Doctors grapple with physician assisted suicide

Most Canadian doctors agree that physicians should have the choice to help patients end their lives, but less than a third would be willing to do it themselves.

A recent Canadian Medical Association poll indicates 20-27 per cent of doctors would be willing to help a patient end his life. In a CMA General Council meeting before the recent Supreme Court decision to overturn laws prohibiting physicians from helping end life, 91 per cent voted to support doctors who choose to assist.

The poll follows the Supreme Court of Canada’s unanimous decision to lift the blanket ban on doctor-assisted suicide Feb. 6.

The judgment reads, ‘a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition’ has the right to obtain a doctor’s help to end his or her life.

The Supreme Court has given the federal government 12 months to craft a bill legalizing doctor-assisted suicide.

Should the bill not become a law in the stipulated time period, the SC will lift the ban on assisted-suicide leaving it in a ‘grey’ area where it isn’t legal but isn’t illegal either.

Dr. Jeff Blackmer, Executive Director, Ethics, Professionalism and International Affairs for the Canadian Medical Association spoke to JNM Journal about ‘what’s next.’

Q: What are your thoughts on the latest Supreme Court ruling?

A: Assisted suicide has been a constant debate in the CMA. It is a sensitive topic and finding a balanced standpoint is never easy. Before the ruling was passed, in a General Council meeting 91 per cent of the members voted in favour of supporting those CMA members who would choose to assist in suicide. There are still those in the profession who believe a doctor should not be part of this. This is not a doctor’s job.

Q: In case the attending physician does not wish to participate, what then? Where does the patient go?

A: In a poll that we conducted, 20-27 per cent of doctors said they would participate. That is a small percentage and the CMA will have to consider perhaps listing doctors or institutions where this service would be available, if the law is passed. It will not be mandatory for every hospital to house at least one such doctor.

 Q: What happens in the case of a patient who medically and legally isn’t capable of deciding for himself?

A: The ruling clearly states ‘competent adults who consent.’ A substitute or a medical proxy cannot take this decision. However, the ruling has intentionally omitted the phrase ‘terminally ill’ and this raises a few problems. The CMA is still discussing the issue. Some guidelines and criteria regarding who can and cannot opt for assisted-suicides need to be established. Over the course of 12 months, the federal government will consult the CMA while drafting the bill.

Q: Do you think this puts added pressure on doctors? Could doctors suffer from psychological distress for participating in ‘taking a person’s life’?

A: At the moment I don’t know. There has been research in countries such as Belgium and Netherlands. Once we acquire that data we will have some information and the CMA might be required to set up support centres for doctors. We are looking into it.

Q: How will the political scene in Canada affect the course of these discussions?

A: Yes, the political scenario may have an impact. The Conservative party has often refused to discuss the issue. But as of now, we have not heard anything from the government.

Q: Preserving the sanctity of life is a doctor’s primary objective. Ethically, how does this affect the Medical Association?

A: As our conversations and discussions with the government continue, we may have to review the Canadian Medical Association’s Code of Ethics. Over a couple of years, there might be a few modifications to the code. However, our dedication towards patients will always remain the same. A doctor’s primary duty will always be to try and save the patient’s life.

Q: In another interview, you mentioned you had a relative in Nova Scotia who was dying of end-stage leukaemia. Personally, what are your thoughts on the subject?

A: Personally, I wouldn’t participate in assisted suicide. I completely respect my colleagues who would. I realize ending a person’s suffering might be the more humane thing to do but I wouldn’t do it. I believe we talk a lot about assisted suicide but not enough about healthcare and preventing such a situation from ever occurring. Symptom management, healthy living, pain alleviation are areas in which we need to advance further. A very small percentage of patients want to end their lives and if we can ensure a good quality of life even if we can’t save them, the question of assisted suicide doesn’t arise.


Should doctor-assisted suicide for terminally ill patients be legalized?


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