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In response to our January post, we received the following letter from Dr. Jeff Blackmer of the CMA. Our comments on the letter may be found here >>

 

I read with great interest the recent unattributed blog post on the Physicians’ Alliance Against Euthanasia website entitled “Canada before the World Medical Association: Representation, or Misrepresentation?”. As the primary subject of this post, I welcome this opportunity to provide additional clarity, and a few counterpoints, to some of the issues raised in the blog.

The Canadian Medical Association (CMA) is the official representative of Canadian physicians at the level of the World Medical Association (WMA). We are a founding member of the WMA. In order to represent Canadian physicians at this level, we rely on the policies of the CMA. We do not simply espouse personal viewpoints. When it comes to the issue of assisted dying, the policy of the CMA is clear – we support the rights of our members to decide whether or not to participate, based on their moral conscience and the parameters set forth in law and regulation. This is the position we use to advocate at the WMA and elsewhere. It is not a position arrived at lightly – it is the result of years of engagement and debate by thousands of physicians across Canada, and I am certain that many physicians reading this article will have participated actively in this important conversation.

There is, and will always be, a complex debate about the intersection between law and ethics. As the unknown author (or authors – I have no idea) of the blog points out, just because something is legal, it may not necessarily be considered ethical – and there may be significant disagreement on this point. This is certainly the case with assisted dying in Canada. It is up to individual physicians in Canada to decide whether or not they will provide this service, and many who opt not to will do so because they do not believe it is ethical, for religious reasons or otherwise.

Given that the CMA supports fully the rights of physicians who do elect to participate, we would not then turn around and condemn them as being unethical when they do so. This is the official position of the CMA. It was arrived at as part of an open and transparent process and debate. It is the position we will continue to promote in Canada and internationally.

The WMA has a policy that condemns any physician who participates in assisted dying as being, by definition, unethical. For obvious reasons, the CMA finds this position extremely problematic, since it labels hundreds of Canadian physicians as being unethical for participating in a legal activity with the support of their medical organizations. We are not asking the WMA to declare assisted dying to be ethical. We have never asked for them to take a “radically pro-euthanasia stance”. This is a profound misrepresentation of our advocacy efforts, made by someone who has never been present for any of these discussions. We are asking the WMA to cease their condemnation of physicians who elect to participate in assisted dying.

During the discussion on this issue, the CMA has presented a balanced and honest view of the situation in Canada. We have made it clear that many physicians will not participate in assisted dying, and that we steadfastly support their rights in this regard. We have also made it clear that even amongst those physicians who do participate, many struggle with the moral implications of their decision.

For years now, conscientiously objecting physicians have lobbied the CMA to advocate on their behalf, and to support their right to refuse to participate in assisted dying. They have made tearful pleas at several CMA General Council meetings, asking their non-objecting colleagues to support them and to defend their rights. The CMA and its members have done so, at the Supreme Court of Canada, at the House of Commons and Canadian Senate, and elsewhere.

Given the evolution of the debate on this issue in Canada, it does not seem unrealistic that these same objecting physicians might consider supporting their non-objecting colleagues – that respect for diversity of views and opinions might work both ways. In this regard, one might expect objecting physicians to defend the rights of the colleagues who participate in assisted dying, even when they could never do so themselves. Physicians who go to meetings demanding that their colleagues support their rights, even though they may disagree with their views, but then refuse to do the same when the shoe is on the other foot, might find themselves accused by some of hypocrisy.

Comparing Canadian physicians who participate in assisted dying to Nazi physicians is morally wrong and should be condemned. This is not limiting the parameters of debate on the subject. It is calling out a small subset of objectors who use grotesque and extreme historical examples to paint their non-objecting colleagues with the most damning brush possible. A comparison of the current situation in Canada to that of Nazi Germany is well beyond the scope of this piece. But I truly despair for anyone who thinks this is rational and valid discourse – comparing a systematic program of euthanizing non-consenting “undesirables” to providing assisted dying for consenting adults at the end of their lives who are suffering intolerably.

The unknown author of the blog asks the CMA to be more balanced in its representations at the level of the WMA. Since the author of this piece was not present for any of the discussions at the Vatican, or anywhere else, and is relying instead on intermittent 140 character descriptions, it is impossible for them to understand the depth and breadth of the conversations which have occurred, and the extent to which the CMA has gone to help our international colleagues understand the complexities of the situation in Canada. I feel most comfortable in stating that the views and opinions across the broad Canadian medical spectrum have been very well represented.

We will never have consensus amongst physicians on this issue in Canada. However, perhaps we can strive for respect, and support, for colleagues with views that are different from our own. Conscientiously objecting physicians have asked for this and received it. Might not your non-objecting colleagues now reasonably expect the same in return? You might not agree with their views, but perhaps you can support their right not to be condemned by an international representative medical organization for holding them.

 

Jeff Blackmer

MD MHSc FRCPC

Vice President, Medical Professionalism

Canadian Medical Association

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