To Cure Sometimes,

To Relieve Often,

To Comfort Always.

As McGill University physicians involved in both patient care and medical education, and in light of the Quebec government passing Bill 52 (legalizing euthanasia), we think it important to clarify what we see as our fundamental responsibilities. (This is not a comprehensive list of responsibilities but rather a focused one.) Because clarity of definitions are critical we include the Canadian Medical Associations 2014 Update Policy on Euthanasia definition: “Medical aid in dying – refers to a situation whereby a physician intentionally participates in the death of a patient by directly administering the substance themselves, or by providing the means whereby the patient can self-administer a substance leading to their death”. The CMA statement (available at www.cma.ca) includes definitions of other terms used below and makes a clear distinction between currently acceptable ways to help dying patients (palliative sedation; withdrawing or withholding life sustaining interventions; dying with dignity; and palliative care) and what we find unacceptable, that is, euthanasia/medical aid in dying that have the physician performing actions with the intention to cause death.

We hereby declare that for our patients we:

· Will always seek the best treatments including advocating for access to care where it is not locally available.

· Will respect their rights, when informed and competent, to not receive medical treatment even if it should result in their death.

· Will, if so requested, allow the disease process at the end of life to take its course without enacting treatments to prolong the dying process. This includes prescribing medications to relieve pain and other symptoms even, in rare cases, and if required, to the point of unconsciousness (i.e. palliative sedation).

· Will not abandon them for any reason including differences in opinion or lack of remaining treatment options, as there is always “more that can be done” in terms of accompanying the sick.

· If asked to end their life, by themselves, their loved ones, or by legal decree we will not accede to this request: It is our role as physicians to uphold that as long as there is life there is hope, even, and especially if the patient no longer has hope themselves for themselves.

We are signing this declaration to make it clear that we will not intentionally participate in the death of a patient.

The paper by Boudreau and Somerville (Medicolegal & Bioethics 2014:4 1-12 ) accessible at; https://www.dovepress.com/medicolegal-and-bioethics-i973-j112, is a helpful outline why, as physicians, to intentionally participate in the death of a patient has more propensity to cause harm than to provide benefit.