Tuesday, October 25, 2016

EPC demands in-depth investigation into murders at care homes in Canada.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Elizabeth Wettlauffer arrested.
Southwestern Ontario is shocked by the revelation of allegations that a nurse was responsible for 8 deaths in care homes in Woodstock and London Ontario.

As shocking as it is that Elizabeth Wettlaufer, 49, of Woodstock; has been charged with 8 counts of first degree murder in what is being defined as possibly the worst case of a seriel killer in Canadian history, we need to demand that an in-depth investigation be done into every care home in Canada, especially now that euthanasia and assisted suicide are now legal.

We should mourn the deaths of James Silcox (84), Maurice (Moe) Granat (84), Helen Matheson (95), Gladys Millard (87), Mary Zurawinski (96), Helen Young (90). Maureen Pickering (79) of Woodstock Ontario and Arpad Horvath (75) who was a resident at Meadow Park nursing home in London, but we must also recognize that these are a group of many deaths caused by people who falsely consider themselves angels of mercy in our medical system.

As Executive Director of the Euthanasia Prevention Coalition, I have received calls from people who are convinced that their loved may have been prematurely killed in a hospital or nursing home. These cases are very frustrating because it is nearly impossible to prove that such an act has occurred and the financial and personal costs associated with gaining justice is prohibitive.

Consider Joy Wawrzyniak who has been fighting for more than 6 years to gain some justice in the death of her father, Douglas DuGuerre. What about the case of Annie Farlow who died under suspicious circumstances at 80 days of age? Should we shrug off Annie's death because she was born with significant disabilities?

Cases of doctors or a nurse intentionally causing the death of a patient are not uncommon.

Several cases have been reported in the media in the past such as the death of David Gray, in which the doctor received a nine month suspended sentence for negligence causing death.

Several medical professionals who killed their patients, include: Dr. Harold ShipmanCharles Cullen, Dr Virginia Soares de Souza, Aino Nykopp-Koski and Dr. Michael Swango.

Further to that, deaths without request or consent occur even when euthanasia or assisted suicide are legal.

A recent NEJM study on the practice of euthanasia in the Flanders region of Belgium found that 1.7% of all deaths (more than 1000 deaths) were hastened without explicit request in 2013.

The Lancet study analyzing the Netherlands euthanasia experience found that there were 310 hastened deaths without explicit consent in 2010 in the Netherlands.

It is not safe to give doctors, or others, the right in law to cause death of their patients.

When a nation legalizes euthanasia, it gives medical professionals, who were already willing to kill their patients the legal right to proceed.

Unless every Canadian Province does an in-depth research study into the deaths at care institutions, we will never know how many intentional killings occur yearly in our country.

Monday, October 24, 2016

Protecting patients in the shadows of euthanasia.

This article was published on the Cardus website on October 12, 2016.

Dr Margaret Cottle.
Co-authored by Dr Margaret Cottle & Faye Sonier.

Bill C-14, which sets out the legal framework for decriminalized euthanasia, satisfies no one. Some feel it is too restrictive. Others of us continue to have serious concerns about its implications.

We will all be vulnerable at some time in our lives and this legislation does not and cannot protect us. Even Justice Lynn Smith, the original Carter trial judge, foresaw the inevitability of wrongful deaths when the healthcare system provides state-sanctioned euthanasia. She suggested strong safeguards that should be “scrupulously enforced.” This bill does little toward establishing concrete guidelines, and life-ending decisions will be made for some patients against their explicit wishes as a result.

Here are some measures that may help to provide somewhat better protection for vulnerable patients.

First, proper care for patients with serious conditions is a basic human right and sufficient funding is essential. Currently, 70% of Canadians do not have access to adequate palliative care. This is a dismal failure for our healthcare system and an unacceptable tragedy. Canadians deserve better care — focused, excellent care that provides all the necessary supports to live life to the full, instead of a cold analysis that the person’s life is “not worth living” and a state-sanctioned system to deliver death instead of support.

Faye Sonier
Next, we must protect the conscience rights of physicians and other healthcare professionals. Thousands of citizens, who pay into our healthcare systems, want nothing to do with any form of hastened death. They have the right to be treated by professionals and in facilities where caring never includes killing. Real patient choice, “patient-centered care” and cultural diversity should mandate that our system accommodates many different demographic groups, including completely euthanasia-free healthcare facilities for those who need such settings to feel and to be safe. The assertion that it is “cruel” to move a patient to a different ward within a hospital or an outside facility that has special expertise in providing euthanasia or assisted suicide is a complete red herring. Patients who are extremely sick are moved all the time without major discomfort — within the hospital, from hospital to home or hospice, or from one hospital to another for specialized imaging or daily radiotherapy treatments. How ludicrous that there is an outcry against moving someone in a scheduled, safe way to a site with expertise in the procedure and yet no similar indignation when patients who are in far worse condition languish in the hallways of emergency departments for days.

The provincial governments and physician regulatory bodies must take a strong stance in support of physician conscience rights. Unfortunately, the College of Physicians and Surgeons of Ontario released two anti-conscience rights policies which violate physician conscience rights. The policies are currently being challenged in court, and the Ontario government has intervened in support of the College. These policies are not only Draconian, but unnecessary. Patients should be able to self-refer to specialized agencies for any of these controversial procedures. Eliminating the requirement for a physician referral provides greater patient autonomy and privacy and streamlines the process. This agency could provide a team of expert assessors who would screen patients with a wish for euthanasia or assisted suicide, to offer help for any untreated symptoms and who would address deficits in the social determinants of health such as inadequate support or loneliness. This system would be better for patients and obviate the need for any physician with conscientious objections to participate.

In addition, we must ensure robust data collection and oversight of euthanasia and assisted suicide reporting procedures. In the jurisdictions that have decriminalized these procedures, including Canada, not a single country has instituted an independent body to oversee those performing the acts. The physicians who write the prescription for assisted suicide drugs or administer the euthanasia drugs themselves are the ones who fill out the death certificates.

Studies have shown that means other than proper euthanasia protocols are used when doctors cannot be bothered to fill out the paperwork. In Belgium, where the legal framework is strikingly similar to Canada’s, studies have documented that up to 32% of all euthanasia procedures have been performed without the patient’s express consent. Another study found that around 47% of euthanasia deaths in a given year went unreported. In Quebec, which passed a voluntary euthanasia law in December 2015, physicians who perform euthanasia cannot record “medical assistance to die” as the cause of death on the death certificate, but must list instead the name of the condition affecting the patient that led the patient to request euthanasia.

Those in favour of these procedures continue to assure Canadians that these measures will only be for “hard cases,” and the public has believed this. However, there are already very credible reports of cases that fall well outside the legislation’s mandate that should cause concern and trigger more careful surveillance. We owe it to ourselves to keep careful, detailed records about the type of patients who are having their deaths hastened and for what reasons. Our strong support of suicide prevention must extend to this vulnerable population as well.

Wrongful and unnecessary deaths will occur. We can and should institute these basic measures to try to limit the damage, to begin to protect patients and to preserve real choice.

Margaret Cottle, MD, CCFP (Palliative Care) is a palliative care physician in Vancouver, BC, a Clinical Assistant Professor at the University of BC and the former VP of the Euthanasia Prevention Coalition. Faye Sonier is Canadian Physicians for Life’s Executive Director and General Legal Counsel.

Thursday, October 20, 2016

Assisted-suicide law prompts insurance company to deny coverage to terminally ill California woman

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Stephanie Packer
The Washington Times reported that the California Assisted-suicide law prompted an insurance company to deny coverage to a terminally ill California woman.

Bradford Richardson, from the Washington Times reported that Stephanie Packer, a wife and mother of four who was diagnosed with a terminal form of scleroderma, said that her insurance company initially indicated it would pay for her to switch to a different chemotherapy drug based on the recommendation of her doctors but shortly after the California assisted suicide law went into effect, her insurance company denied her treatment.
Richardson reported Packer as saying:
“And when the law was passed, it was a week later I received a letter in the mail saying they were going to deny coverage for the chemotherapy that we were asking for,” 
She said she called her insurance company to find out why her coverage had been denied. On the call, she also asked whether suicide pills were covered under her plan. 
“And she says, ‘Yes, we do provide that to our patients, and you would only have to pay $1.20 for the medication,’”Mrs. Packer said.
Stephanie Packer believes that legalizing assisted suicide creates an incentive for insurance companies to deny terminally ill people coverage. Packer stated:
“As soon as this law was passed — and you see it everywhere, when these laws are passed — patients fighting for a longer life end up getting denied treatment, because this will always be the cheapest option,” 
The attitude also changed in her support group:
After the right-to-die movement began garnering national attention, Mrs. Packer said she noticed a change in tone at her support groups for terminally ill patients. While the meetings were formerly positive and encouraging, she said the specter of suicide now hangs above them like a dark cloud. 
“And people, once they became depressed, it became negative, and it started consuming people,” she said in the video. “And then they said, ‘You know what? I wish I could just end it.’ “
Stephanie Parker is not the first person to be denied chemotherapy but offered assisted suicide. Several years ago Barbara Wagner and Randy Stroup, in Oregon, were denied medical treatment but offered assisted suicide.

Belgium: Euthanizing the Mentally Ill.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Washington Post published an article on October 19 by Charles Lane examining the recent report from Belgium's Federal Commission on the Control and Evaluation of Euthanasia that was presented in the Belgian parliament on October 7, 2016. Lane, in his article, focuses on the data related to euthanasia for psychiatric reasons. Lane reports in his article:
In the 2014-2015 period, the report says, 124 of the 3,950 euthanasia cases in Belgium involved persons diagnosed with a “mental and behavioral disorder,” four more than in the previous two years. Tiny Belgium’s population is 11.4 million; 124 euthanasias over two years there is the equivalent of about 3,500 in the United States. 
The figure represents 3.1 percent of all 2014-2015 euthanasia cases — and a remarkable 20.8 percent of the (also remarkable) 594 non-terminal patients to whom Belgian doctors administered lethal injections in that period.
Order the Euthanasia Deception documentary, featuring Belgian people with personal experience with euthanasia and assisted suicide. One of the interviews concerns a man whose depressed mother died by euthanasia.
Lane points out that the Belgian euthanasia is now being criticized:
Recent newspaper articles and documentaries focused on cases in which psychiatrists euthanized or offered to euthanize people with mental illnesses, some still in their 20s or 30s, under dubious circumstances. 
In December, 65 Belgian mental-health professionals, ethicists and physicians published a call to ban euthanasia of the mentally ill. 
Seemingly stung by these criticisms, the commission spends two of its report’s pages defending the system, explaining that all is well and that no one is being euthanized except in strict accordance with the law.

Wim Distelmans, who is the chair of the Belgian Federal Commission on the Control and Evaluation of Euthanasia defends the Belgian law, but Distelmans is also the doctor who operates a euthanasia clinic that is responsible for a large percentage of the euthanasia deaths for psychiatric reasons. Lane writes:
In particular, the regulatory panel — chaired by Wim Distelmans, a leading proponent of euthanasia who conducts the procedure himself — defends the one-month waiting period required between the time a mentally ill or otherwise cognitively impaired person puts his or her signature on a written request for death, and the time it may be carried out. 
Objections that this is too little time are “unfounded,” the report asserts, because “the formation of the true will of the patient is a long process that takes several months, sometimes years,” then culminates in the written request. In any case, the waiting time is often longer in practice.
Lane counters Distelmans defense of psychiatric euthanasia by quoting from opponents of the practise:
“We see that some who were first declared incurable, eventually abandon euthanasia because new prospects showed up. In a paradoxical way, this proves that the disease can not be called incurable.”
Lane responds by publishing the data concerning euthanasia for psychiatric reasons:
This, regarding a Belgian medical system that over the past two years administered lethal injections upon the request of five non-terminally ill people with schizophrenia, five with autism, eight with bipolar disorder and 29 with dementia — an increasingly common condition in the aging Western world — as well as 39 with depression, according to the report.
As a father of a adult autistic son, I find this data very disturbing. 

Lane continues by stating that the American Psychiatric Association a declaration that it is unethical for any psychiatrist to participate in the euthanasia of people who are not terminally ill and the World Psychiatric Association, which has a position discouraging participation in euthanasia of people who are not terminally ill, will revisit the issue in 2017.

Sadly, the new Canadian euthanasia law permits euthanasia for people who are living with physical or psychological suffering.

Wednesday, October 19, 2016

South Australia MP floats new euthanasia bill because old one expected to fail.

This article was published on the HOPE Australia website on October 19, 2016.

Paul Russell is the director of
HOPE Australia
y Paul Russell

Last night the mover of the Voluntary Euthanasia Bill 2016, Steph Key gave a rather cryptic comment to the South Australian media about the possible adoption of their 'plan b'.

It is not a stretch to observe that one only goes to a 'plan b' if 'plan a' - the existing bill, is not going to pass muster.

This was a clear admission from Steph Key that she and her team were not confident that her bill would pass at the Second Reading vote scheduled for this Thursday the 20th of October.

So what does 'plan b' look like?

Readers will recall that, after the Voluntary Euthanasia Bill 2016 had been in the chamber for something like eight months, Steph Key recently tabled a set of her own amendments to her own bill that she had hoped would convince MPs who were rightly concerned about the Belgian style model in the current bill, to allow the bill to pass on Thursday so that these amendments could be discussed and the bill modified.

This 'eleventh hour' amendment schedule (less that a week from the scheduled debate) as the Australian Medical Association observed, ran to thirteen pages - only a few pages short of the length of the bill itself. Parliamentarians and the public will have had little time to scrutinise the changes, which can only have added to the cynicism amongst Key's parliamentary colleagues.

Key clearly expected her colleagues to pass a very dangerous bill on the possibility that the amendments she foreshadowed would be adopted during the debate on clauses that would have followed. That is never certain. This is reckless and MPs clearly agreed in the majority.

We now understand that a new bill will be introduced today that is essentially the old bill with the flagged amendments incorporated.

I can understand that with everything invested in what must be said was a comprehensive campaign in support of the bill, that to lose on Thursday was not something that Key and her allies wanted to face. Regardless, much of that impetus is now lost as the debate begins again. Key's colleague Duncan McFetridge MP announced the tabling of this new bill in his name. He said that he hoped to have the matter 'approved in about a month'. The Advertiser story repeated the false claim that, 'A request for voluntary euthanasia would not be granted if there was another medical treatment or palliative care option that would relieve the person’s suffering.'

In normal circumstances, this 'new' bill would progress at a snails pace like all private member's bills. That would normally mean that the debate in earnest would probably not occur until the second half of 2017 - when MPs are beginning to focus on the March 2018 election. But these are not necessarily normal times and one can bet that Steph Key will be pressuring the Premier for special treatment. Originally the Premier had signaled that he wanted the issue out of the way by Christmas. It remains to be seen if that commitment extends to this new bill.

One hopes that MPs will remain cynical that Steph Key and her cohort have essentially used the parliament as something of a private play thing. Many MPs will have private members business of their own that they would also dearly love to progress.

While the old bill would have made the state the 'Belgium of the South', the new bill is closer to the Oregon model but with some curious additions. Like its predecessor, it will fail to protect people. Only a total ban on euthanasia & assisted suicide can achieve that.

Euthanasia begets more euthanasia.

This article was published by OneNewsNow on October 18, 2016

Alex Schadenberg
According to an expert on the issue, once euthanasia is legalized it becomes a natural trend – and he cites astonishing numbers from a European country to support his argument.

The latest figures from Switzerland (from 2014) show assisted suicide deaths are up 26 percent from 2013 – and more than 2.5 times as many as five years previously. The Swiss suicide clinic "The Exit" reported a 34-percent increase in business for 2015, while deaths from the other Swiss suicide clinics remain unknown.

"This is a worldwide phenomenon. Every time you legalize euthanasia, the numbers only go up every year," says Alex Schadenberg with the Euthanasia Prevention Coalition, "because there's more and more reasons why people now say I want to die – and there's more and more people willing to do it for more and more conditions. That's what we see in the Netherlands, and that's what we're seeing in Switzerland."
OneNewsNow reported earlier this year on the steady rise in doctor-assisted suicide in the Netherlands over the past five years.

Recent examples in Switzerland include a 62-year-old magistrate killed, but whose autopsy revealed an incorrect diagnosis; and an 85-year-old woman who was euthanized because she didn't like her appearance.

Schadenberg explains that for many individuals, euthanasia is becoming "the answer" for loneliness and depression – resulting in a "ridiculous situation."

"... When you've got a culture that kills its most vulnerable who are lonely or going through a time in their life when they really need others ... this is what it's coming down to," he laments. "Even in Oregon and Washington state they can say what they want, but their numbers have gone up every year in the last few years."
Links to more information on this topic:

Tuesday, October 18, 2016

Mentally Ill OK'd for Assisted Suicide in California hospitals.

This article was written by Wesley J Smith and published in the National Review on October 18, 2016

Wesley Smith
By Wesley Smith

California has promulgated a regulation to assure that the mentally ill who have been ordered hospitalized in California have access to assisted suicide if they are dying and deemed able to make medical decisions. From 9 California Code of Regulations § 4601 (my emphases): 
(a) A terminally ill patient, as defined by the End of Life Option Act, may petition the superior court for access to participate in activities under the End of Life Option Act by requesting release from the custody of the Department of State Hospitals from the court. If the court orders release from the custody of the Department of State Hospitals, the Department of State Hospitals shall release the patient to the ordered entity or person. 
People can be involuntarily hospitalized for psychiatric reasons in CA if they are found by a court, beyond a reasonable doubt, to be a danger to themselves or others. 

Thus, if a suicidal patient requests to be released to commit suicide but isn’t terminally ill, he will be refused if he is still considered a mortal danger to himself. But if the same patient has terminal cancer, he must be released in order to commit suicide

That’s not only nuts, but the state is abandoning the terminally ill with mental illnesses to their darkest impulses. 

And what if a court decides the patient is, say, too dangerous to be let out? The state must facilitate the suicide by either transporting the mentally ill patient to a death locale or see the deed done at the state facility
If a court orders that the patient meets the qualifications under the End of Life Option Act, and that the Department of State Hospitals shall facilitate the patient’s access to participate in activities under the End of Life Option Act, the Department of State Hospitals will facilitate the patient’s access to an off-site facility that allows the patient the ability to participate in activities under the End of Life Option Act…. 
1) If the court orders that the patient meets the qualifications under the End of Life Option Act, and the Department of State Hospitals is unable to find an off-site facility for the patient to participate in activities under the End of Life Option Act, the Department of State Hospitals will facilitate the patient’s ability to participate in activities under the End of Life Option Act on-site. 
Think about this. There will be patients forcibly hospitalized in these institutions because they are suicidal, who will know that other patients are being assisted in suicide. The mind just boggles! 

But it’s not unexpected. In Oregon, Michael Freeland was lethally prescribed (two years before dying naturally). Before getting around to killing himself, he became psychotic and was forcibly hospitalized. His psychiatrist made sure his guns were taken but also that the poison prescription “remained safely at home,” even though he would “experience periods of delirium,” the shrink wrote in Freeland’s medical records. 

Abuses of assisted suicide in Oregon, Wesley? What abuses? 

To recap: My state, which may soon do away with the death penalty, specifically will require government participation and facilitation of the suicides of mentally ill people if they have been diagnosed with a terminal illness. 

This so-called “death with dignity” movement is driving us out of our collective minds.

Colorado Springs Gazette: No to Proposition 106, assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Colorado Springs Gazette is urging Colorado citizens to vote no on the assisted suicide Proposition 106. In its recent summary of Gazette endorsements, the paper stated:
Out-of-state billionaire George Soros wants to impose this irresponsible law on Colorado as another of his infamous arms-length social experiments. It is a badly written law that will come with unthinkable consequences. Colorado's suicide rate is already too high and rising, especially among teens. This sends the wrong message. But it's worse than that. The law could facilitate impatient heirs in coercing the early deaths of relatives, friends and business partners. It shields from accountability anyone who witnesses a suicide. A similar law in Oregon has greedy insurance companies encouraging suicides to save the costs of treatments and cures. We don't need more suicide, much less a law that allows for almost anything-goes assisted suicide.

Monday, October 17, 2016

Disability rights activists say no to euthanasia bill.

This article was published on the HOPE Australia website on October 17, 2016.

Lives Worth Living and Not Dead Yet Australia have joined together to let the South Australian Parliament know that they strongly oppose the Voluntary Euthanasia Bill 2016 in its current and its proposed (amended) form.

Writing to the parliament this week, Lives Worth Living made some keen observations:

  • We note that there have been significant amendments to the Bill which attempt to remove some issues but there are still considerable areas of concern to us.
  • This is now to some extent a new Bill and this warrants consultation. Lack of consultation with the disability community on euthanasia is an ongoing concern.
  • The Bill does not name the disabilities or conditions covered or exclude any disabilities, illnesses or chronic conditions instead focusing on how the condition is experienced and perceived.
  • This Bill does not define a terminal medical condition and imagines that you can make a clear distinction between a person with a medical condition and a person “suffering from a disability”. Most disabilities shorten the lifespan and there is no clearly defined boundary between a shortened life span and a terminal illness.
  • The attempt to excise disability in section 10 is welcome but is actually ineffectual and this is apparent in the way it is framed i.e, “a person is not an eligible person merely because the person is … suffering from a disability (however described).
  • All people with disability have medical conditions that cause a disability, meaning that disability is in scope at the outset. The disability arising from a condition is caused by a lack of access to rights, access, treatments and disability. The Bill misunderstands this on a basic level.
LWL canvasses an alternative:
We would prefer that the South Australian Parliament addressed secondary comorbidity, barriers and lack of supports experienced by people with a disability rather than provide a mechanism for suicide because of them. Instead of safeguards, we need to be talking about preconditions. Like the precondition that half of us no longer live in poverty, have good access to medical treatment and palliative care, that we have the care and support to live a good life.
And suicide prevention rather than enabling:
LWL is concerned that the Bill creates a double standard in the treatment and interventions around ending one’s life based on disability. Euthanasia is assisted suicide and as we read it the Bill it fails to mandate suicide prevention and other counselling which may identify other issues in people’s lives which weigh in their decisions. Where counselling is addressed it is an option for the primary practitioner, not mandated. For any other group in the community – young people, LGBTIQ people, indigenous people – we do everything we can to avert suicide. Where are the suicide interventions for people with disability?
The letter goes on to outline some of the difficulties people with a disability encounter when engaging with the medical profession. Difficulties that create or exacerbate concerns about legalised euthanasia and assisted suicide.
We are not satisfied with decision making and safeguards by medical practitioner around euthanasia as outlined in Section 11.
  • Many people with long term disabilities have endured a string of negative interactions with medical practitioners who underestimate the life chances, value and worth of people with disability; 

  • This occurs for a reason. Disability advocates operate from a social model of disability which assumes that barriers in the community should be addressed, whereas the medical model assumes we are the problem. 

  • Medical interventions are different from disability supports and in some cases people require advocacy against medical interventions or decisions. Doctors with the best of intentions are often unaware of disability supports, interventions and advocacy that make a person’s life liveable rather than just trying to cure a person’s underlying disease; and crucially 

  • The Bill does not even mention disability supports or advocacy.
LWL closes by calling on the parliament to reject the bill:
LWL believes that the Bill as it stands raises serious risks for people with disability and we hope it is defeated in the Parliament of South Australia. We are also releasing this letter publicly to contribute to community debate.
The release of the LWL letter is timely, given that disability activists from across Australia will be fronting the media and providing a briefing for parliamentarians this week ahead of the debate on the 20th of October.

The event was bolstered by a video presentation from UK actress, disability activist, comedian and braodcaster, Liz Carr directed at all members of parliaments in Australia.

Liz Carr puts the disability argument clearly in her 8 minute video which has also been released to the Australian media (see video at the top of the page).

You can read the Lives Worth Living letter in full HERE.

Dr Ramona Coelho: ‘I’m just trying to live by my conscience’

This article was published by the Ottawa Citizen on October 8, 2016.

By Joanne Laucius

Dr. Ramona Coelho
This spring, a patient told Dr. Ramona Coelho she was thinking about physician-assisted death.

Coelho gently probed to find out what was at the heart of the woman’s fear, anxiety and depression. The patient felt her life was diminished and no longer meaningful. Coelho says she steered the patient away from assisted death to finding ways to make every day seem worthwhile.

“My patients’ death wishes go away when their issues are dealt with,” says Coelho, who has practised medicine since 2007 and did palliative-care work in Montreal before moving to London, Ont., in 2012. She believes time, careful listening, affection and respect are key to a good relationship with patients.

“We have a rushed, overworked health-care system. Patients feel neglected. It can create an overwhelming anxiety. What is driving a lot of death wishes is anxiety. It’s not overwhelming pain.”

Coelho was interested in social justice long before she went to medical school. And yet she is surprised to be considered a “conscientious objector” to assisted death.

“I’m just trying to live by my conscience and with integrity,” she says.

A College of Physicians and Surgeons of Ontario policy acknowledges that physicians who object to providing medical assistance in dying for reasons of conscience or religion are not required to provide that assistance or assess whether a patient is eligible. However, these conscientious objectors must provide “an effective referral” to a patient in a timely manner. That means a referral made in good faith, to a non-objecting, available and accessible physician, nurse practitioner or agency.

This “active” referral is the sticking point for physicians like Coelho, who believe the province should set up a self-referral phone line for patients and not require physicians to act against their conscience.

“Patients want to know, ‘What would you do if you were me?’ So why would I offer them something if I feel it would be bad for them?” she says.

If a patient insisted on seeking access to assisting dying, Coelho says, she would respectfully ask that patient to find other means.

“They could still see me for emotional support. I truly have affection for people I disagree with. I wouldn’t terminate the relationship. The important thing is that we don’t abandon a patient. But you don’t have to do something that’s against your conscience.”

Coelho doesn’t want to bring religion into it. Assisted death has been a polarizing issue, and neither side is open to debate. Talking about religion creates a bias about the person making an argument, she says.

“If I brought religion into it, people would try to put me in a box and explain me away.”

The College of Physicians and Surgeons of Ontario has had no discipline cases for access to medically assisted dying, a spokeswoman says.

“In the event that we receive a complaint from the public relating to the provision of medical assistance in dying, we will investigate just as we would when a concern is raised about any other area of medical practice.”

Coelho recognizes speaking to a reporter about referring patients puts her viewpoint “out there.” But at the end of the day, a patient is free to see another doctor, she says.

“I respect free will. I can’t control people. I’m passively objecting. This law stands, unfortunately. But I shouldn’t be forced to do it. There’s a thousand other medical acts I can do. And I do them well.”