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End of life: CMA positioned to take lead role in crafting new regulations

The Canadian Medical Association (CMA) is ready to play an integral role in the crafting of any new laws governing medical aid in dying, following the unanimous Supreme Court of Canada decision striking down the existing law prohibiting physician-assisted death.

In a news release following the ruling, CMA President Chris Simpson said any new legislation must “ensure patient needs are respected and the physician perspective is reflected.”

The court’s ruling is suspended for 12 months, meaning medical aid in dying remains illegal until that time. The Court deferred to Parliament and provincial legislatures to respond, should they so choose, with legislation that would respect the Charter rights of patients and providers.

The ruling dealt with the Carter case about whether the prohibition on assisted death in the Criminal Code of Canada was unconstitutional under the Canadian Charter of Rights and Freedoms. The Carter case began in 2011, when the BC Civil Liberties Association (BCCLA) joined Dr. William Shoichet, Gloria Taylor – who had an incurable, progressive disease – and the family of Kay Carter, who also had an incurable disease, to challenge the law against assisted dying.

In 2012, the B.C. Supreme Court ruled the Criminal Code of Canada provisions against assisted dying violated the rights of the gravely ill. The federal government appealed that decision, and the provincial Court of Appeal overturned the lower court ruling in October 2013 and upheld the ban, citing the 1993 precedent case of Sue Rodriguez. The Supreme Court granted the BCCLA, the Carter family and others permission to appeal the case.

In the wake of the CMA’s annual General Council meeting in August, the association’s long-standing policy against medical aid in dying was changed to support the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether or not to provide medical aid in dying.

A 2014 survey of 5,000 members showed 45 per cent favoured legalizing physician-assisted death, while 27 per cent said they would likely participate if the act is legalized.

In its news release, the CMA stated the association would conduct a detailed analysis of the ruling and its implications.

The Supreme Court set out some criteria that would define individuals who would be eligible for physician-assisted dying, noting that they must be competent adults who clearly consent and are suffering with a “grievous, irremediable medical condition” that is intolerable to the individual.

When the Supreme Court heard the case in October 2014, the CMA appeared as an intervener to provide insight into the diverse views of its membership and highlight practical considerations if the law was changed.

Simpson said the CMA has already been developing draft guidelines to deal with the practical considerations of medical aid in dying, and the association will now also examine ways to support doctors who choose to participate in assisted dying with education and training.

At the same time, Simpson stressed the CMA respects all members’ views on this sensitive topic and is equally supportive of those members whose choose not to offer medical aid in dying.

“A physician should not be compelled to participate in medical aid in dying should it become legalized,” the CMA policy states. “However, there should be no undue delay in the provision of end-of-life care, including medical aid in dying when it becomes legal.”

The Court noted a physician’s decision to participate in assisted dying is a matter of conscience and in some cases religious belief, and stated nothing its decision would compel physicians to provide assistance in dying. The

Court stated what happens now is in “the hands of the physicians' colleges, Parliament and provincial legislatures.”

“The CMA is well positioned to continue to play a leadership role in the debate around end-of-life care in Canada,” said Simpson. He noted the extensive consultation process the CMA undertook in 2014 with a series of town hall meetings for both the public and its members to share their views on the issue.

Simpson also stressed that the CMA continues to advocate for quality care on other end-of-life issues, such as the need for access to proper palliative care services for all Canadians and the need for a national strategy in this area.

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