Doctor-assisted suicide a therapeutic service, says Canadian Medical Association

The Canadian Medical Association supports patients who seek "medical aid in dying" as well as physicians' choice to participate, the group's president said Thursday in response to a Supreme Court decision.

As the legal environment changes, the CMA said it will support doctors and patients who find medical aid in dying their best option.

"What we want to do is really make sure patients who are eligible under the new rules have access to this therapeutic service, but at the same time we need to be very careful that physicians have the right to conscientious objection for moral or ethical reasons or religious reasons," CMA president Dr. Chris Simpson said in an interview from Yellowknife.

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Simpson said the court gave 12 months to answer detailed questions such as:

• How will consent be determined, such as through discussion and counselling?
• What is the best way to provide safeguards, such as using two doctors or a board?
• How could patients apply?

Simpson said his group will continue to promote access to high-quality palliative care.

In 2014, the CMA sponsored a survey of 5,000 of its members. Nearly 45 per cent said they were in favour of legalizing doctor-assisted suicide. When asked if they would likely or very likely participate if physician-assisted death was legalized, 27 per cent said yes.

Simpson said physicians have been uncomfortable partly because the role they're being asked to play is a departure from the past.

"If you cast them in the role of patient, though, the case of Dr. Don Low whose video went viral last year, is a case in point. When we are patients, we don't think a whole lot differently than any other patient."

Low was an infectious disease specialist who helped lead Toronto's reponse to the SARS outbreak in 2003. He recorded a death-bed plea for assisted suicide, which was released after his death from a brain tumour.

The Council of Canadians with Disabilities and the Canadian Association for Community Living said they were disappointed with the decision and concerned about its implications.

"As we each near the end of our lives, at the time when we are likely to be most vulnerable to despair and fear, we have now lost the protection of the Criminal Code.  Where shall we now find that protection?" the disability groups asked in a statement.

Simpson said he didn't anticipate that the decision would refer to a "grievous and irremediable medical condition" not a terminal illness. The implications of that degree of permissiveness remain contentious.

While some patient groups argue they own their body and its up to them to define what constitutes a grievious and irreversible illness, it remains to be seen whether there will be a list of eligible conditions, he said.

Most patients don't request assistance to die, said Dr. James Downar, a critical care and palliative care doctor in Toronto and co-chair of Dying With Dignity Canada.

"This Supreme Court decision will hopefully be a spur to governments and stakeholders to make assisted death part of a comprehensive package of much better end-of-life care available for everybody," Downar said.