With Quebec set to implement its comprehensive medical aid in dying law, the Supreme Court of Canada expected to hand down a ruling on assisted suicide and opinion polls registering overwhelming support for legalizing the right to die, the Canadian Medical Association, the largest association of doctors in the country, is adjusting to the new reality. Is it moving fast enough?
Yes, says Kingston cardiologist Dr. Chris Simpson, president of the CMA, admitting the organization has gone through "a sea change" on physician-assisted dying in the past year. In August, the membership of the CMA voted 91 per cent in favour of allowing doctors to follow their conscience if PAD is legalized. Then, in October, the CMA told the Supreme Court it was changing its long-standing policy that "Canadian physicians should not participate in euthanasia or assisted suicide."
That was the adamant stance of the CMA when a discussion about PAD erupted on the floor of the annual general council meeting in Calgary in August, 2013, in the wake of Quebec tabling Bill 52 in the National Assembly.
It "very quickly got bogged down because of misunderstandings and differences in terminology," Simpson recalled. "People criticized us for not tackling a very topical issue," he said. "We realized that this was something that society needs us to lead on."
Belatedly, the CMA embarked on a series of five regional town halls to hear what patients had to say about end-of-life care. It also organized sessions with its own members on what many abhorred as a violation of their duty to uphold the sanctity of life, and just as many thought was appropriate care for the small number of dying patients whose pain and suffering could not be alleviated. Others, including then-CMA president Dr. Louis Francescutti, believed that any discussion of PAD should be put on hold until all Canadians who needed it had access to quality palliative care. You are putting "the cart well before the horse," he argued in response to an editorial in the Canadian Medical Association Journal in May, 2014, calling on doctors to move beyond "yes or no" on PAD to discuss implementation, safeguards and regulations.
Critical-care physician Dr. James Downar, one of the authors of the editorial, welcomes the change in the CMA's official policy. "This is a very mature decision," he said in an interview. "What this represents is a frank recognition" that since the SCOC ruled 20 years ago to uphold the prohibition against assisted suicide in the Sue Rodriguez case, "a multitude of jurisdictions have shown that palliative care can survive and thrive in an environment where assisted death is legal." Consequently, "many of the members of CMA have changed their opinions." He is one of them.
"Some years ago I did not support assisted death," he said, but "I changed my mind on the basis of the evidence I saw."
When the "data changes, you need to take a good hard look at your opinions, because if they aren't supported by data, they are probably not very good opinions," Downar contends.
"The fact that we were going out and seeking the public's input on this showed some humility," says Simpson, the new man at the helm of the CMA. The process wasn't so much about "achieving consensus," but how we are going to "support physicians and patients if the law changes."
Even that studied and neutral response is "courageous," says Downar, a former CMA critic, because it is "hard for people in prominent positions to frankly and publicly change their opinions." Courageous is not a word the CMA is used to hearing on physician-assisted dying.