Canada's doctors, who have never been staunch supporters of medically assisted death, now seem to be open to a liberalization of the law.
A straw poll conducted on Wednesday at the Canadian Medical Association annual meeting found that 83 per cent of delegates supported allowing "advance directives" – meaning, for example, that people with dementia could, while they are still competent, decide they want an assisted death at a later time.
The informal poll of the 600 delegates also found that 67 per cent backed the idea of "mature minors" being allowed to access assisted death. (A mature minor is someone under 18 who is deemed mature enough to make decisions about their own medical treatment.)
Physicians, however, were far less enthusiastic about allowing assisted death for patients whose sole problem is mental illness: Only 51 per cent backed that idea.
Similar CMA straw polls showed that, in 2013, only 34 per cent of doctors supported assisted dying legislation; that rose to 45 per cent in 2014.
"The mood is changing," said Jeff Blackmer, vice-president of medical professionalism at the CMA, in an interview. "Physicians see that things are going relatively well, and that provides comfort to those on both sides of the debate."
However, unlike past meetings, CMA delegates did not publicly debate their position on assisted death. Rather, they held small group discussions and made written recommendations, which were not publicly disclosed.
In September, 2015, the Supreme Court of Canada struck down the law making assisted dying a criminal offence – still, only 29 per cent of CMA delegates said they would perform assisted death.
In June, 2016, the federal government introduced legislation allowing Canadians over the age of 18 who are deemed competent to request medically assisted aid in dying if their medical condition makes death "reasonably foreseeable."
The law was challenged almost immediately – seen as too restrictive.
In response, Ottawa appointed the Council of Canadian Academies to review three of the most contentious issues – advance directives, mature minors and patients with intractable mental illness – and report back to Parliament by late 2018. Last month the council created a 43-member expert panel on assisted dying, chaired by former Supreme Court of Canada justice Marie Deschamps, and subdivided it into working groups on the three issues.
As of December, 2016, a total of 970 assisted deaths had been reported, about 0.6 per cent of all deaths nationwide last year. Dr. Blackmer said that number, as much as anything, assuaged a lot of fears about the indiscriminate use of the law.
The very public discussions about people who are refused assisted death, such as those with dementia or intractable mental illness, have also forced physicians to rethink those issues, he said.
The reluctance to support assisted death for those with mental illness revolves principally around the issue of consent. Dr. Blackmer said physicians recognize that mental illness is as serious and painful as physical illness, but "they've also been taught that people come out the other side," so they are reluctant to perform an assisted death.
Doctors have spent years in often-bitter debate about assisted death, but the discussion at this year's CMA general council was serene.
"We continue to be divided in our views and opinions, but we continue to be supportive of our colleagues," Dr. Blackmer said.
Physicians, however, did express frustrations with the practice of assisted death, but mostly on technical issues such as the excessive paperwork required and the lack of good data collection.
The interim report showed that the average age of Canadians requesting assisted death is 72 and that three in every five have terminal cancer. Just more than half of assisted deaths take place in hospitals, a third in the home and the balance in facilities such as nursing homes.
Delegates to the CMA conference passed a number of motions on a broad range of issues, including calling on provincial governments to provide health services at no cost to all residents, regardless of their immigration status.
They also endorsed a call to implement a federal excise tax on sugar-sweetened and artificially sweetened beverages, with the money raised to be used to subsidize healthy foods.
The CMA called for mandatory labelling of all prescription drugs that contain gluten and other common allergens.
Delegates also discussed and seemed to enthusiastically endorse the idea of a national pharmacare plan; however, they did not take a formal stand, as the debate was interrupted when the conference room filled with smoke due to an electrical problem.
The Canadian Medical Association represents 85,000 physicians, residents and medical students.