In a report released in July entitled “End-of-life Care: a National Dialogue,” the CMA released the findings of its consultation with members over the past year. The association conducted six meetings with members over the spring and created a web site where members could post comments. It also held public town hall meetings.
Though end-of-life care includes advance care directives and palliative care, the CMA reported the issue the “majority of members” wanted to discuss was “physician-assisted dying and the role of the medical profession.”
“This was graphically demonstrated in the online dialogue where 80 per cent of comments posted dealt with euthanasia and physician-assisted dying and the current CMA policy opposing physician involvement.”
The report cited the main reasons why most members oppose legalizing “medical aid in dying.” Members believe it “would negatively affect the trust patients have in physicians and would jeopardize the physician-patient relationship” and that “the physician’s role is to heal, not end life.” It also noted that legalization is a “slippery slope” that would put “vulnerable populations” at risk and many felt it “could be used for economic purposes” to save the public health system money
The report also outlined the reasons why some members supported legalization, including respect for patient autonomy and palliative care can’t “ameliorate” some forms of suffering. Some also noted that “medical aid in dying is a form of medical care and part of the palliative care continuum — despite most palliative care physicians consistently and definitively stating the opposite.”
Members also voiced concerns about how euthanasia and assisted suicide could play out in practice, according to the report, including difficulties in establishing “competency and voluntariness” in emergency department or acute care settings and physicians fear of being forced to participate if it is legalized.
Members’ comments also pointed out the “link between inadequate palliative care services and calls for legalization of physician-assisted dying” and the fact palliative care is lacking outside major urban centres. They also discussed a lack of training in palliative care treatment and lack of proper remuneration for physicians’ services, the report said.
“Given the diversity of views on end-of-life issues it is not surprising that the CMA was not given a clear mandate on future activity dealing with the sensitive area of euthanasia and physician-assisted dying.”
The CMA members were in support of:
o “The importance of discussing advance care directives with patients in a timely manner”;
o A national palliative care strategy; and
o Better palliative care training.
The report noted many thought doctors should not provide euthanasia if it is legalized but some other group should provide it. Many said the CMA should protect physicians’ conscience rights if it is legalized.
“Finally, there was a general acknowledgement that society would make the final decision concerning euthanasia and physician-assisted dying and that it was not the role of the CMA or the medical profession to dictate what this should be, as a reflection of patient-centred care,” the report concluded.
Meanwhile, Ottawa Archbishop Terrence Prendergast, along with an imam and a rabbi, have written a joint-intervention in favour of physicians’ conscience rights.
“No Canadian citizen, including any physician, should ever be disciplined or risk losing their professional standing for conducting their work in conformity with their most deeply held ethical or religious convictions,” wrote Prendergast, Rabbi Reuven Bulka and Imam Samy Metwally in a July 31 letter to the College of Physicians and Surgeons of Ontario.
The College had been seeking input until Aug. 5 on its policy review entitled “Physicians and the Ontario Human Rights Code.”
“It is crucial that we preserve the right of our doctors to refuse to participate in such services even if they are legal.”