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]

 

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]

 

Emerging assault on freedom of conscience

Canadian Family Physician

Stephen J. Genuis

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]

 

MDs group disappointed by recommendation to require referrals for assisted death

Canadian Press

Sheryl Ubelacker

TORONTO — A parliamentary committee’s recommendation that doctors who object to assisted dying be required to at least refer patients to a willing colleague is not only disappointing, but has also led some physicians to consider leaving their practices, says the Canadian Medical Association.

The all-party committee, which released a set of recommendations Thursday aimed at helping the federal government draft legislation governing medically aided death, said Ottawa should work with the provinces and territories to establish a process that respects a doctor’s freedom of conscience, while respecting the needs of patients.

“At a minimum, the objecting practitioner must provide an effective referral for the patient,” the committee said. . . [Full text]

Report on physician-assisted dying gives attention to key issues; critical matters still to be addressed with federal legislation

A Statement from Dr. Cindy Forbes, President of the Canadian Medical Association

News Release

Canadian Medical Association

OTTAWA, Feb. 25, 2016 /CNW/ – The Canadian Medical Association (CMA) is pleased to see physician input reflected in a number of recommendations released today in the report of the Special Joint Committee on Physician-Assisted Dying.

In particular, the CMA welcomes the recommendation to re-establish a secretariat on palliative and end-of-life care and to implement a pan-Canadian palliative care strategy with dedicated funding. We are also pleased to see the recommendation for the development of a pan-Canadian strategy to improve quality of care and services received by individuals living with dementia.

While there is much to praise in this report, it does fall short on the issue of respecting a physician’s right to conscientious objection. As the government moves forward in drafting legislation, we must focus on ensuring effective access while also respecting different views of conscientious objection. Both can be achieved. While not addressed by this report, a central mechanism to coordinate access must be a key part of the solution.

The doctors of Canada hope that the recommendations outlined in today’s report will result in a consistent approach across provinces, including federally-coordinated reporting and oversight. In particular, we are dedicated to finding a solution, in partnership with legislators and regulators, that ensures patients have effective access to the service should they need it, no matter where they live.

–Dr. Cindy Forbes, President of the Canadian Medical Association

For further information: mediainquiries@cma.ca, 613-806-1865


The Canadian Medical Association (CMA) is the national voice of Canadian physicians. Founded in 1867, the CMA is a voluntary professional organization representing more than 83,000 of Canada’s physicians and comprising 12 provincial and territorial medical associations and over 60 national medical organizations. CMA’s mission is helping physicians care for patients. The CMA will be the leader in engaging and serving physicians and be the national voice for the highest standards for health and health care.

 

SOURCE Canadian Medical Association

 

Doctors won’t impede assisted death, says CMA in open letter

Dr. Cindy Forbes

The Canadian Medical Association (CMA) would like to correct suggestions that timely patient access to assisted dying will be impeded by physicians choosing either not to provide the service or not to make a referral to a colleague or an agency.

The CMA would like to respectfully suggest that this is simply not true, and that many years of international evidence definitively shows this to be the case.

This should not be a debate between patient access or the right to conscientious objection by health care professionals; we absolutely can accomplish both. Put simply, there are other ways besides a referral to ensure access, without requiring a physician to violate his or her moral integrity. And none of these in any way involve abandonment of the patient in a time of great distress.

Access to assisted dying will not be constrained if we do not impose mandatory referral requirements on physicians who see referral as being complicit in the act itself. Nor does this in any way involve imposing the moral views of the physician on the patient he or she serves. . . [Full text]