This week (August 21 - 24) Canadian doctors met in Vancouver for the annual Canadian Medical Association (CMA) General Council meeting. Medical Assistance in Dying and the passing of Bill C-14 was a major point of discussion (Aid-in-dying issue comes full circle back to GC). 

In an open dialogue with Canadian doctors, facilitated by the CMA, many expressed their thoughts on the new law:

As a compassionate physician, I need not – indeed, I cannot – aim to end a patient’s life in order to do them good. I have other means at my disposal to relieve their physical suffering, and I do not know on the basis of biomedical science what it is like beyond the grave.

Physicians who don’t want to participate in physician assisted suicide should clearly have the right to opt out. However, failure to refer that patient onto an appropriate physician is inappropriate and unacceptable. Being a physician does not mean you get to force your patient to live their life in accordance with your personal choices.

Dr. Louis Roy, a palliative care doctor in Quebec City, shares how his thinking about MAID has evolved.

Over the last two years the CMA held consultations with its members regarding Bill C-14, the federal government's proposed legislation on medical assistance in dying. These consultations resulted in the publication of the CMA's Principles-based Recommendations for a Canadian Approach to Assisted Dying

The results of a (June 2016) CMA member survey revealed that approximately 25% of respondents would be willing to provide MAiD for their patients; 61% said they would not; and 14% were uncertain. Of the 61% who said they would not provide MAiD, 67% would be uncomfortable referring the patient to a colleague willing to provide it. Of those who were on the fence, 91% were likely to be comfortable making a referral.

According to the medical review journal Healio Psychiatric Annals it was found that:

  • in the U.S., less than 20% of clinicians reported receiving requests for euthanasia or physician-assisted suicide and 5% or less have complied
  • less than 1% of licensed physicians wrote prescriptions for physician-assisted suicide per year in Oregon and Washington
  • in the Netherlands and Belgium at least half of physicians reported ever receiving a request for MAiD and 60% of Dutch physicians had ever granted these requests

Dr. Wendy Johnston, Professor of Neurology, and Medical Director at the University of Alberta’s ALS Clinic.

In Canada the rights of health-care providers has been a major concern across the country. Are doctors now legally obligated to provide medical aid in dying (MAiD)? What happens if they refuse? 

Under the new federal legislation on medical assistance in dying, which received royal assent on June 17, 2016, Canadian doctors are not compelled to provide MAiD. However to ensure that patients have access to MAiD, “the [federal] government will work with provinces and territories to explore options to facilitate access and care coordination, while recognizing the personal convictions of health care providers.”

Each province has its own set of policies and regulations when it comes to conscientious objection. In most cases, the doctor is required to provide a referral to a healthcare professional or agency willing to carry out the patient’s wishes.

To assuage their members hesitations and prepare them for conversations with their patients, the CMA announced a new education program. Hopefully through initiatives like this and deeper dialogue healthcare providers will be more comfortable with the new legislation. 

Legalization of assisted dying is a societal prerogative. It is a done deal. But we still have an opportunity to help shape what it will look like in practice.
— Dr. Jeff Blackmer, CMA Vice-President, Medical Professionalism