The nation’s largest doctors’ group is quietly preparing for possible changes in federal laws governing physician-assisted death, as support among its own members for medical aid in dying grows.
The Canadian Medical Association has consulted medical associations in jurisdictions around the world where euthanasia or assisted suicide is legal to devise possible protocols for Canada if the federal law is changed.
The powerful doctors’ lobby says it would be naïve not to prepare for “all eventualities” as the country awaits a Supreme Court of Canada ruling over whether the federal prohibition outlawing assisted suicide is unconstitutional.
“I think we’re looking at the possibility that the court will refer this back to the lawmakers,” said Dr. Jeff Blackmer, the CMA’s director of ethics.
The Supreme Court could strike down Canada’s ban on assisted suicide and give Parliament one year to craft new legislation, as it did with prostitution.
“They could suggest some framework from the bench that we might want to be in a position to comment on fairly quickly. Or there could be a long period for reflection and committee hearings that we would want to be prepared for,” Blackmer said. “We’re preparing for all eventualities, and that [a lifting of the ban] is absolutely one of them.”
If there is a change in law, Blackmer said doctors opposed to physician-assisted death “will be looking to us for protection of their conscience and their right not to participate.”
“(Doctors) who do support a change in legislation will be looking to us to help make sure that legislation is crafted in a way that make sense from a medical standpoint,” he said. “Whether or not you agree with this, as a physician, I think you still want to see your medical association at the table when those discussions are happening.”
The organization’s polling shows that 20 to 30 per cent of doctors would be prepared to help terminally ill patients end their lives, should physician-assisted death become legalized, and that a noticeable shift is occurring, with more doctors moving from “undecided” to “pro,” particularly in the area of assisted suicide, Blackmer said.
With assisted suicide, the doctor would prescribe a lethal dose of drugs that patients would take themselves.
Euthanasia means the active termination of a life by the doctor, usually by lethal injection.
The CMA has spent the past year consulting medical associations in Oregon, Washington, Montana, Vermont and New Mexico, U.S. jurisdictions where physician-assisted death is legal, to find out “what has worked, what hasn’t worked and how Canada can learn from those experiences,” Blackmer said.
“We’ve also had long conversations with the Netherlands, Belgium and Switzerland,” he said. “We’re now in the process of internal consultation and thought processing to look at some of the options and possibilities, to try to come up with a reasonable suggested framework and approach.”
For decades, the CMA’s position on euthanasia was unequivocal: the organization opposed doctor-hastened death in any form. But this summer, the CMA’s general council voted to allow doctors to follow their conscience when deciding whether to participate in medical aid in dying.
In a recent article in the journal HealthcarePapers, Blackmer and past CMA president Dr. Louis Hugo Francescutti said many doctors remain “terrified” by the prospect of a change in federal law.
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When a doctor enters a patient’s room, “their purpose is clear: to cure when possible, to care always,” they wrote. “The fact that they might actively hasten the patient’s death does not enter into the equation.”
In an interview, Blackmer said some doctors see aid in dying as an extension of compassionate, end-of-life care.
“And then there are others who say, very clearly, ‘this is not why I became a physician. It was to protect life, to maintain life — certainly to alleviate suffering whenever possible, but not to prematurely end life. That was never part of the deal.’ ”
But, over the past two years, the CMA has held a series of public, as well as doctor-only town hall meetings and online consultations. As doctors learn more about the experiences in other jurisdictions, “more and more doctors are saying, ‘Okay. I feel more comfortable, like there might be a scenario one could imagine where this type of intervention wouldn’t be abused,” Blackmer said.
“Where it would be the really exceptional patient that would need this, and that we could set up some sort of system where we make sure that the vulnerable, and other people are protected, and where physicians have support to participate.’”
Blackmer said it’s a “fool’s game” to try to predict which way the Supreme Court will rule. “But we’re trying to at least look at some of the options that they might have at their disposal.”
He said doctors, and the public, are becoming more comfortable about talking about death and dying “They are not taboo subjects in the same way they were.”
The Supreme Court heard arguments in October over whether the criminal ban on assisted suicide violates the Charter of Rights and Freedoms.
Judgments are normally rendered, on average, six months after a hearing.