At its policy convention in Calgary this week, the Canadian Medical Association was poised to debate one of the most emotionally charged and ethically perilous issues in medicine: doctor-assisted death.
But physicians got bogged down in semantics, in lengthy discussions about the appropriate language to use to describe hastening death at the end of life, and deferred real debate to a later, unspecified date and another unspecified time.
In short, fear prevailed.
Fear of exposing the deep, deep divisions in the medical profession. The same fears that exist in society more broadly.
Anna Reid, outgoing president of the CMA, tried to put a positive spin on the outcome, saying: "We didn't make any final decisions, but that wasn't our intention. Our goal was to begin the discussion."
While the need for "physician leadership" on all aspects of health care was the overriding theme of the convention, on this contentious issue, Dr. Reid said, "Physicians are waiting for leadership from the Canadian public." A poll of Canadian doctors conducted earlier this year found that 38 per cent think euthanasia should be illegal, 34 per cent think it should be legal, and 28 per cent were unsure or would not say.
This three-way split was reflected in voting patterns and debate, both of which reflected trepidation.
A motion calling for the CMA to replace the term "physician-assisted suicide" with "physician-assisted death" in all its official documents actually generated the most passionate debate.
"Suicide is an unhappy word," said John O'Brien-Bell of Surrey, B.C., a past CMA president. "Assisting suicide is also illegal." Lawrence Erlick of Scarborough, Ont., tried to find a compromise, suggesting the unwieldy term "patient-requested medically assisted death." Robin Saunders, chair of the CMA ethics committee, would have none of it. "Let's call a spade a spade: It's euthanasia," he said.
In the end, delegates referred the question to the CMA board of directors to decide.
The key motion related to the debate, that the CMA call for a "large-scale public consultation to regard medical aid in dying as appropriate end-of-life care" was defeated. But, again, most of the debate revolved around the appropriateness of the term "medical aid in dying." Doctors never really delved into the ethical and legal implications, and that frustrated some, particularly the delegation from Quebec, where the government is poised to adopt legislation that would allow physicians to administer drugs to hasten the death of terminally ill patients in certain conditions.
"It looks like doctors outside Quebec don't want to talk about this," said an exasperated Ruth Vander Stelt, a physician from Gatineau, Que.
Physicians, however, did find some points of agreement. They adopted motions saying that every doctor should have the "right to conscientious objection" when faced with a request for medical aid in dying (or whatever term they eventually settle upon).
The CMA delegates also agreed, nearly unanimously, that every Canadian has the right to palliative care at the end of life, and that medical students should have more palliative-care training during their studies and residency.
But those are easy issues to agree upon.
After several days of discussion at the "Parliament of Canadian medicine," the public still has no real idea where doctors stand.
If terminally ill patients decide to end their suffering (and life), can they count on a physician to help? Patients deserve an answer.
With doctors ducking the issue, the final word will come from Parliament (which, on nine occasions, has rejected private members' bills on the issue) or from the courts – which have several important cases pending.
That is unsatisfactory, and it's no way to show physician leadership.
We trust doctors with our lives, and with our deaths. Physicians make tough decisions every day at the bedside. They should be willing and able to do so on the convention floor as well.
André Picard