U of M school of medicine looks at teaching doctor-assisted dying
The Dean of Medicine at the University of Manitoba says it is developing education programs for medical students about physician-assisted dying.
Dr. Brian Postl admits a physician assisting a patient to die is not currently part of the culture or the mission of the school. At the same time, he says there is a recognition that these are the real needs of real people.
Postl was responding to guidelines set out Thursday by the College of Physicians and Surgeons of Manitoba in its proposed guidelines on physician-assisted dying.
Postl said the lack of legislation on the issue has left a void that by necessity physicians must move to fill.
"I think it was a good effort the college made in trying to find balance, to make sure that there would be no flippancy in any decision that gets made in this regard. It tries to find space to meet the needs of patients and at the same time not compromise physicians who won't participate or refer," said Postl.
The college's guidelines have implications for what will be taught to med students and Postl said that work has already begun.
"Clearly we will have some responsibility in ensuring that any physician who is willing to participate has access to the appropriate training and supports. That's likely to occur at a post-graduate level, not at an undergrad level. But perhaps residents and more importantly people already working in the community [would also need some training]," Postl explained.
If they are willing to participate, the school of medicine will have to make sure they are trained and competent in that participation, Postl said.
"So we will be looking at building education programs to at least make them available for those who might be interested," he said.
Training would be targeted to post-graduate students who are in in their final years of speciality or family medicine, because undergrads would not be in a position to participate in assisted dying.
At the undergrad level, physician-assisted dying is already part of class discussions and the curriculum around ethics, Postl said.
At the same time, training and education in both pain management and palliative care is being increased, he said, in response to changing needs.
Palliative care, pain management training increased
"There's more interest in palliative care programming in family medicine and specialty care now. So there's a strong interest in further developing both of those. More speciality training in pain management. Palliative care of course becomes part of the debate."
Postl questioned whether much of the concern around doctor-assisted dying could be addressed with improved and more accessible palliative care.
"I think that's part of the dilemma. The points of view are quite varied in that regard and most palliative care physicians are hesitant about moving into supported death. On the other hand, there are many physicians who feel this is a professional obligation."
Post said the curriculum gets reviewed regularly and staff are now beginning to examine what some of the training and courses will look like for assisted dying.
"We haven't worked out the program yet, but it would be a combination of classroom training about the use of drugs, discussions around ethics and constraints, the College's guidelines when they are ultimately approved, and making sure people understand them. Probably some training around legal implications and some practical training would be part of it that could occur in simulation labs or hospitals. "
Postl said the debate is polarizing students in the faculty.
"They for the most part have an understanding there are circumstances where this could be seen as a route that patienst would chose to take. At the same time, they are confused. Confusion of what it means to be a physician and to participate, when the entire history and culture of the profession has really been about something else."
For his part, Postl is clear on where he stands on physician-assisted dying.
"I believe at its core patients have the right to make choices. Provided that we are sure that the choices are lucid and supported for that individual and safeguards are put in place to ensure that the criteria are met and it doesn't extend to people who are unable to make adequate choices. I do support the capacity for the patients to make choices."