Interview with Dr. Michèle Aubin
Last May, we were happy to host Michèle Aubin into our research team. Today, Dr Michèle Aubin, Clinical Researcher, Professor and Fellow of the College of Family Physicians of Canada, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSS) de la Capitale-Nationale, Canada, reflects on her research interest in Euthanasia and her research visit here in Belgium.
Can you briefly explain your current situation and research to us?
I am a family physician working in a teaching unit of family medicine affiliated to the Department of Family Medicine and Emergency Medicine, Université Laval; I am also a clinical researcher, holding the Research Chair in Palliative Care of the Faculty of Medicine of that university. My main research interests are in palliative care (for patients with cancer and for the elderly with dementia living in long-term care facilities), health services research particularly in collaboration between family physicians and oncology teams in the follow-up of patients with cancer; I am also interested in supportive care for family caregivers of patients with cancer.
What specific interest brought you to Belgium? Why did you choose to come to Belgium? How long will you be staying?
I am currently on sabbatical and my visit in Belgium was to learn more about the practice of euthanasia in your country, how it is integrated to palliative care, and also about the education given about euthanasia in the curriculum of medicine (how and when it is teached), and in continuous medical education. As you know we have adopted a law in Quebec about palliative and end-of-life care, continuous sedation and medical assistance in dying. This law is in application since December 2015, so it is really new for us. I wanted to meet physicians and other health professionals, as well as organizations in palliative care in Belgium to learn from your experience, since you have a law permitting euthanasia under specific circumstances since 2002.
What are the main similarities/differences between Belgium and Canada concerning your field of interest?
Our law was inspired from yours, but it is more restrictive. Our law has the same eligibility criteria as yours (the person must be competent to request medical assistance in dying, must have an incurable disease with irreversible declining, experience unbearable suffering (psychological and/or physical). But our law is limited to terminal diseases only (in the form that we have to complete to declare each case, we have to indicate the prognosis and the law specifies that the patient must be at the end of life (the law does not define in term of delay what it means, but it is understood that the prognosis must be quite short (weeks, or a few months at the most). It is also limited to adults (≥ 18 years).
The patient has to complete and sign a form to request medical assistance in dying, and he/she gives it to his/her treating physician. The physician may refuse (objection of conscience), but he has to transfer the form to another physician. Ultimately, each public health institution (hospital or community health center) has the obligation to be ready to respond to a request (they cannot refuse, as an institution, to eventually give medical assistance in dying if the patient fulfills all criteria). If the physician agrees to go further and assess the eligibility of the patient to receive medical assistance in dying, he has to be ready to give the lethal injection. He has to ask a second physician to review the eligibility of the patient and the second physician has to agree that all criteria are fulfilled before the medical assistance in dying may be given. The physician who gives the lethal injection has to complete a form and declare each case of medical assistance in dying (which is essentially euthanasia).
For continuous sedation, our law requires that the patient signs a consent form before receiving it (sedation was part of palliative care and given before the application of the law, but now, the patient has to sign a written consent (which was not needed before the law). If the patient cannot sign him/herself, a witness can sign in replacement. The physician has also to declare each case of terminal sedation. The government has not yet produced an official form to declare each case, but certain institutions have produced one.
What has visiting Belgium given you so far? What are your memorable moments? What are the elements you will be using in your future research?
Thanks to Prof. Luc Deliens and Dr. Kenneth Chambaere who helped me to contact key informants to learn about the practice of euthanasia and how it is integrated to palliative care, I was able to meet 23 different persons (physicians in family medicine, oncology, geriatrics, palliative care, professors and professionals in ethics, and different representatives of palliative care organizations, and of the Association Dying in Dignity). I have met people from Flanders and from the French speaking part of Belgium. This was very informative for me. All key informants were very open to share with me their views, experience and thoughts regarding euthanasia. In particular, all physicians freely shared with me their clinical experience of this practice and kindly gave me some advices and tips on strategies to adopt in the evaluation of each case. They also shared with me their feelings and how they cope with their emotions after having performed euthanasia. All this information will be very useful for me and my colleagues at Université Laval regarding the clinical issues related to the application of our new law on end-of-life care and medical assistance in dying. It will also enrich our discussions regarding the educational aspects to consider around this law. We have started a reflection on the training needed to medical students, residents during their clinical training and physicians in practice (who have to be prepared to receive a request for medical assistance in dying from their patients). We are in the process of defining specific training objectives and competencies to develop at different points in the curriculum of medicine and in continuous medical education.
Also, my contact with researchers from the End-Of-Life Care Research Group will be very useful to develop research projects related to the monitoring of end-of-life care practices (including medical assistance in dying) I am also interested in developing research projects to assess the experience of physicians with the application of our law on medical assistance in dying, how they cope with it. Finally, I would like to study the reaction of families of patients having received medical assistance in dying.
We thank Dr. Michèle Aubin for this interview, coming all the way from Canada. We sincerely wish her for the very best in her future endeavors.