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Physicians would be wary of providing assistance in dying for mature minors, patients with sole diagnosis of mental illness

Although an overwhelming majority (90%) of Canadian Medical Association (CMA) members who responded to a recent survey on medical assistance in dying (MAiD) support having new federal legislation in place, only approximately 25% say they are willing to participate.

On average, 90% of respondents felt there was a need for federal legislation, including robust patient safeguards, to ensure a consistent legislative/regulatory framework for MAiD across Canada, but results varied slightly across the country. In Newfoundland, almost all respondents (98%) felt this way while in Quebec, 84% agreed on the need for federal legislation.

“Based on what our members and patients have told us, the CMA considered a federal law on medical assistance in dying to be extremely important,” said CMA President, Dr. Cindy Forbes. “Now that the law is in place, Canada must move to address the critical underlying issues confronting end-of-life care in this country, specifically improving access to high-quality palliative care for all Canadians who need it.”

Consistent with previous CMA surveys, approximately 25% of respondents indicated that they would be willing to participate in assistance in dying for their patients. The majority of respondents indicated they would not participate (61%) or were not sure if they would (14%).

Of those willing to participate, less than a quarter (22%) would consider providing the service for patients whose sole diagnosis is mental illness, 59% would provide it for non-terminal physical illness and 38% would provide the service to mature minors, were these issues to be covered under future federal legislation. The federal government has committed to further study of these issues, and the CMA will be an active participant in that process.

Of those who were definitive about not providing the service (61%), two thirds (67%) would also be uncomfortable referring to a colleague who would provide it. Those who were uncertain as to their own participation (14%), on the other hand, were more likely to be comfortable making a referral with 91% saying so. The issue of mandatory referral continues to be a concern particularly in Ontario, where a court challenge has been launched against the College of Physicians and Surgeons of Ontario.

“The CMA believes that establishing a central referral system is the best way to ensure access to assistance in dying for patients who desire the service while protecting the rights of physicians who conscientiously object to providing it on moral or ethical grounds,” said Dr. Forbes. “Setting up such a structure is a key next step.”

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