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CMA says central referral system critical piece of assisted dying legislation

The Canadian Medical Association (CMA) is pressing the federal government to establish a central referral agency or process that would coordinate patient access for those seeking assistance in dying. This will ensure that all patients can effectively access this service, while also respecting physicians’ right to conscientiously object.

Dr. Jeff Blackmer, the CMA’s vice-president of medical professionalism, says a recent case of assisted dying in Canada—a Calgary woman was forced to travel to Vancouver to end her life—emphasizes the need for a central referral system as a critical component of federal legislation.

“[The CMA] is really focused on how to ensure that patients who qualify will have access without compromising the rights of physicians and other health care providers and that’s where we come to the importance of a central coordinated referral mechanism,” says Dr. Blackmer.

Troublingly for the CMA, this recommendation was left out of the parliamentary report on assisted dying released last month.

The 70-page report of the Special Joint Committee on Physician-Assisted Dying, titled Medical Assistance in Dying: A Patient Centred Approach, includes 21 recommendations and suggests a two-phase approach that would enable eligible Canadians suffering from “grievous and irremediable” medical conditions to access aid in dying.

The CMA was very pleased to see physician input reflected in a number of other recommendations specifically with regards to re-establishing a secretariat on palliative and end-of-life care and implementing a pan-Canadian palliative care strategy with dedicated funding.

However, the CMA did feel the report fell short with respect to the proposed mandatory referral process. This goes against what the medical group has been advocating for, as it does not respect the conscience of all physicians.

“There are physicians who see making a referral as morally analogous to doing the act itself,” says Dr. Blackmer.

As an alternative to establishing an obligation to refer, the CMA recommends that legislation not only include a centralized hub—which would help patients facilitate necessary connections with non-objecting health care providers—but that it also include positive obligations that a physician has when dealing with a patient who requests aid in dying.

“No one is suggesting that we force physicians to participate directly in assisted dying against their moral views. The more complicated issue is what positive obligations physicians have after that,” says Dr. Blackmer.

Under these guidelines, if a physician elects not to provide assisted dying, they must still talk to their patients about all the options available to them—including the act itself. Additionally, they must transfer the care of a requesting patient to another provider upon request of the patient. The goal is to ensure that patients are supported and will receive continuous care until transfer.

In order for this process to be successful, the CMA says there must be a consistent approach across provinces, including federally-coordinated reporting and oversight.

This week, CMA President Dr. Cindy Forbes wrote a letter to the federal health minister’s office to stress the importance of a collaborative national approach, which would ultimately prevent a patchwork of information with potentially detrimental effects on patients.

“As the June deadline fast approaches, it’s important that we work together to get this right,” says Dr. Forbes. “The CMA is ready to inform and support the federal government’s advancement of this legislation.”

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