On February 6, 2015, the Supreme Court of Canada delivered a landmark ruling establishing that doctors will no longer be prohibited from assisting competent adult persons with ending their own lives, when certain conditions of suffering and clarity of consent are met.
This ruling has enormous implications for the practice of medicine in this country, perhaps most acutely for our physicians working with critically-ill patients. As the national professional association that oversees the medical education of specialists and supports their lifelong learning to ensure continued competence in a constantly-evolving medical environment, the Royal College will contribute to the evolving policy framework on behalf of patients and Fellows.
Part of the conversation at our October Council meeting centered on what form this response should take. In the ensuing discussion, Council members from across the country made it clear that there are strong positions on both sides of this ruling and a myriad of possible consequences (legal, psychological, emotional, etc.) for medical professionals.
The courts gave government 12 months to respond to the ruling with new legislation, until which time the ban stands. Barring an extended deadline linked to the recent change in federal leadership, after February 6, 2016, physicians will be entering as-yet uncharted waters.
I know from speaking to some of you that this looming change has been front of mind, and I can assure you that physician organizations across the country have also been debating next steps.
If the government does not take a leadership role in enacting legislation to govern physician-assisted death, it risks jurisdictional and/or regional differences in how this care is accessed and delivered. This is why collaboration is essential.
The Royal College recognizes that it has a role to play in assisting physicians in gathering the knowledge and training they need to navigate these new care parameters. As a first measure, we are collaborating with the Canadian Medical Association to support their current efforts to create a unified, profession-wide response to the Supreme Court decision.
The CMA’s set of principles and recommendations intends to clarify patient qualifications and a decision-making process to access medical aid in dying, as well as physician roles and responsibilities, including provisions for individual-moral or institutional opposition. The Royal College Ethics Committee was invited to review the first draft and provided its feedback this July.
Going forward, we will also endeavour to support Fellows by linking them with important resources such as
- province-specific rules, as developed by medical regulatory authorities;
- other educational supports, such as modules and fact sheets;
- enhanced bioethics resources related to this theme; and
- other supports, as identified/appropriate.
As this change comes into effect in early 2016, we will also connect with our specialty committees and medical school partners to determine how best to prepare future doctors for this new norm and to incorporate the impact of this new legal landscape into training standards.
Physician-assisted death is a polarizing topic. We are fully committed to working with our partners to address this landmark change and, as always, remain steadfast in our efforts to support members in the modern practice of specialty medicine.
If you have any ideas for resources that you would find useful, please let me know via email or using the comment functionality below. I recognize that this topic may elicit strong feelings about the ruling itself, but I’m hopeful that we can focus our conversation on the kinds of educational supports or services you would find most valuable.
Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer