Care at the End of Life: An Evolving Canadian Landscape: Joint Centre for Bioethics Seminar by Jeff Blackmer, MD, MHSc, FRCPC
Author: Rebecca Ruddy
On April 1st, 2015, I had the opportunity to attend a seminar as part of the Joint Centre for Bioethics seminar series entitled “Care at the End of Life: An Evolving Canadian Landscape” by Jeff Blackmer, the Vice President of Medical Professionalism at the Canadian Medical Association (CMA).
The seminar tackled the controversial and topical subject of physician-assisted death in Canada in an enlightening and informative manner. Throughout the seminar, the speaker relayed information on the history of physician-assisted death in Canada, as well as the most recent Supreme Court decision. In addition, Dr. Blackmer highlighted the perspective of the CMA on the issue and the work that their organization has completed to better understand the viewpoints and concerns of their members across the country.
On February 6th, 2015, the Supreme Court of Canada unanimously ruled, in the Carter vs. Canada case, to legalize physician-assisted death and that to deny a suffering individual the right to end their life would be unconstitutional.1 While the history of physician-assisted death in Canada has been marked by several milestone cases, all of these have led to this significant and most recent Supreme Court ruling. Although these cases were only briefly touched upon at this seminar, they provided the audience with some background and a more well-rounded idea of this controversial topic with respect to its history in Canada. Overall, it is clear that this landmark decision will greatly affect Canadians, health care professionals, and the health care system in Canada.
Dr. Blackmer also discussed several key unanswered questions that were, likely intentionally, not addressed in the Supreme Court ruling and will need to be clarified before this ruling can be successfully implemented in Canadian institutions. Firstly, there was no reference to “terminal illness” in the ruling. If it is not essential that the illness be terminal, there must be some guidelines to determine eligibility. Secondly, will there be a process for “requesting aid in dying” and determining patient qualification? If so, who will be mediating these requests? Thirdly, what will the process be for determining if the patient is mentally capable of giving consent and how will consent be determined? Additionally, will doctors who do not agree with physician-assisted death be obligated to refer patients to another doctor who will comply? Finally, will these rules and regulations be determined at the federal or provincial level? These are just some of the questions and concerns that were raised by Dr. Blackmer at the seminar, but one can imagine the endless number of questions that accompany such a complicated and multi-faceted issue.
During the seminar, Dr. Blackmer detailed the CMA’s position on physician-assisted death and discussed how the CMA would be involved in the legislative process. He also discussed the efforts that the CMA has undertaken to truly understand the position and concerns of its members across Canada. As of now, current CMA policy states that the association will support members on both sides of the issue, for the medical profession, much like the public, is divided on the matter of physician-assisted death. Dr. Blackmer also explained that the CMA recognizes that there are important practical considerations to take into account, such as capacity assessments and technical expertise. Doctors will have to be taught how to conduct physician-assisted death and understand what the process entails. Dr. Blackmer also stated that end of life discussions between patients and physicians should be part of normal medical practice. In addition to practical considerations, the importance of palliative care was reiterated, further emphasizing the necessity to adopt national palliative care.
In order to understand the views and concerns of CMA members, the CMA held town hall meetings across the country with an unprecedented turnout, indicating that doctors are very interested in having a discussion about physician-assisted death. These town hall meetings were very informative and the CMA released a report in June 2014. They discovered that doctors are ready to lead the discussion on physician-assisted death, demonstrating that it is no longer a taboo subject. The CMA and its members recognize the need for physician-assisted death, as well as the value of palliative care.
The CMA wants to support the right of all doctors to follow their conscience on this important issue and will work to assist in developing a legislative framework. To date, the CMA has drafted such a legislative outline which they will bring to the board for approval and receive feedback from members and stakeholders. This framework will be the basis for discussions with the federal government and will identify the important areas that the law should address.
After attending this seminar, I have gained a better understanding of the history of physician-assisted death in Canada, as well as learned the current state of the issue with the most recent Supreme Court ruling. It was interesting to hear this seminar from the perspective of a medical doctor and learn how doctors from around the country feel about physician-assisted death since this profession will be most significantly affected. During this seminar, it was thought provoking to recognize the many unanswered questions that this ruling has brought up. I will be eagerly awaiting news as to how the government will implement physician-assisted death into practice and how it will affect the lives of Canadians.
Recording of this seminar as well as other Joint Centre for Bioethics seminars, can be found here: http://www.jcb.utoronto.ca/tools/seminars.shtml
- Mulholland A. Supreme Court doctor-assisted death decision: At a glance. CTV News. 2015.