TACKLING THE UNIMAGINABLE
CMA drafts aid-in-dying protocols
Frustrated by the Harper government’s silence on assisted death, the nation’s most powerful doctors’ lobby — once long opposed to euthanasia in any form — is proposing its own aid-in-dying protocols that include death by lethal injection.
In a draft document, the Canadian Medical Association sets out the terms under which Canadians should qualify for assisted dying and the processes to be followed after a person requests to be put to death.
The proposed scheme calls for several cooling off periods, or time for sober second thought. Someone seeking aid in dying would have to make two oral requests — at least 15 days apart — followed at least seven days later by a completed written request on a special declaration form.
Two doctors would have to agree the person is competent, acting voluntarily and has made an informed decision. The patient must be informed of the “right to rescind” his or her request at any time.
The draft framework — based on legislative criteria across jurisdictions where doctor-assisted death has been decriminalized — will go to CMA’s annual general council meeting in August for a vote.
“It’s not exhaustive; it’s not meant to constitute an entire legislative framework,” said Dr. Jeff Blackmer, CMA’s director of ethics and professionalism.
But, the recommendations, Blackmer said, help fill a void left by a government that “hasn’t put anything out there for consultation" in the nearly five months since the Supreme Court of Canada unanimously struck down the Criminal Code’s absolute prohibition on assisted dying.
“So here’s a straw dog,” he said. “Fire away. Tell us, does it make sense? Does it not make sense? Are we missing something? We’re ready to lead that conversation.”
The Supreme Court suspended its historic February ruling for 12 months to allow Parliament time to legislate new rules permitting assisted death for certain patients, should it choose to do so.
But the Conservative government has indicated no new legislation will be considered before the October federal election, and there is still no word on public consultations promised by outgoing Justice Minister Peter MacKay’s office in February.
Blackmer said he detects a mood of nervousness and uncertainty as the profession comes to grips with what was once unimaginable. “This is the biggest change in the medical profession in Canada, maybe in centuries,” he said.
Under its proposed national framework, CMA is recommending creation of a national oversight body, safeguards to protect the vulnerable and freedom for doctors who refuse to participate in assisted dying on moral or religious grounds. It includes both voluntary euthanasia — in which a doctor directly administers a lethal injection of barbiturates — and assisted suicide, in which a doctor writes a prescription for an overdose a patient actually takes.
CMA is conducting surveys and an online “dialogue,” seeking input from doctors.
The Supreme Court set out only broad parameters, saying a person must be competent and suffering a “grievous and irremediable” condition causing enduring and intolerable suffering.
“I’ve now given dozens or hundreds of presentations on this and every time I speak about it and I ask doctors, ‘Look, have any of you ever told a patient that you’re really sorry but their condition is grievous?’ Of course, no one ever has,” Blackmer said. “No doctor in Canadian history, I don’t think, has ever told a patient that they’re suffering from a ‘grievous’ condition. So none of us know what that means.”
CMA is also polling doctors to gauge how many are prepared to help patients end their lives — including in cases in which a person isn’t terminal or near death, or is suffering psychologically, but not physically.
While surveys suggest growing support for “mercy killing ” of those dying of advanced cancer or other catastrophic illnesses, many doctors are profoundly uneasy when it comes to mental disorders such as intractable depression.
MacKay has hinted the government would seek an extension to the court-imposed deadline, something University of Calgary bioethicist and lawyer Juliet Guichon said the justices are highly unlikely to grant.
It’s not exhaustive; it’s not meant to constitute an entire legislative framework.