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CMA creates draft framework for legislating medical aid in dying

The Canadian Medical Association (CMA) has created a set of principles and a draft framework spelling out specifics of how legalizing medical aid in dying could be implemented in Canada.

The draft framework is intended to assist policy-makers in preparing legislation in the wake of the Feb. 6 Supreme Court of Canada decision striking down the law against medical aid in dying.

The court suspended its ruling for 12 months.

The CMA’s framework is based on nine foundational principles, such as respect for patient autonomy and equity and the protection of vulnerable persons, and on research into experience in other jurisdictions involving Quebec’s Bill 52 and the Supreme Court decision.

The CMA Board of Directors approved the draft documents, which will now be circulated to CMA members and other stakeholders for feedback on key questions in advance of a discussion at the CMA General Council meeting in August.

“In keeping with our intervention before the Supreme Court of Canada and our past work with hosting public and member town halls, the CMA will continue to be a vital part of this critical public conversation,” said CMA President Chris Simpson. “We recognize that our members have diverse views on this topic. The touchpoints are reasonable accommodation for all perspectives and patient-centredness.

“The document is very much a work in progress and will continue to evolve as more feedback is provided.”

In keeping with earlier CMA statements, as well as with the Supreme Court decision, the draft framework notes no one should be compelled to participate in medical aid in dying. It also states that physicians should be able to follow their conscience on whether to offer medical aid in dying. This should not result in undue delay for patients seeking access these services.

The CMA document notes: “… in order to reconcile physicians’ conscientious objection with patient access to care, a system should be developed whereby referral occurs by the physician to a third party that will provide assistance and information to the patient.”

The proposed legislative framework contains recommended practical steps for implementing medical aid in dying:

  • The attending physician must be satisfied the patient is mentally capable of making an informed decision.
  • The physician must be satisfied the patient is making the decision voluntarily, and has made the request for medical aid in dying “thoughtfully and repeatedly.”
  • The attending physician must consult a second physician, independent of both the patient requesting medical aid in dying and the attending physician, before the patient is considered qualified to undergo medical aid in dying.
  • Substitute decision-makers will not be able to request medical aid in dying on behalf of a patient.
  • A process map for requesting medical aid in dying would mandate an oral request followed by a wait of at least 15 days, a second request and a second seven-day wait, followed by a written request completed via a special form.

The CMA will launch an online member dialogue on medical aid in dying and seek feedback on the principles and key elements of the draft framework, and ask how the association can support members in this area. Members will also be surveyed on these issues, and face-to-face meetings will be held to brief local medical societies and other key stakeholders such as the Canadian Medical Protective Association.

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