MONTREAL — If physician-assisted suicide becomes legal, at least 13,500 Canadians will die that way each year, a Montreal rabbi argued at a Jewish medical ethics symposium on end-of-life care.

Rabbi Raphael Afilalo, director of pastoral services at the Jewish General Hospital (JGH), said the figure is his “conservative projection” based on statistics in the Netherlands where it has been legal for doctors to provide lethal drugs for several years.

Rabbi Afilalo, who previously had a financial career, estimates that more than 2.4 million people globally will die this way annually, and he is taking into account only the 50 most populous countries.

(His calculation is the ratio of .038 per cent of the total population, or 6,386 annual deaths, to Holland’s population of 16.8 million.)

Rabbi Afilalo, who convened the conference, warned in no uncertain terms that he believes the trend toward acceptance of what he calls “active euthanasia” is growing worldwide, even in Israel, where it has been raised in the Knesset.

In Quebec, it will soon be a fact. Bill 52, An Act Respecting End-of-Life Care, passed in June 2014, is due to come into force at the end of this year. It provides for “medical aid in dying,” that is, a physician may administer to a consenting adult patient, whose condition is considerable hopeless and is suffering, drugs that result in death.

Rabbi Afilalo fears Quebec could eventually follow Holland and Belgium where, he said, depression, for example, can be cause for assisted suicide and some patients have been “killed” without their explicit consent.

The Supreme Court’s decision in February that the Criminal Code section that outlaws assisted suicide is unconstitutional likely means that there will be no court challenge of Quebec’s law based on the Criminal Code. The court has invited Parliament to draft new legislation.

Rabbi Afilalo was unequivocal that Judaism proscribes the taking of another life under any circumstances, except self-defence.

He finds Bill 52 vague in defining an “incurable” condition and “suffering,” particularly when it’s psychological.

“Without clear parameters, a Pandora’s box is opened,” he warned.

He made clear that he was not speaking for the JGH, under whose the auspices the daylong conference was held, primarily for health-care and social services professionals and lawyers, as well as interested members of the public.

Besides the ethical aspect, it was clear from the panellists that many practical questions from a medical and legal standpoint remain to be answered about the new law.

The JGH, like other hospitals in the province, is required under Bill 52 to formulate a policy on this issue, which it has not yet made known.

Speaker Dr. Eli Segal, a JGH emergency department physician, said that on moral and religious grounds, he does not support euthanasia – the term he also favours. 

“I find [the law] a bit frightening as a physician. As a health practitioner it goes against our primary instinct to heal. To kill is very scary,” he said.

He believes better use of pain control and psychiatric support, and especially more accessible palliative care in Quebec are better recourses.

 But it is now the law, and polls show that a majority of Canadians, the largest in Quebec, do want the option of physician-assisted suicide, he said, so the medical profession has to establish an approach.

Bill 52 does not force any doctor to assist with dying, which is a great relief to Segal, as an observant Jew. However, if he refuses, it means he may be “dumping it on a colleague… Will someone become the hatchet man for the hospital?” Segal wonders. 

Surveys show a wide discrepancy among doctors, Segal said. Only about 20 per cent of doctors in Canada said in 2013 they would assist with dying, while two-thirds of those in Quebec said they favoured that option.

Segal said he fears the legislation could lead families to pressure a patient to choose that option, because they don’t want the burden or are after an inheritance. If doctors can deliberately take lives, it could also lead to a mistrust of the medical profession, he said.

He is also concerned that the law could eventually be extended to include those with dementia or youths with incurable diseases.

Audience member, Dr. Paul Saba, a leader among physicians opposed to the bill, noted that 70 per cent of Quebecers do not have access to adequate palliative care. With the government cutting the health-care budget, he worries that euthanasia will become a cheaper alternative.

Rabbi Afilalo said he tried hard to find a doctor in favour of assisted dying to speak, but could not. “One said yes, but backed out at the last minute. I understand why they are uncomfortable.”

Audience member Sheila Whitzman, who writes and speaks on issues related to seniors, differed from Rabbi Afilalo’s perspective, pointing out that Quebec and Canada are secular societies and, like abortion and same-sex marriage, medical aid in dying will become more acceptable. 

From the legal point of view, lawyer Gerard Samet called the bill “an extremely dangerous law” that will change society’s values and “trivialize” euthanasia. Terminating life should not be put forward by the government as the right thing to do if you are against prolonging suffering or for personal autonomy, he said.

Gordon Kugler, a prominent lawyer in the field of personal injury, said the bill contains a large number of safeguards, but “time will tell if there is abuse of the system, or whether very few meet the criteria in Bill 52… I hope the rabbi’s statistics are way off base.”

Kugler does foresee situations arising from the vagueness in the language of the law that, after it comes into force, could come before the courts and be decided on a case-by-case basis.