Canadian Medical Association members ready to lead principles-based discussion on end-of-life care

OTTAWA, Aug. 17, 2015 /CNW/ - The Canadian Medical Association (CMA) has released results of an important new consultation with its members that provides input and opinion from front-line physicians on key issues surrounding care for patients at the end of life.

The issues raised by members in the dialogue will be used to inform debate and discussion during special sessions on a principles-based approach to assisted dying in Canada at the CMA's 148^th annual meeting of General Council in Halifax next week.

The results of the discussion by delegates to the CMA annual meeting will provide critical input into both the federal panel struck to consult with Canadians on options to respond to the Supreme Court of Canada's decision in Carter v. Canada and a newly formed provincial/territorial panel.

The work of both these groups is critical given that the unanimous Supreme Court of Canada decision that Criminal Code provisions banning assisted dying were unconstitutional is scheduled to come into effect February 2016.

Key findings

The member dialogue took place between June 8 and July 20, 2015.

A Canadian Approach to Assisted Dying:  CMA Member Dialogue is a summary report of 545 comments posted by 595 CMA members on fundamental issues surrounding a framework for assisted dying.

The CMA also received several dozen emails relating to the topics under discussion and direct feedback from several medical and non-medical stakeholder groups.

The online dialogue was configured around questions relating to six themes:

1. Principles-based approach to assisted dying
2. Responding to a request for assisted dying
3. Oversight and data reporting
4. Conscientious objection and equitable access
5. Clinical specifications or requirements
6. Supporting resources for physicians

Reconciling the right of a physician who chooses not to participate in assisted dying while ensuring access to this service for eligible patients was the most discussed issue in the online dialogue.

CMA members continue to be divided on the issue of legalizing assisted dying, and a significant minority of respondents to these polls said they will participate in offering this service to their patients.

Given these results as well as the fact that the procedure will soon become legal, the CMA remains committed to continuing to encourage policy-makers to implement legislation or policies that will respect the Supreme Court decision while protecting vulnerable patients and the rights of physicians.

Most conscientious objectors responding to the dialogue rejected the notion that physicians not wishing to be involved with assisted dying should refer these patients to an independent third party who would provide information and assistance for the patient; they proposed instead that patients self-refer to these services.

Other respondents noted that self-referral may not be feasible or would force the patient to face undue hardship. The CMA will be seeking specific input from General Council delegates as to their preferred option concerning referral.

Asking patients to self-refer may not be accepted by legislators so the CMA has proposed a "middle ground" approach where patients receiving a referral to a third party would not access assisted dying but would learn about the options available, including palliative and spiritual care.

Although not specifically identified as a theme of the online dialogue, the importance of palliative care services and the interaction between palliative care and assisted dying was noted by many physicians.

Participants highlighted the need for more formal education, certification and other support for physicians providing assisted dying, tools the CMA is developing right now.

Quotes

"As a society, we are at a critical time in this discussion in terms of how we will respect the Supreme Court decision while protecting the rights of our most vulnerable. Our members are telling us clearly they want and expect the CMA to continue to press for a principles-based approach to this serious issue."
-- Dr. Chris Simpson, CMA President

"The protection of palliative care is crucial if we are to allow assisted dying in our country since the majority of requests for hastened death are related to pain and symptoms that can be controlled by specialized Palliative Care teams and studies have shown clearly that the majority of those requests dissipate along with the symptoms."
-- Dialogue participant

Background

The Canadian Medical Association (CMA) has been conducting consultations with members and the public on end-of-life issues since 2014.

In May, the CMA Board of Directors approved released "Draft Principles-based Recommendations for a Canadian Approach to Medical Aid in Dying" for consultation with members and stakeholders to inform discussion at the CMA's General Council meeting in August 2015 in Halifax.

SOURCE Canadian Medical Association

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