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We need clear guidelines on referral in physician assisted dying: Simpson

The Canadian Medical Association (CMA) continues to engage politicians and stakeholders at the highest level on the medical profession’s perspective on physician-assisted dying and the need for clear guidelines in this area.

CMA President Chris Simpson discussed the CMA’s perspective on this issue recently when he met with federal Health Minister Rona Ambrose. The CMA is also seeking a meeting with federal Justice Minister Peter MacKay to discuss the recent Supreme Court of Canada ruling that the Criminal Code ban on physician assisted dying is unconstitutional.

The CMA has also been outspoken in recent weeks on the need for physicians to be able to act on their conscience on this issue.

In an interview published in the National Post, Simpson stated “we simply cannot accept a system that compels physicians to go against their conscience as individuals on something so profound as this.”

Mandatory referral in physician-assisted dying is one of the major issues that need to be resolved in the wake of the unanimous court ruling. While the CMA does not have specific policy in this controversial area, it will be consulting with its members in the coming months and hopes to have guidance following its General Council meeting in August.

The court said the charter rights of both patients and doctors will need to be reconciled when the ban is lifted in a year. Simpson said many doctors opposed to physician-assisted dying feel that even referring a patient to another doctor to deal with the issue “is contrary to their personal ethics or moral or religious beliefs.”

However, in the interview, Simpson also stressed resources must be put in place to ensure that patients who want assisted dying can “self-refer” to physicians who will assist them.

“I can’t emphasize enough that in us taking this position about conscientious objection we feel equally strong that we need to have other mechanisms to make sure that patients who need the service get it,” said Simpson.

Just one day after the interview was published, the College of Physicians and Surgeons of Ontario – the country’s largest regulatory authority for physicians – released a new policy stating physicians who are opposed to certain medical practices must refer patients to other physicians who will assist them.

However, in a background document the College said because the Supreme Court decision is not yet in effect “the case does not have any implications for the Professional Obligations and Human Rights policy. If Parliament and/or the provincial legislature develop a legal framework to enable physician assisted death to be provided to patients, the College will consider the legal framework and evaluate whether any changes to the policy are required.”

In another development, the CMAJ published a March 9 commentary that supported the CMA’s position calling for significant involvement of the medical profession in the development of any regulations or policies governing physician-assisted dying.

The commentary by Jocelyn Downie, a member of the pro bono legal team that challenged the ban on physician-assisted dying in the Supreme Court, stated “physicians have an extraordinary opportunity to have a tremendously positive impact on end-of-life care in Canada.”

Downie also said physicians have “a singular opportunity” to advocate for expanded palliative care in the wake of the Supreme Court decision.

The types of questions raised by Downie that must be addressed in developing new regulations are exactly the ones already being considered by the CMA Committee on Ethics in its development of a draft regulatory framework and foundational principles.

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