Moving forward with PAD

February 24, 2016

Dr. Carl W. Nohr, AMA President

Dear Member:

I am writing to update you on Physician Assisted Death (PAD). You will recall that I wrote previously about this issue (January 14 President’s Letter).

The Supreme Court of Canada (SCC) initially granted the Federal Government a one-year period to introduce relevant legislation, which expired on February 6, 2016 (click this link for the original SCC decision). The SCC has now granted a four-month extension to June 6. During this extension, persons may apply to the courts for an exemption to proceed according to the criteria established in last year’s decision.

Regardless of our individual opinions, PAD is now a patient right by law. While some will wish to continue the social and moral debate over whether it should exist in Canada or not, we must pay attention to implementation and how to focus on the rights of patients and compassionate care. This will involve federal and provincial legislation, regulatory standards of practice and the creation of an effective access model.

The Canadian Medical Association (CMA) continues to provide leadership and the Alberta Medical Association (AMA) Board of Directors supports their position.

PAD is a complex matter that encompasses many aspects of our personal and collective professional attitudes. The Government of Alberta has just announced a public consultation process. We do not want to duplicate those efforts. We do, however, want to provide physicians with good information and the opportunity to debate matters relevant to the profession with respect to PAD.

A special meeting following the Representative Forum (RF)

At the upcoming RF on March 11-12, delegates may bring forward motions about PAD as they will for other topics that are important for patients and care. In addition, a two-hour information session will be held from 12:30-2:30 p.m. immediately following adjournment of RF.

This panel session is oriented for physicians and professional issues. It is not intended to re-open debate on fundamental questions about PAD. Instead, we will begin from the starting point of the SCC decision and consider where we need to go to reach the point of providing access to PAD. Accordingly, we are bringing together leaders from the College of Physicians & Surgeons of Alberta (CPSA), CMA, Alberta Health Services, Alberta Health and the AMA to provide information and to answer questions about implementation.

Space will necessarily be limited to RF delegates, observers, speakers and guests. We are planning, however, to make the event available as a live web-based broadcast on the afternoon of March 12. The video will be archived on our website thereafter.

We will email all members closer to RF with details about how you can access the webcast.

A few thoughts in conclusion

I have heard from many physicians on the subject of PAD, but there are two concerns that arise most frequently. These are concerns about the conscientious objections of individual physicians and the eligibility criteria.

With respect to the objections of individual physicians, I am confident that a sufficient number of physicians will be available to provide PAD without any need to override an individual physician’s conscience. Respecting the choice of physicians who do not wish to participate will not hinder patient access. The discussion should be about effective access and care arrangements, not about overruling the conscience rights of individual physicians.

It is neither necessary nor productive to argue that all physicians must, or must not, participate. In wishing to exercise our personal beliefs in this matter, we should accord our colleagues the same opportunity to choose for themselves – whether for or against. The principle of physician autonomy is not served by forcing all to one side or the other. Regardless of personal opinion, we must all support the right of choice – either way.

Regarding the age of eligibility, the SCC decision stated that the candidate must be a competent adult. This statement is accurately reflected in the CPSA Advice to the Profession. What “adult” exactly means was not further defined. The possible interpretations that this is (i) equivalent to the age of majority or (ii) that it reflects decision-making authority granted by a court for other matters than PAD are both premature. It remains for legislation, and possibly subsequent case law, to define the age limits, if any. Until such legislation appears, the College’s advice to use a “careful and conservative approach” when dealing with mature minors is reasonable. When dealing with new and sensitive situations, respectful discussion is always appropriate.

While we await further legislation, the AMA continues to advocate for individual physician choice. In order to claim our individual right to decide one way, we must respect the right of others to decide another way. In this matter, I ask you to show your greatest compassion and understanding for your patients and your colleagues.

Thank you, as always, for your emails and comments. You can always reach me at president@albertadoctors.org or leave a comment below.

Kind regards,

Carl W. Nohr, MDCM, PhD, FRCSC, FACS
President

2 comments

Commenting on this page is closed.

  • #1

    Gaylord Wardell

    Physician

    12:20 PM on February 24, 2016

    When a physician accepts public funding for his or her business model, it is important to know you forgo the right to deny care to anyone, except for objectionable or criminal behaviour. The CPSA is well aware of this yet for years many physicians have refused to provide many types of care without providing the patient with an alternative. If there is a patient who may benefit from a particular therapy you disagree with(morally or ethically) you violate this principle if you refuse to offer a referral. The PAD issue has now forced us to look seriously what public funding means. It means doctors do not have the right to force their moral, ethical or religious mores on a patient. If you want to do so opt out of the system and make each individual patient the payer.

  • #2

    Ed Papp

    Physician

    7:54 PM on February 25, 2016

    It is interesting that the AMA will argue on both sides of an issue depending upon which way the government and legal winds are blowing. PAD is an excellent case in point.

    We have become a Professional organization that espouses the principles of choice for patient ("Patient First") and provider alike (Constitution & ByLaws - Purposes: 2.4 The continuation of the traditional unwritten contract between the medical practitioner and any member of the public and the protection and defense of the principle of this contract from any third-party interference & 2.5 The representation of physicians and Members in any and all matters related in any way whatsoever to the carrying out of the Constitution and Bylaws of the Association and shall include, but not be limited to, representation regarding the requirement for, provision of or payment for health care services arising privately or from any legislation relating to such matters.)

    However, we are never consistently true to those principles depending upon the politics of the issue at hand. The overarching new AMA strategy is to play nicely in the sandbox with the only payer allowed in Canada for the services that we are allowed to prescribe or provide. This is not consistent with our stated goals to represent (aka advocate for) patients and physicians alike to the best of our ability as an organization. And, regardless of the fact that we are the only democratic country in the world (North Korea is not a democracy) that specifically legislates against the provision of health care services outside of the government monopoly; and, regardless of the governments' ability/inability to provide those needed/wanted services in a timely manner; we keep trucking down that road to the detriment of our patients and our ability to serve those patients properly and ethically.

    It is interesting how previous President's Letters dealing with the issue of stewardship totally ignored our work as physicians to suggest other resources available to patients such as medical tourism, particularly if they are not a WCB patient. Federal statute outlaws the provision of these services outside of publically funded healthcare even if only in underutilized existing health care infrastructure.

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