A panel of Canadian doctors and coroners has drafted guidelines to help physicians walk the fine line between palliative care and euthanasia.

For some, the end-of-life means a painful, anxious death in an intensive care or palliative care unit.

Many doctors are reluctant to prescribe high doses of pain-relief because these drugs can hasten a patient's death. It's also hard to determine safe levels because everyone reacts differently to narcotics like morphine.

Dr. Peter Singer
Dr. Peter Singer

Some physicians have been worried about the potential of being charged with euthanasia, according to Dr. Peter Singer, director of the Joint Centre for Bioethics at the University of Toronto.

"Euthanasia is like a 10,000-pound gorilla sitting on the back of good pain and symptom control," he said.

Singer helped write a report by a panel of 21 intensive care physicians and coroners that proposes new end-of-life guidelines for doctors.




Doctors should feel comfortable giving as much pain medication as it takes to ease suffering, even if it hastens death, he said.

The guidelines draw a line between pain management and euthanasia that removes the "gorilla," he added. The key is a doctor's intent when giving drugs.

Coroners back proposals

Ontario deputy chief coroner Dr. Jim Cairns said he likes the guidelines because they explain how physicians can make their intentions known, and then document them. If a patient receiving a small amount of morphine suddenly gets a lot more, then suspicions will be raised.

The "consensus guidelines" have been endorsed by deputy chief coroners from five provinces. Coroners look at toxicology reports to determine if there was foul play in a patient's death.

Six years ago in Halifax, Dr. Nancy Morrison was accused of murdering a terminally ill patient by giving potassium rather than morphine. The case against Morrison was eventually dropped, but it created a chill among Canadian doctors who treat dying patients.

Joel Pink, the lawyer who successfully defended Morrison, said the suggested guidelines validate doctors' decisions to prescribe potentially dangerous doses of painkillers at the end of life – even if it hastens death.

The report's authors hope the guidelines will be formally accepted by hospitals or groups like the Canadian Medical Association. Others, however, think more palliative experts should be consulted first.

It's up to doctors, patients and their families to decide whether the guidelines will be widely adopted, Singer said.