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Plenty of opinions on assisted dying: CMA members

An online consultation with Canadian Medical Association (CMA) members about the logistics of legalizing assisted dying has shown the continued depth of feeling among Canadian physicians about the issues involved.

The online dialogue with members was conducted between June 8 and July 20 and – along with new survey data –provides the basis for a debate at the CMA’s General Council meeting later in August on a principles-based approach to assisted dying in Canada.

“Given the deeply held views of our members on the issue of assisted dying I am impressed by the degree of decorum and respect for opposing views seen throughout the online dialogue,” said CMA President Chris Simpson.

The CMA has been conducting consultations with members, as well as the public, on end-of-life issues since 2014. This process took on more urgency in the wake of the unanimous Supreme Court of Canada decision in the Carter case in February 2015, which ruled that Criminal Code provisions banning assisted dying were unconstitutional.

At its May 2015 meeting, the CMA Board of Directors gave approval for the document “Draft Principles-based Recommendations for a Canadian Approach to Medical Aid in Dying” to be released for consultation with members and stakeholders.

A total 595 members registered for the online discussion and posted 545 comments in the dialogue moderated by Dr. Jeff Blackmer, CMA vice-president of medical professionalism.

Many members applauded the CMA for taking leadership on the challenging issues involved, and praised the association for reaching out to its members for feedback and input.

Several comments opposed the Supreme Court decision and/or the CMA’s attempt to provide a balanced perspective respecting all member views on the issue of assisted death. However, recent polls show that CMA members are evenly divided on the issue, and a significant minority of respondents to these polls said they will participate in offering this service to their patients.

“The CMA remains committed to continuing to encourage policy-makers to implement legislation or policies that will respect the Supreme Court decision while protecting the rights of all its members,” said Simpson.

“Whether you agree with assisted dying or not, whether you decide to participate or not, we will be at the table to protect your rights and interests,” wrote Blackmer at one point in the online discussion.

Reconciling the right of a physician who chooses not to participate in assisted dying to ensuring access to this service for eligible patients was the most hotly debated issue in the online dialogue.

Most conscientious objectors rejected the CMA proposal that physicians not wishing to be involved with assisted dying refer these patients to an independent third party who would provide information and assistance for the patient. Instead, they proposed that patients self-refer to these services.

Others pointed out that self-referral may not be feasible or would force the patient to face undue hardship.

Blackmer wrote that a self-referral approach is unlikely to be accepted by legislators. He said the CMA proposal was intended to be a “middle ground”, and that most patients receiving a referral to a third party would not ultimately access assisted dying but would learn about options available — including palliative and spiritual care.

Although not specifically identified as a theme of the online dialogue, the importance of palliative care services and the interaction between palliative care and assisted dying was noted by many physicians in the dialogue discussions.

Participants also commented on the need to provide formal education or some form of certification and other support for physicians providing assisted dying, and to better inform all physicians on the issues involved. Blackmer noted the CMA is in the process of developing such educational tools.

“The CMA is to be commended for taking a measured approach to this very difficult new reality,” commented one respondent. “I am proud of the way the CMA has shown leadership for patients, physicians and policy-makers in this vitally important debate leading up to the recent Supreme Court decision.”

A recently appointed independent panel appointed by the federal government to consult on assisted dying in light of the Supreme Court decision has suspended its direct consultations with groups such as the CMA until after the October federal election.

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