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

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