “standard of care.”
    • Regardless of the state of the law on euthanasia and assisted suicide, physicians should keep in mind that killing is not medical treatment. It is neither the duty nor the responsibility of medical staff to end the life of persons under their care, even if the person requests it.  The medical profession is charged to value, preserve and improve the quality of life until the moment of natural death.  This includes implementing the public policy of suicide prevention, not providing suicide assistance.  A person who wishes to end his or her life may refuse medical treatment if s/he is too ill to take her own life, or otherwise commit suicide unaided.


  • Activists with NDY-UK were in the streets of London again today to protest the Falconer bill, which is being heard in the House of Lords. 350 people participated in a “Thunderclap” campaign which generated 200,000 tweeted messages opposing the Falconer bill. In addition, activists created posters with photos and messages so activists who couldn’t be their physically could attend virtually.
  • Man serving life sentence in Belgium won’t get euthanasia – Frank Van Den Bleeken, who is serving a life sentence, had been granted permission by the Euthanasia Commission to be euthanized. However at the last minute, Belgium’s Justice Ministry intervened and cancelled the procedure.  No reason was given for the change.
  • In December, a bill was proposed in France that would allow for terminal palliative sedation, or passive euthanasia.