Debate flies at CMA meeting over physician’s role in assisted dying

WATCH ABOVE: Dozens of doctors shared their opinions of how involved they should be when it comes to assisted dying. The discussion came during the annual meeting of the Canadian Medical Association. The current ban on assisted dying expires next year. Julia Wong reports.

HALIFAX – Physicians from across the country spent hours at the Canadian Medical Association’s annual general meeting discussing what their role would entail if asked to assist a patient in dying.

Dozens of physicians took the floor to share their thoughts, concerns and worries over what was morally acceptable and what to do if they had a conscientious objection.

The Supreme Court of Canada struck down the ban on assisted dying in February and gave the federal government one year to create a new law. It will technically be legal for a physician to be involved in assisted dying next year.

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Dr. Douglas Maynes, a Halifax psychiatrist who has been practicing for 43 years, said he has concerns about those with mental illness.

He calls the law “over-inclusive, vague and ambiguous”.

“I’m concerned about the potential for victimization of the mentally ill with this law,” he said. “I think we need help from the legislators federally, provincially and our provincial colleges, to define the criteria.”

Maynes said physicians who have a conscientious objection to make referrals.

Dr. Nuala Kenny, a medical ethics professor at Dalhousie University, said medicine has an internal morality and assisted dying conflicts with that.

“I do not believe killing is an act of medicine. Medicine is about the healing arts. This is clearly the medicalization of suffering and the medicalization of death. But I know now that this is legal and so we have to respond as doctors,” she said.

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“What makes medicine medicine and not a Superstore is that the doctor’s special gift is the ability to make judgments about how medicine can in fact bring potential benefits and limit harms in the choices that are then presented to the patient.”

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A poll conducted during the discussion showed the majority of doctors favoured an option that would allow them to refer a patient to another physician, to provide the patient with all their options and to advise the patient on how to access that information.

“The option…respect that doctors can’t abandon patients. But at the same time, a doctor’s consciences about an act like killing and ending life really has to be respected,” Kenny said.

Dr. Alana Cormier, a family physician who practices in Musquodoboit, said the option allows doctors to balance their views with their patient’s best interests.

“I definitely think physicians need to be willing to have the discussion with their patients about all their options,” she said. “I don’t think avoiding options that you personally disagree with is acceptable.”

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“You don’t in any way want to obstruct the patient’s ability to have the choices that are legal but we want to be able to have those discussions and make sure they’re considering all their options.”

Training for doctors

CMA Vice-President of Medical Professionalism Dr. Jeff Blackmer said physicians will be offered a two day training course to become certified in assisted dying.

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When asked by Global News whether two days was sufficient, Blackmer said it may sound short but doctors would be learning in an intensive environment. He also said that doctors would not necessarily be starting from scratch either on the topic.

CMA President Dr. Chris Simpson said there is concern the federal government could fail to enact new regulation by February 6, 2016. The responsibility would then fall on each province and territory, which is a situation he wants to avoid.

“We don’t want to arrive at February 6 with everybody saying ‘Assisted dying in Canada is legal. Does anybody know how to do it?'”

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“What is likely to happen perhaps is we’ll have different timelines in different provinces,” he said. “We’ll have different sets of edibility criteria in different provinces. We’ll have different ways to evaluate and monitor so it just creates something I don’t think Canadians wants to think about. This is hard enough as it is.”

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Blackmer noted that the option physicians preferred that allowed them to refer a patient is something the CMA will have to look at.

“We may have to be able to provide that system ourselves but we also heard delegates say we should advocate for the creation of that. We can certainly provide some recommendations on what we think that might look like,” he said.

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The CMA said it is reaching out to health ministers in every province and territory to provide guidance in the scenario no federal regulation is enacted.

Nova Scotia Health Minister Leo Glavine is calling on the federal government to act. But he said he is slowly preparing a contingency plan.

“What we have done here in the past couple of months is I have been on a couple of conference calls with colleagues across the country. We have committed to a Canadian approach. We do not want a fragmented standard of care, criteria put in place,” he said.

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