There were 803 euthanasia/assisted suicide (EAS) deaths in Canada during the first six months after the procedures were legalized. In the second half of the first year (ending in June, 2017) there were 1,179 — a 46.8% increase, and about 0.9% of all deaths. Health Canada correctly states that the latter figure falls within the range found in other jurisdictions where euthanasia/assisted suicide are legal, but the Canadian EAS death rate in the first year was not reached by Belgium for seven to eight years. The dramatic increase of EAS deaths in the last half of the first year would have had a direct impact on EAS practitioners, and this may be why they ended the first year by sounding the alarm about access to the service. . . .[Full text]
Doctors attending a session on medical aid in dying at the Canadian Medical Association (CMA) General Council supported the use of advance directives and allowing mature minors to access assisted death. However, they split on opening up the service to otherwise healthy people with mental illness.
In a poll, 83% said they would support the use of advance directives to request medical aid in dying in cases where a person was otherwise unable to give consent. Some 69% would support opening the service to “mature minors,” including cases in which a guardian might request assisted death for a terminally ill infant, for example. However, after roundtable discussions, less than half (46%) of doctors polled said they would support assisted death on the basis of mental illness alone. . . [Full text]
A straw poll conducted on Wednesday at the Canadian Medical Association annual meeting found that 83 per cent of delegates supported allowing “advance directives” – meaning, for example, that people with dementia could, while they are still competent, decide they want an assisted death at a later time.
The informal poll of the 600 delegates also found that 67 per cent backed the idea of “mature minors” being allowed to access assisted death. (A mature minor is someone under 18 who is deemed mature enough to make decisions about their own medical treatment.)
Physicians, however, were far less enthusiastic about allowing assisted death for patients whose sole problem is mental illness: Only 51 per cent backed that idea.
Similar CMA straw polls showed that, in 2013, only 34 per cent of doctors supported assisted dying legislation; that rose to 45 per cent in 2014. . . [Full text]
A year since assisted suicide became legal, only a small number of physicians are willing to perform the procedure, and their numbers are shrinking. Taking a life is harder than they thought
The first thing April Poelstra noticed was the hitch in her father’s shoulder. Jack’s left arm was drooping, hanging limply at his side, as if he didn’t have the muscle to cinch it into alignment. It was the fall of 2015, and Jack was living in Frankville, Ontario, waking up at 4:30 a.m. to plow roads and work odd jobs for a construction company. . . Jack tried to downplay his shoulder problems. He visited his doctor for a battery of tests, but always changed the subject when April pressed for details. . . .In early 2016, her fears were validated: Jack was diagnosed with ALS. Amyotrophic lateral sclerosis, or Lou Gehrig’s disease . . .On June 17, Bill C-14 became law, making medical assistance in dying, or MAID, legal for mentally competent Canadians. Jack Poelstra was overjoyed. . . [Full text]
Canadians ask a lot of our physicians – years of education, long hours, complex cases and demanding patients (full disclosure – I am married to a doctor).
Since June of last year, we have also been asking them to help some of their patients take their own lives.
No matter how you feel about assisted dying, you have to admit that having a role in the act is a burden that few of us would ever welcome. And yet as a society we seem to forget that doctors are no different. . . [Full text]
Some doctors who have helped the gravely ill end their lives are no longer willing to participate in assisted death because of emotional distress or fear of prosecution if their decisions are second-guessed, according to their colleagues.
In Ontario, one of the few provinces to track the information, 24 doctors have permanently been removed from a voluntary referral list of physicians willing to help people die. Another 30 have put their names on temporary hold.
While they do not have to give a reason, a small number have advised the province they now want “a reflection period to decide whether medical assistance in dying is a service they want to provide,” according to a health ministry spokesman. . . [Full text]
Ottawa has seen 28 people take their life with the help of a doctor since legislation came into force.
Since new legislation came into place last year, 28 people in Ottawa have ended their lives with the help of a physician.
Advocates say the new legislation, which came into force last June, is taking a toll on some doctors, who are finding it difficult to help patients who want to die. . . .
Jeff Blackmer, vice-president for medical professionalism at the Canadian Medical Association, said doctors have been telling his group that they struggle with taking part in assisted-death procedures. . .. [Full text]
With no law in place to govern assisted suicide, physicians and vulnerable patients face uncertainty, confusion and more opinions than facts.
“It’s a matter of weeks before people (in healthcare) are going to have to choose between their conscience and their career,” said Deacon Larry Worthen, executive director of the Christian Medical and Dental Society.
Doctors have told Worthen that some hospitals have already put in place procedures and protocols for doctor-assisted death. Some hospitals will force objecting doctors to refer for assisted suicide, even though, said Worthen, “our physicians are just unable to refer” for reasons of conscience.
Worthen and the doctors he represents want Bill C-14 passed, but they also want the Senate to add specific conscience protections for objecting doctors and health-care institutions.
“We’re pleased with what’s there, but we want to be more specific,” he said. “We want to protect facilities. We want to protect against the requirement to refer.” . . . [Full Text]
While not explicit in the language of the legislation, new physician-assisted dying laws would include the creation of a centralized referral mechanism for doctors and nurse practitioners who refuse to help a patient end their own life.
Dr. Jeff Blackmer, vice-president of medical professionalism with Canadian Medical Association, said the government has assured the medical professional community the database – which could be as simple as a toll-free number – will connect patients with willing providers. . . [Full text]
Discussion on physician autonomy at the 2014 and 2015 Canadian Medical Association (CMA) annual meetings highlighted an emerging issue of enormous importance: the contentious matter of freedom of conscience (FOC) within clinical practice. In 2014, a motion was passed by delegates to CMA’s General Council,and affirmed by the Board of Directors, supporting the right of all physicians, within the bounds of existing legislation, to follow their conscience with regard to providing medical aid in dying. The overwhelming sentiment among those in attendance was that physicians should retain the right to choose when it comes to matters of conscience related to end-of-life intervention. Support for doctors refusing to engage in care that clashes with their beliefs was reaffirmed in 2015. However, a registrar from a provincial college of physicians and surgeons is reported to have a differing perspective, stating “Patient rights trump our rights. Patient needs trump our needs.1
So, do the personal wishes of doctors hold much sway in Canadian society, where physicians are increasingly perceived as publicly funded service providers? Should the colleges of physicians and surgeons have the power to remove competent physicians who refuse to violate their own conscience?
And what about FOC in a range of other thorny medical situations unrelated to physician-assisted dying?
Genuis SJ. Emerging assault on freedom of conscience. Canadian Family Physician April 2016 vol. 62 no. 4 293-296 [Full text]