The SCC’s ruling on assisted death: Where do we go from here?
It has been just eleven days since the Supreme Court of Canada’s (SCC) unanimous ruling to remove the ban on physician-assisted death. This leaves 354 days until the ruling becomes law, at which point our governments, healthcare organizations, educational institutions, and healthcare professionals need to be ready to handle and implement such requests.
For years, physician-assisted death has been a highly tumultuous discussion topic in Canada, and one that we recently confronted at our annual Travill Debate at Queen’s. Yet even after a ruling of the highest court and decades of debate, this decision will be celebrated by many and denounced by others. Those who were against this ruling have argued valid points, and we must remain keenly aware of the risks involved, and work inter-professionally to help protect the vulnerable and not allow the guidelines of eligibility to slip over time.
As an individual physician and faculty member, I personally applaud the ruling. I would also note that we are fortunate to have forward-looking organizations such as the Canadian Medical Association (CMA), led by Queen’s own Dr. Chris Simpson, that have been working towards this outcome. In August, the CMA reformed its policy on physician-assisted death to support all physicians to follow their conscience when deciding to partake in such acts, as long as it is within the bounds of Canadian legislation. At that time, the CMA also declared “there should be no undue delay in the provision of end-of-life care, including medical aid in dying when it becomes legal.”1
With the official SCC ruling, the CMA now plans to move to examining “ways to support doctors who choose to participate in assisted dying with education and training.”1 Naturally, we at Queen’s University’s Faculty of Health Sciences must do the same to prepare our country’s future healthcare professionals. My personal view is that there will be many details to work out with respect to the development of very tight guidelines and the identification of appropriate mechanisms for physicians to follow their conscience. But we should not shy away from this work, and need to be progressive leaders given the brave SCC ruling.
Geriatric care specialist and Associate Professor in the Department of Medicine, Dr. Chris Frank, considers that “current medical students will need to be prepared to adapt to a new law by the time they are residents. Discussions with students and with residents in advance of the change in the federal legislation should start now. The evolution of the policies of organizations such as hospitals, the CMA, and provincial governments will obviously need to inform the curriculum along the way.”
Naturally, this leads us to ask who should be involved in this type of education. Dr. Ray Viola is a Palliative Care physician and Associate Professor in the Palliative Medicine Division of Queen’s Department of Medicine. He explains that there seems to be an impression that palliative care teams will play a major role to ensure assisted dying is used appropriately, even though the majority of palliative care physicians do not see this as a part of palliative care services. “We will need to engage all physicians to think about what this means, how it fits into their practices and the health care system in general. We should not see it as something that only certain medical disciplines will need to address. During our careers, all physicians will likely be asked. It is so very important that we resist making judgments about colleagues who choose to participate or not participate; we must ensure that dialogue occurs in a mutually respectful manner.”
It is true that it would be easy for us to assume that only palliative care specialists would be confronted with such requests, but in reality, a wide range of health care professionals will encounter patients who are facing severe, incurable, debilitating and life-threatening illnesses. Most of them will never request assisted death. And yet, how can we empathize with them if they do? There are inherent elements of empathy that cannot be taught, and yet we as a Faculty will need to provide our students with the tools to work with patients and each other in these delicate situations.
As the government refines the rules and regulations that will ensure the ethical implementation of this law, we here at the Faculty of Health Sciences will be working to prepare Canada’s future healthcare leaders for this new aspect of patient empowerment.
Share your thoughts on physician-assisted death by commenting on the blog…or better yet please drop by the Macklem House. My door is always open.
I would like to acknowledge Emma Woodman for her assistance in researching and writing this blog.