Report on physician-assisted dying gives attention to key issues; critical matters still to be addressed with federal legislation

A Statement from Dr. Cindy Forbes, President of the Canadian Medical Association

News Release

Canadian Medical Association

OTTAWA, Feb. 25, 2016 /CNW/ – The Canadian Medical Association (CMA) is pleased to see physician input reflected in a number of recommendations released today in the report of the Special Joint Committee on Physician-Assisted Dying.

In particular, the CMA welcomes the recommendation to re-establish a secretariat on palliative and end-of-life care and to implement a pan-Canadian palliative care strategy with dedicated funding. We are also pleased to see the recommendation for the development of a pan-Canadian strategy to improve quality of care and services received by individuals living with dementia.

While there is much to praise in this report, it does fall short on the issue of respecting a physician’s right to conscientious objection. As the government moves forward in drafting legislation, we must focus on ensuring effective access while also respecting different views of conscientious objection. Both can be achieved. While not addressed by this report, a central mechanism to coordinate access must be a key part of the solution.

The doctors of Canada hope that the recommendations outlined in today’s report will result in a consistent approach across provinces, including federally-coordinated reporting and oversight. In particular, we are dedicated to finding a solution, in partnership with legislators and regulators, that ensures patients have effective access to the service should they need it, no matter where they live.

–Dr. Cindy Forbes, President of the Canadian Medical Association

For further information: mediainquiries@cma.ca, 613-806-1865


The Canadian Medical Association (CMA) is the national voice of Canadian physicians. Founded in 1867, the CMA is a voluntary professional organization representing more than 83,000 of Canada’s physicians and comprising 12 provincial and territorial medical associations and over 60 national medical organizations. CMA’s mission is helping physicians care for patients. The CMA will be the leader in engaging and serving physicians and be the national voice for the highest standards for health and health care.

 

SOURCE Canadian Medical Association

 

Doctors won’t impede assisted death, says CMA in open letter

Dr. Cindy Forbes

The Canadian Medical Association (CMA) would like to correct suggestions that timely patient access to assisted dying will be impeded by physicians choosing either not to provide the service or not to make a referral to a colleague or an agency.

The CMA would like to respectfully suggest that this is simply not true, and that many years of international evidence definitively shows this to be the case.

This should not be a debate between patient access or the right to conscientious objection by health care professionals; we absolutely can accomplish both. Put simply, there are other ways besides a referral to ensure access, without requiring a physician to violate his or her moral integrity. And none of these in any way involve abandonment of the patient in a time of great distress.

Access to assisted dying will not be constrained if we do not impose mandatory referral requirements on physicians who see referral as being complicit in the act itself. Nor does this in any way involve imposing the moral views of the physician on the patient he or she serves. . . [Full text]

Supreme Court of Canada respect for physician freedom of conscience and religion is not “a cop-out”

Responding to “Patient rights – even in death – must trump a doctor’s discomfort.” Globe and Mail, 1 February, 2016

Sean Murphy*

According to André Picard, the Supreme Court of Canada decided last year that patients could ask to be killed by physicians or ask physicians to help them commit suicide, but physicians could not be compelled “to actually kill a patient.” He describes this as “a perfectly reasonable balancing and reconciling of rights.”1

Indeed, it is perfectly reasonable to believe that physicians should not be forced to actually kill a patient. However, Mr. Picard is mistaken when he claims that the Supreme Court of Canada reconciled or balanced the rights of patients and physicians in the Carter ruling. The Court did not even attempt to do so, stating, instead, that patient and physician rights “will need to be reconciled.”2

With respect to physicians, the Court stated that “nothing” in the ruling would compel physicians to “provide” or “participate in” euthanasia or assisted suicide. This is precisely the language and thinking adopted by the Canadian Medical Association (CMA) in its policy framework.3 Mr. Picard is clearly angry about this, calling it “a cop-out that creates real barriers for desperately ill patients,” one that “regulators and legislators cannot and should not accept.”

However, in the face of the Carter ruling, Mr. Picard cannot expect the CMA, regulators and legislators to impose his deeply held personal belief that refusing to compel physicians to provide or participate in homicide or assisted suicide is an unacceptable “cop-out.”

Mr. Picard clearly prefers the policy of the College of Physicians and Surgeons of Ontario (CPSO) on “effective referral,” which demands that physicians who refuse “to actually kill a patient” must help find someone willing to do the actual killing.

Contrary to his claim that effective referral is a “well-established policy,” it was first imposed by the CPSO in Ontario last year in the face of overwhelming opposition, on the basis of deficient, erroneous and seriously misleading briefing materials, and without evidence that even a single person in Ontario had ever been unable to access medical services because of conscientious objection by a physician.4 It is the subject of an ongoing constitutional court challenge,5 and is not supported by the BC Civil Liberties Association – one of the driving forces behind Carter’s challenge to the law.6 None of this seems to concern Mr. Picard.

“Patient need takes precedence over physician discomfort,” he says, “and patient rights trump physician rights.”

However, the CMA’s Dr. Jeff Blackmer told the joint parliamentary committee on assisted dying that this is a false dichotomy. There are enough physicians willing to provide euthanasia or assisted suicide to meet the expected demand, he said, and other jurisdictions do not require “effective referral” by objecting physicians but there is no difficulty with access.7

“This should not be a debate between patient access OR the right to conscientious objection by health care professionals,” writes CMA President, Dr. Cindy Forbes. “We can absolutely accomplish both.”8

Mr. Picard’s demand that physicians must get over discomfort about killing people at least to the extent that they will contract out the actual killing no doubt reflects his deeply held personal beliefs. However, if the real goal is to ensure access – not ideologically driven ethical cleansing – there is no reason to demand that physicians do what they believe to be wrong. If the real goal is to ensure access to services – not to punish objecting physicians – that goal is best served by connecting patients with physicians willing to help them, and that can be done without demanding “effective referral.”

Notes

1. Picard A. “Patient rights – even in death – must trump a doctor’s discomfort.” Globe and Mail, 1 February, 2016 (Accessed 2016-02-04).

2. Carter v. Canada (Attorney General), 2015 SCC 5, para. 132. (Accessed 2016-02-04).

3. Canadian Medical Association,  Principles-based Recommendations for a Canadian Approach to Assisted Dying (2016) (Accessed 2016-01-09).

4. Protection of Conscience Project, Submission to the College of Physicians and Surgeons of Saskatchewan (5 June, 2015) Re: Conscientious Refusal (as revised). Appendix “A”: Ontario College briefing materials .

5. Ontario Superior Court of Justice, Between the Christian Medical and Dental Society of Canada et al and College of Physicians and Surgeons of Ontario, Notice of Application, 20 March, 2015. Court File 15-63717.

6. Legislative Assembly of British Columbia, Report of Proceedings (Hansard), Select Standing Committee on Health. Wednesday, July 15, 2015, Issue No. 17, p. 270 (Accessed 2016-02-02).

7. Special Joint Committee on Physician Assisted Dying, Evidence: Wednesday, January 27, 2016. (Accessed 2016-02-04)

8. Forbes C. “Time for myth-busting on assisted dying.” Canadian Medical Association (4 February, 2016)

Doctors with moral objections to assisted dying should be able to opt out, committee hears

Assisted dying law could be coupled with improved palliative care, committee hears

CBC News

Peter Zimonjic

Doctors who morally object to physician-assisted dying should not be obligated to refer patients to a doctor who will provide the service, a joint Commons-Senate committee studying the issue heard Wednesday.

Dr. Cindy Forbes, president of the Canadian Medical Association told the panel that doctors shouldn’t have to refer a patient, but they must “advise the patient on all of their options … including physician assisted dying, and make sure the patient has the information they need to access that service” . . . [Full text]

Quebec MDs to get euthanasia guide to prepare for legalized assisted death

Unclear whether other provinces and territories will adopt a similar practice

The Canadian Press

Sheryl Ubelacker

The college that regulates Quebec doctors will soon provide practitioners with detailed guidelines – including what drugs to use – for euthanizing terminally ill patients who seek help to end their lives.

But it’s unclear whether other provinces and territories will adopt a similar practice when doctor-assisted death becomes legal across the country early next year.

With the passage of Bill 52 in June 2014, Quebec became the first jurisdiction in Canada to legalize medical aid in dying for mentally competent patients who meet a strict set of criteria. The law goes into effect in December, allowing physicians to begin helping patients with an incurable condition and intolerable physical or psychological suffering to die. . . [Full Text]