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As CMA meeting nears, debate over end-of-life care increasing

As physicians prepare to discuss end-of-life care during the CMA's annual meeting this August, debate is beginning to heat up about the many issues surrounding such care.

In June, for example, Quebec tabled legislation that sets "specific requirements for certain types of end-of-life care, namely terminal palliative sedation and medical aid in dying."

Although the word "euthanasia" does not appear in the 20-page bill, the provision for "medical aid in dying" means that Quebec physicians would be allowed to administer drugs that cause death.

"Most people want palliative care, but for the exceptional cases we need to have an answer," said Quebec Social Services and Youth Protection Minister Véronique Hivon when she introduced Bill 52 (An act respecting end-of-life care) on June 12. The legislation also calls for improved hospice palliative care standards across the province.

Although the Canadian Society of Palliative Care Physicians (CSPCP) applauded the commitment to improve standards, it says there should be universal access to quality hospice palliative care "before any introduction of 'medical aid in dying,' more commonly referred to as euthanasia."

In a news release that was issued jointly with the Canadian Hospice Palliative Care Association, the society, which is an affiliate of the CMA, also said that only a fraction of Canadians - 16 to 30% - have access to comprehensive end-of-life care.

CMA policy, last updated in 2007 but reviewed annually, states: "Canadian physicians should not participate in euthanasia or assisted suicide."

In its news release, the CSPCP took a similar stand. "The dedicated and committed physicians who work in hospice palliative care should not be expected to participate in this practice [euthanasia]," said the society president, Dr. Doris Barwich.

A recent CMA survey found that members' opinions on end-of-life care vary greatly, with 20% of respondents saying that they would participate in euthanasia (the act in which a physician performs the act that causes a patient's death), while 42% would refuse. (Almost one-quarter of respondents, 23%, were not sure how they would respond, while 15% did not answer.)

With physician-assisted suicide - in which doctors provide patients with the means to kill themselves - 16% of CMA members said they would be willing to participate, while 44% would not. (Twenty-six per cent were unsure of their response, and 15% did not answer.)

A recent CSPCP poll of its 311 members found there is strong opposition to euthanasia, with 90% of respondents stating they would not participate in it and 88% opposing its legalization.

The CMA's General Council (GC) will debate the issues surrounding end-of-life care during a special 90-minute strategic session in Calgary Aug. 19. It is being held in response to a 2012 GC motion that called on the CMA to "foster a public debate on end-of-life care issues in Canada."

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