Dr. David Amies: Pioneering association helps assisted dying providers navigate new terrain

In the face of so much uncertainty and opposition following the passage of Bill C-14, healthcare professionals willing to provide assisted dying have banded together to support and educate each other. In this blog post, Dr. David Amies introduces the Canadian Association of Medical Aid in Dying Assessors and Providers and writes about its importance.

The introduction of Bill C-14, which legalized voluntary assisted dying, changed the practice of medicine in Canada in a tremendously profound way. Beforehand, a practitioner who administered a dose of a heavy sedative or painkiller, knowing full well that such a dose would almost inevitably lead to death, ran the risk of prosecution and, if found guilty, faced a long prison sentence. Undoubtedly, practitioners had willingly taken this risk in the past, to ease intolerable suffering on the part of their patients. Once assisted dying became legal, they were no longer obliged to put themselves in such a dangerous position.

By December 31, 2016, about 750 people across Canada had applied for and received assistance to die because they were suffering intolerably and realized that there was no available remedy they were prepared to accept. This implied that there were willing health professionals prepared to assess and prescribe, and in some cases, administer, lethal doses of medication aimed solely at bringing sufferers’ lives to an end. It is known that such practitioners are in the minority in their professions.

Progressive members of the healthcare community meet regularly to discuss difficult cases and to exchange ideas for the purposes of continuing medical education. It is not surprising that those who have become involved in medical aid in dying (MAID) would seek a means of doing just that. Consequently, the Canadian Association of Medical Aid in Dying Assessors and Providers (CAMAP) has been formed. Its stated aims are to support MAID services and providers; to educate the public and the healthcare community about MAID; and to provide leadership on determining standards and guidelines in MAID provision. CAMAP has set up a website, and regular newsletters, news updates and conferences are planned. This new association is mainly directed at physicians and nurse practitioners, but others who support the work, such as pharmacists, administrators, legislators, lawyers, social workers and activists are also welcome to join as associate members.

Since Bill C-14 has introduced several uncertainties, CAMAP should become a very useful vehicle to enable both providers and assessors to share their experiences. There is a good deal of debate about what precisely the “reasonably foreseeable” clause means when applied to a gravely ill person. MAID providers must also satisfy themselves that those applying for assisted death are mentally competent and know precisely what the implications of their request means. Additionally, it is necessary to ascertain as far as possible that applicants are making their requests free of duress. Requests for MAID, which on the face of it may look entirely straightforward, can turn out to be anything but.

Mutual support and education in the face of opposition

Unsurprisingly, the introduction of a law as transformational as Bill C-14 has provoked a good deal of opposition. Hospices, hospitals and aged care homes that are affiliated with religious organizations have expressed their determination not to allow the procedure to take place upon their premises. In other instances, the management of some hospices are reluctant to permit it because they are uncomfortable about it taking place. Many practitioners have declared that they wish to have nothing to do with either the provision or assessment of patients. Several have gone so far as to refuse to refer their patients to other more willing colleagues. Currently, an association of Christian doctors in Ontario is mounting a legal challenge against regulations surrounding assisted dying.

In view of the legal uncertainties, the organized opposition and the question of conscientious objection raised by some practitioners, the pioneers working in the field have shown wisdom by setting up CAMAP for mutual support and education. By sharing knowledge and experience, members become better able to find their way through the many potential pitfalls which surround this new practice.

It ought not to be forgotten that deliberately ending another's life is a very grave step and one likely to lay a considerable emotional burden on the practitioner. Work in this field will never become mere routine and those that carry it out will benefit from knowing that they can turn to others for support. CAMAP is a small organization entirely funded by the subscriptions of its members and is unlikely to become wealthy enough to employ office staff. In my opinion, those who have set it up deserve the gratitude of the healthcare community and of the public.

Opinion polls seem to suggest that most Canadians are strongly in favour of the new laws. Both the federal and provincial governments are supportive. CAMAP should ensure that providers and assessors are as well-equipped as possible to help those in intolerable medical circumstances obtain relief.

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.

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