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A majority of the members of the Canadian Medical Association have taken position against euthanasia during consultations held during winter and spring. At the same time, they emphasized the inadequacy of palliative care services in Canada.

This was reported by the Association in a report entitled End of Life Care, a National Dialogue, released in July.

The CMA conducted several meetings in different parts of Canada and created a website for members to comment on various end-of-life care issues. Attendance at the meetings ranged from 20 to 70 members, and more than 1200 members registered on the website. There were no consultations in Quebec because a government-led public consultation had already been held in the province.

“Overall, a majority of the CMA members who participated in the dialogue either in person or online favoured maintaining the current CMA policy opposing physician involvement in euthanasia and physician-assisted dying.” says the report. It states, however, that a “significant minority” advocates a review of CMA policy so that it supports “some form of physician-assisted dying in Canada.”

Of the 151 members who responded to the online poll concerning the CMA Policy on Euthanasia and Physician-Assisted Suicide, 71.5% agreed with the existing policy while 25.8% said they disagreed with it, and 2.6% were undecided.

Doctors opposed to legalizing medical aid in dying cited the negative impact of euthanasia on the trust patients have in physicians, the incompatibility between the role of caregiver and the act of ending life, the effect of “a slippery slope” that would endanger vulnerable groups, and the threat of the use of euthanasia for economic purposes to save money in the health care system.

Those advocating change in the CMA position pleaded for “respect for patient autonomy”. They argue that “medical aid in dying” is a form of medical care and that palliative care can not relieve “some forms of suffering”, and that strict regulations could prevent the expansion of euthanasia practices.

Consensus on the need for better palliative care

Consensus was reached on the need for a national palliative care strategy and adequate resourcing of such a strategy to ensure its success, including adequate physician remuneration for providing palliative care services.

Online and at meetings, members have referred to palliative care services as “inadequate” in Canada and were concerned about the “fundamental” link between the status of these services and requests for euthanasia. Physicians also spoke about the lack of services outside of major urban centers, the insufficient training of family physicians and other caregivers, and the lack of proper remuneration.

In the report, one can find several viewpoints from physicians that are going in different directions. Here are some comments on the experiences of other countries:

• “No matter how stringent the protocols and so-called safeguards, studies of the PAD [physician-assisted dying] practices in Holland and Belgium show that they are not followed. A study that was published in the Canadian Medical Association Journal (June 2010) showed that 32% of euthanasia deaths in the Flemish region of Belgium were done without explicit request. A meta-analysis that appeared in The Lancet (July 11, 2012) concerning euthanasia and end-of-life practices in the Netherlands indicated that in 2010, 23% of all euthanasia deaths were not reported.”
• “Belgium legalized euthanasia about 10 years ago now and recent legislation this year will likely allow the euthanasia of children in that country. If that is what happens after only 10 years, then ‘no thanks’. This is proof of the slippery slope. Need I say more?”
• “Belgium has blazed the trail of what not to do. We have legions of physicians and non-physicians who would stand steadfast, shoulder to shoulder, to make sure we do not go down any kind of the slippery slope.”