Canadian medical schools tackle assisted suicide
Canada’s medical schools are preparing for what was once unimaginable — teaching medical students and residents how to help patients take their own lives.
As the nation moves toward legalized physician- assisted death, Canada’s 17 faculties of medicine have begun to consider how they will introduce assisted dying into the curriculum for the next generations of doctors.
It is a profound change for medical educators, who have long taught future doctors that it is immoral to end a life intentionally.
“If legislation passes, and if it becomes a standard of practice in Canada for a small subset of patients who desire assisted death, and where all the conditions are met, would we want a cadre of doctors that are trained in the emotional, communicative and technical aspects of making those decisions, and assisting patients,” said Dr. Richard Reznick, dean of the faculty of health sciences at Queen’s University in Kingston. “We would.”
In its landmark, unanimous ruling in February that swept away Criminal Code prohibitions against doctor- assisted death, the Supreme Court of Canada gave Parliament one year to craft a new law — should it choose to do so — that recognizes the right of consenting adults with a “grievous and irremediable” medical condition to seek a doctor’s help to end their lives.
Medical schools have begun to consider how they will adapt to a change in law, once it comes into force. When should classes on assisted- suicide and voluntary euthanasia be introduced? Would there be sufficient numbers of faculty members willing to teach the next generation of their trainees in the art and science of assisted death? Would young doctors wishing to incorporate it into their practices for consenting patients first have to demonstrate they are appropriately skilled?
“There will be many complexities to this — it’s not going to be a simple process — and whatever we teach our medical students will have to be congruent with the legal parameters, the professional guidelines that are developed and the way that this may be carried out in the future,” Reznick said in an interview.
He stressed that it would be unacceptable to force any medical student or resident to participate in a medical procedure that is nevertheless legal. “We have to be respectful of the first principle here, that this is a choice,” Reznick said.
“There will be students who, for personal, religious or philosophical reasons, may not feel comfortable in ever thinking about themselves as perhaps participating in assisted death, as will be true of many physicians, perhaps the majority of physicians,” he said.
“It won’t be a mandatory core competency of any of our training programs.”
The issue has been brewing on medical school campuses since the Supreme Court denied Sue Rodriguez the right to a doctorassisted death in 1993. Voluntary euthanasia ( death by a lethal injection administered by a doctor) and assisted suicide ( death by a lethal prescription the patient takes herself) are already discussed in medical ethics and health law courses, medical educators say, as are other difficult end- of- life issues, such as discussions around “do- not- resuscitate” orders.
“It’s not like we’re starting from ground zero on this,” Reznick said.
Formal assisted- dying curriculum would likely be reserved for certain specialties in which future doctors are most likely to get such a request, say in family medicine and palliative care, although there is deep controversy among palliativecare doctors as to whether the role should fall to them.
Quebec’s “medical aid in dying” law, Bill 52, is expected to come into effect in December.
Until the law is implemented, said Maryse Grignon of McGill University’s office of undergraduate curriculum implementation, “it’s premature to incorporate [ assisted dying] formally into the curriculum.”
However, once new federal or provincial laws and policies are in place, “this would need to be introduced definitely in the early stages of medical school,” said Dr. Genevieve Moineau, president and chief executive of the Association of Faculties of Medicine of Canada.
Together the schools graduate more than 2,300 doctors a year, have more than 10,000 undergraduate medical students in training and more than 12,000 postgraduate trainees.
The challenges facing medical schools echo abortion, “where there were changes in laws that required changes in how we approach a topic in our Canadian curriculum and our practice,” Moineau said.
Canada’s abortion law was struck down in 1988. No doctor is forced to perform abortions; however early termination of pregnancy is now a component of residency training in obstetrics and gynecology.
Dr. Jacques Bradwejn, dean of the University of Ottawa’s faculty of medicine, said simulation exercises could help students practice dealing with requests for assisted death, including how to evaluate the severity of a patient’s suffering, dealing with families and, ultimately, “whether this is the right thing, the ethical thing, to do.
“There would ( also) be modules to teach how to use the various ( life- ending) medications,” he said.
Reznick said that, despite “all our best efforts in palliative care,” many patients with incurable diseases face an “agonizing” death.
“My own personal view, as a citizen, as a doctor, is that I do believe that this will, for some patients, provide a comfort and a relief that’s necessary in certain illnesses,” he said.