Canadian doctors vote for right of referral on assisted dying

Members of the Canadian Medical Association have voted overwhelmingly against a policy that, if adopted by healthcare regulators, would severely limit patient access to assisted dying when it becomes available.

On Wednesday at the CMA’s annual general meeting in Halifax, 79 per cent of members in attendance voted against recommending that physicians who oppose assisted dying be allowed to refuse to refer patients who request it to another provider.

The vote represents a big victory for patient rights and suggests the CMA is not comfortable allowing physicians who refuse to perform assisted dying the option to block patient access.

"What we expect from physicians, at a minimum, is that they provide further information to patients on all the options including the spectrum of end-of-life care to access those services," said Dr. Jeff Blackmer, the CMA’s vice president, medical professionalism, according to the Canadian Medical Association Journal.

The CMA's membership also gave the organization the go-ahead to develop draft guidelines for assessing a patient’s eligibility for access to physician assisted dying. In its February decision to strike down the Criminal Code ban on end-of-life choice, the Supreme Court of Canada sketched out general eligibility requirements for assisted dying. It ruled that it will no longer be illegal for physician to help end the life of a consenting adult patient who is experiencing “grievous and irremediable suffering” resulting from disease, disability or injury.

The CMA's leadership has endorsed the option of allowing a doctor to refer to a third-party institution, which would in turn provide patients with information about assisted dying and connect them with a participating physician. This setup would prevent objecting physicians from having to refer patients directly to a doctor or institution that is willing to provide an assisted death.

Developing criteria for eligibility

The Supreme Court said its decision would come into effect on Feb. 6, 2016, giving lawmakers and healthcare regulators a year to adapt new rules. However, no new legislation on assisted dying has been tabled federally or by the provinces since the release of the decision.

"We don't want to arrive on Feb. 6 asking … does anyone know how to do it? Does anyone know who qualifies?" said Dr. Chris Simpson, the CMA's outgoing president. "The worst-case scenario is the complete absence of any federal legislation" resulting in a "patchwork quilt" of provincial and territorial regulations, he told told the CMAJ. "This is hard enough as it is; the last thing we want is 10 different sets of rules."

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