Responding to articles by CMA officials (BMJ 2019; 364)
It is disconcerting to find that the CMA’s President-Elect thinks that Canadian law “does not compel any physician to be involved in an act or procedure that would violate their values or faith.” The state medical regulator in Canada’s largest province has enacted policies that do just that, requiring physicians who refuse to kill their patients to find a colleague who will. These policies do have the force of law, and objecting physicians were forced to launch an expensive constitutional challenge to defend themselves. The Protection of Conscience Project and others have intervened in the case to support them; the CMA has not.
Further, the Canadian Medical Association’s assertion that it has successfully adopted a “neutral” position on euthanasia and assisted suicide (EAS) is challenged in a World Medical Journal article by seven Canadian physicians. “For refusing to collaborate in killing our patients,” they write, “many of us now risk discipline and expulsion from the medical profession,” are accused of human rights violations and “even called bigots.” . . . Full Text
In July, 2017, Canadian euthanasia/assisted suicide (EAS) practitioners and advocates alleged that patient access to euthanasia and assisted suicide was in danger because of “barriers” and “disincentives” to physician participation. Dr. Stefanie Green, president of their professional association, described the situation as “a crisis.”1 There was, in fact, no crisis — only a false perception of crisis fuelled by unrealistic expectations about levels of physician participation in euthanasia and assisted suicide.2
Nonetheless, it is reasonable for policy makers to respond to their concerns that physicians are discouraged from participating in euthanasia and assisted suicide. Indeed, objecting physicians are less likely to experience disadvantage and coercion if policy-makers seriously consider suggestions by EAS practitioners and advocates about how to encourage physician participation in euthanasia.
Removing barriers and disincentives to physician participation
Minimizing procedural and administrative requirements
Returning to the complaints and concerns of Canadian euthanasia practitioners (see Canada’s Summer of Discontent2), reducing or streamlining procedural requirements and minimizing burdensome paperwork might encourage more physicians to participate. However, this raises a question that may prove difficult to answer. Is a procedural requirement a “barrier” — or a necessary safeguard? A “disincentive” — or an essential ethical prerequisite? The difficulty is illustrated by developments in Belgium. . . .[Full text]
Shortage of euthanasia practitioners “a real problem”
There were 803 euthanasia/assisted suicide (EAS) deaths in Canada during the first six months after the procedures were legalized. In the second half of the first year (ending in June, 2017) there were 1,179 — a 46.8% increase, and about 0.9% of all deaths. Health Canada correctly states that the latter figure falls within the range found in other jurisdictions where euthanasia/assisted suicide are legal, but the Canadian EAS death rate in the first year was not reached by Belgium for seven to eight years. The dramatic increase of EAS deaths in the last half of the first year would have had a direct impact on EAS practitioners, and this may be why they ended the first year by sounding the alarm about access to the service. . . .[Full text]
Doctors attending a session on medical aid in dying at the Canadian Medical Association (CMA) General Council supported the use of advance directives and allowing mature minors to access assisted death. However, they split on opening up the service to otherwise healthy people with mental illness.
In a poll, 83% said they would support the use of advance directives to request medical aid in dying in cases where a person was otherwise unable to give consent. Some 69% would support opening the service to “mature minors,” including cases in which a guardian might request assisted death for a terminally ill infant, for example. However, after roundtable discussions, less than half (46%) of doctors polled said they would support assisted death on the basis of mental illness alone. . . [Full text]
The Globe and Mail
Canada’s doctors, who have never been staunch supporters of medically assisted death, now seem to be open to a liberalization of the law.
A straw poll conducted on Wednesday at the Canadian Medical Association annual meeting found that 83 per cent of delegates supported allowing “advance directives” – meaning, for example, that people with dementia could, while they are still competent, decide they want an assisted death at a later time.
The informal poll of the 600 delegates also found that 67 per cent backed the idea of “mature minors” being allowed to access assisted death. (A mature minor is someone under 18 who is deemed mature enough to make decisions about their own medical treatment.)
Physicians, however, were far less enthusiastic about allowing assisted death for patients whose sole problem is mental illness: Only 51 per cent backed that idea.
Similar CMA straw polls showed that, in 2013, only 34 per cent of doctors supported assisted dying legislation; that rose to 45 per cent in 2014. . . [Full text]
A year since assisted suicide became legal, only a small number of physicians are willing to perform the procedure, and their numbers are shrinking. Taking a life is harder than they thought
The first thing April Poelstra noticed was the hitch in her father’s shoulder. Jack’s left arm was drooping, hanging limply at his side, as if he didn’t have the muscle to cinch it into alignment. It was the fall of 2015, and Jack was living in Frankville, Ontario, waking up at 4:30 a.m. to plow roads and work odd jobs for a construction company. . . Jack tried to downplay his shoulder problems. He visited his doctor for a battery of tests, but always changed the subject when April pressed for details. . . .In early 2016, her fears were validated: Jack was diagnosed with ALS. Amyotrophic lateral sclerosis, or Lou Gehrig’s disease . . .On June 17, Bill C-14 became law, making medical assistance in dying, or MAID, legal for mentally competent Canadians. Jack Poelstra was overjoyed. . . [Full text]
Canadians ask a lot of our physicians – years of education, long hours, complex cases and demanding patients (full disclosure – I am married to a doctor).
Since June of last year, we have also been asking them to help some of their patients take their own lives.
No matter how you feel about assisted dying, you have to admit that having a role in the act is a burden that few of us would ever welcome. And yet as a society we seem to forget that doctors are no different. . . [Full text]
Some doctors who have helped the gravely ill end their lives are no longer willing to participate in assisted death because of emotional distress or fear of prosecution if their decisions are second-guessed, according to their colleagues.
In Ontario, one of the few provinces to track the information, 24 doctors have permanently been removed from a voluntary referral list of physicians willing to help people die. Another 30 have put their names on temporary hold.
While they do not have to give a reason, a small number have advised the province they now want “a reflection period to decide whether medical assistance in dying is a service they want to provide,” according to a health ministry spokesman. . . [Full text]
Ottawa has seen 28 people take their life with the help of a doctor since legislation came into force.
Since new legislation came into place last year, 28 people in Ottawa have ended their lives with the help of a physician.
Advocates say the new legislation, which came into force last June, is taking a toll on some doctors, who are finding it difficult to help patients who want to die. . . .
Jeff Blackmer, vice-president for medical professionalism at the Canadian Medical Association, said doctors have been telling his group that they struggle with taking part in assisted-death procedures. . .. [Full text]
While not explicit in the language of the legislation, new physician-assisted dying laws would include the creation of a centralized referral mechanism for doctors and nurse practitioners who refuse to help a patient end their own life.
Dr. Jeff Blackmer, vice-president of medical professionalism with Canadian Medical Association, said the government has assured the medical professional community the database – which could be as simple as a toll-free number – will connect patients with willing providers. . . [Full text]