World Medical Association urged to change policy against euthanasia, assisted suicide

Canadian & Royal Dutch Medical Association want censure dropped

Sean Murphy*

The President of the World Federation of the Catholic Medical Associations has disclosed that the Canadian Medical Association (CMA) and Royal Dutch Medical Association (RDMA) have asked the World Medical Association to change its policy against euthanasia and physician assisted suicide.

The WMA issued a Declaration on Euthanasia in 19871 and a Resolution on Euthanasia  in 2002;2  they are now identical. The WMA Statement on Physician Assisted Suicide was made in 1992 and reaffirmed in 2005 and 2015:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical is a basic right of the patient, and the physician does not act unethically even if respecting such a wish results in the death of the patient.3

Writing to the President of the World Medical Association, Dr. John Lee stated that the CMA and RDMA suggested that existing policy be replaced with the following:

8. The WMA does not support euthanasia or physician assisted suicide, but WMA does not condemn physicians who follow their own conscience in deciding whether or not to participate in these activities, within the bounds of the legislation, in those jurisdictions where euthanasia and/or physician assisted dying are legalized.

9. No physician should be forced to participate in euthanasia or assisted suicide against their personal moral beliefs. Equally, no conscientiously objecting physician should be forced to refer a patient directly to another physician. Jurisdictions that legalize euthanasia or physician assisted suicide must provide mechanisms that will ensure access for those patients who meet the appropriate requirements. Physicians, individually or collectively, must not be made responsible for ensuring access.4

Dr. Lee also expressed opposition to a planned revision to the Declaration of Oslo concerning abortion, which, he said, would require objecting physicians to refer for abortions and even to provide them.  However, he commented at greater length on the proposed change to WMA policy on euthanasia and assisted suicide.

Based on the Canadian experience, acceptance of the ethical neutrality of medically-assisted death has resulted in almost immediate challenges for physicians who are unable to refer because of moral, religious, or ethical concerns. It is a serious problem, with physicians put in the impossible position of having to choose between their conscience and being allowed to continue to care for their patients.4

The Canadian roots of the CMA/RDMA proposal

Dr. Lee’s observations about developments in parts of Canada are accurate.  The text of paragraph 8 is very similar to the CMA resolution used by the CMA Board of Directors as the basis for reversing CMA policy against euthanasia and assisted suicide. . . [Full Text]

Canada’s summer of discontent: euthanasia practitioners warn of nationwide “crisis”

Shortage of euthanasia practitioners “a real problem”

Sean Murphy*

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]

Physicians support assisted death for mature minors, but not mental illness

CMAJ

Lauren Vogel

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]

 

CMA poll finds rising support for medically assisted death

The Globe and Mail

André Picard

Canada’s doctors, who have never been staunch supporters of medically assisted death, now seem to be open to a liberalization of the law.

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]

 

How to End a Life

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

Toronto Life

Nicholas Hune-Brown

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]

 

Ontario must amend its assisted dying legislation to recognize conscience rights

National Newswatch

John Milloy

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]

 

‘Take my name off the list, I can’t do any more’: Some doctors backing out of assisted death

National Post

Sharon Kirkey

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]

 

Doctors struggling to cope with assisted death

Ottawa has seen 28 people take their life with the help of a doctor since legislation came into force.

Vancouver Metro

Ryan Tumilty

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]

 

Uncertainty, confusion reign for physicians over assisted suicide

Catholic Register

Michael Swan

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]

 

Doctor-assisted death rollout would include referral database

Ottawa Citizen

Aedan Helmer

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]