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Assisted dying debate to feed federal, provincial action

At this year’s debate on assisted dying at the Canadian Medical Association (CMA) annual general council meeting, delegates will once again be doing what they’ve done so well over the years — providing the critical physician and patient perspectives to a key policy issue.

Based on polling results and a recent online dialogue with members, the issue most concerning physicians as Canada struggles to determine how to operationalize the February Supreme Court decision on the question is balancing patient and physician rights.

As CMA President Chris Simpson made clear in a television interview on Canada AM earlier in the week, it’s not a question of pitting one right against the other as “both are legitimate aspirations.”

However, he admitted the matter of referral to assisted dying services is a “sticky issue” because some physicians who consider themselves conscientious objectors feel that even referral to a neutral party is against their principles.

Some have proposed that patients self-refer to these services but others point out that self-referral may not be feasible or would force the patient to face undue hardship.

In the online dialogue, Dr. Jeff Blackmer, CMA vice-president of medical professionalism, wrote that a self-referral approach is unlikely to be accepted by legislators. He said most patients receiving a referral to a third party would not ultimately access assisted dying but would learn about options available — including palliative and spiritual care.

“We have deep respect for all points of view,” said Simpson “but there has to be some middle ground reached.”

The focus of the discussions about assisted dying on Tuesday will be the “Draft Principles-based Recommendations for a Canadian Approach to Medical Aid in Dying” produced for the association.

Simpson said this document offers a framework for policy-makers who may have to provide legislation on assisted dying when the current ban on the practice is lifted next February.

The CMA is well-positioned to take on this lead role, he noted, because it is the only organization that has consulted Canadians so extensively on issues concerning end-of-life care.

The online consultation with CMA members about the logistics of legalizing assisted dying, conducted in July, documented the continued depth of feeling among Canadian physicians about the issues involved.

A total 595 members registered for the online discussion and posted 545 comments in the dialogue moderated by Blackmer.

Many members applauded the CMA for taking leadership on the challenging issues involved, and praised the association for reaching out to its members for feedback and input.

Most conscientious objectors commenting in the dialogue rejected the CMA proposal that physicians not wishing to be involved with assisted dying refer these patients to an independent third party who would provide information and assistance for the patient.

Several motions have been submitted for debate by delegates. This discussion will follow the sessions on assisted dying, and deal with the issue of referrals as well as restating important principles around palliative care — another cornerstone of the CMA’s approach to end-of-life care.

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