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I understand that the States of Guernsey will soon be voting on a proposal to legalise euthanasia and could be the first jurisdiction to do so in the UK. As a Professor Emeritus of Obstetrics and Gynaecology (Obs/Gyn), who married a local nurse and although living in Canada we still has strong family ties to the Island. I practised in Guernsey in the early 1970s for a couple of years before deciding on a fulltime career as a specialist. Please allow me to comment on the effect this legislation will have on society and the practice of medicine.
The UK 'Abortion Act' of 1967, the first in a Western country, brought about a fundamental change in the practice of obstetrics and midwifery. The Act was supposedly intended initially for hard cases (e.g. to prevent a maternal mortality or in the case of rape). Through a process of gradualism however abortion became legal up to 28 weeks gestation as a matter of “choice’ on demand and the right of obs/gyns and midwives to practice according to their consciences supposedly protected by clause 4 of the legislation was soon ignored. Those who maintained a fundamental stand in defence of life, and remained faithful to their faith beliefs were considered to be “ultra conservative”, “professionally out-dated” and even possibly “negligent” and earned the opprobrium of governments and medical associations. So this gradual discriminatory process continues to this day, which has had very negative effects on recruitment to obstetrics. The Royal College of Obstetricians and Gynaecologists is proposing that abortion should be removed from the criminal code altogether. The questions that must be considered are; what effect does all this have on women, are they being unduly influenced by those who do not understand or care about religious convictions?
For the second time, all doctors and are being given a license to kill patients. It is inevitable that physician assisted suicide will progress through the process of gradualism, initially only for hard cases but will become a primary “solution”, for the dependent aged and patients terminal ill as health care costs continue to rise. Here in Canada, the first report on the operation of the Quebec’s Euthanasia and Physician Assisted Suicide law is illustrative. There were nearly three times the number of deaths expected by the Quebec Minister of Health (100 expected, 282 occurred) in the first 7 months and 21 (8%), were non-compliant with the law. Canada has become a morally totalitarian country, with no law protecting the unborn, and is second only to the Netherlands in the liberalisation of euthanasia. A legal safeguard in law was supposed to be a conscientious objection clause, but this has been removed, by the College of Physicians and Surgeons of Ontario (CPSO) which has a new policy requiring physicians and surgeons to make referrals when their consciences will not allow them to cooperate with a particular procedure or treatment.
In an article by Savulescu and Schuklenk (Professors of Bioethics, at Oxford University, and Queen’s, in Canada) entitled “Doctors Have no Right to Refuse Medical Assistance in Dying, or Abortion” the authors argue in favour; by removing a right to conscientious objection; by selecting candidates into relevant medical specialities or general practice who do not have objections. It is also being suggested that applicants to medical school should be questioned about their views on these moral questions.
It is ironic that it is universally accepted that it is unethical for doctors to be involved with capital punishment but it is acceptable that they be required to use their medical skills to solve social problems by assisting in the killing of the unborn, the sick or elderly. Primum non nocere (First do no harm) has always been the principal precept of medical practice throughout the world. Sadly the practice of medicine is being forced to change from one of a covenant of trust with all patients to one that is simply a contractual agreement as a service provider. Perhaps it is time to de-monopolise the provision of these services away from the medical profession to some other trained profession.
Dr. Robert Walley FRCSC, FRCOG, MPH (Harvard)
Founder and Executive Director, MaterCare International
Professor Emeritus of Obstetrics and Gynaecology
Telephone: +1(709) 579-6472