The Canadian Medical Association, the national organization representing most Canadian physicians, released its report on End of Life Care in June 2014. This is an issue that has seen nationwide dialogue recently and the release of this report confirms that this dialogue will continue.
The CMA made a few recommendations, the main one being that, “all Canadians should discuss end-of-life wishes with their families or other loved ones.” This is significant and shows a changing attitude of the gatekeepers of this issue. Of further significance, CMA President Louis Hugo Franscescutti said that although the CMA was not making any substantive “recommendations” at this time it is prepared to reassess its 2007 position of being “against” physician assisted death – keeping in line with the changing views of what the public wants.
Although public opinion has changed or is changing (dare I say evolved) since 2007 when the CMA released its last report on this issue, the CMA still found Canadians divided on the issue of physician assisted suicide.
The report refers to five public town hall meetings held by the CMA across the country and online discussions. According to the findings of the CMA, at a minimum Canadians want access to palliative care and information about palliative care whether they choose it in the end or not. This confirms the generally held belief that palliative care helps patients maintain a quality of life by treating pain and preventing suffering regardless of whether patients receive palliative care during treatment for a disease or while they are dying. This finding also supports the point (which is less known) that there is not necessarily a conflict between palliative care and physician assisted death. (For more information on palliative care check out the Health Canada website).
The CMA research also found that although many Canadians inquire about palliative care few fill out the necessary forms and even fewer seek implementation of existing advance health care directives/powers of attorney for personal care documents. We, as Canadians, are therefore being encouraged to obtain information and engage is discussions about end-of-life care, including opinions about euthanasia and physician assisted death but are not necessarily following through and acting on the information.
Another finding of the CMA Report was that there is a clear consensus Canadians want to feel control over the end of life process with the top concerns cited by participants being 1) dying alone, 2) pain and 3) being a burden on loved ones. Participants stated they want to be able to talk openly with their doctors and families and be “free” to make their own decisions, leading the CMA to further encourage everyone to discuss end-of-life wishes not only in the public arena but also in the personal arena with families and loved ones.
Much like those nearing end of life, Canadians in general, are also divided on the end of life issue according to the findings of the CMA. In August 2013, the CMA published a poll which found that 26% of doctors in Canada were prepared to help patients die should the laws change to allow them to do so, but a further 20% were unsure of how they would act. Despite differing viewpoints, there was consensus that a national strategy would be needed to make palliative care available to dying Canadians no matter where they live in the country given that, according to the CMA, fewer than 30% of Canadians who will die this year will have access to palliative care. What this Report highlights again (and what may be a relatively unknown fact) is that access to palliative care is quite limited outside major cities where people are crying out for more education and training on palliative care and advance care directives for medical students, residents and practising physicians alike.
When asked if its recommendations were affected by the landmark passing of Quebec’s right-to-die bill, Bill 52, the CMA said that it could not “draw parallels to the rest of the country based on the bill’s passing as Quebec has certain cultural distinctions” – rather the preference and what was needed was a discussion on the federal level which, with the potential legal challenge of Bill 52 by Ottawa and the October 2014 scheduled appeal in the Supreme Court of Canada in Carter et al v. Attorney General of Canada (which deals with the constitutionality of the provisions in the criminal code prohibiting assisted suicide and a case that the CMA is seeking intervener status is), this is expected to take place – even though the federal government has said it has no intention (now) to change the criminal law against physician-assisted dying.
Lesson Learned: A lot has happened in 10 years as we see with this end of life report. What the next 10 years will bring will likely be just as interesting, although we will likely see faster change as we engage in further discussion and policy planning.
Until next time,
Jasmine Sweatman
