Dr. Jeff Blackmer, vice-president of medical professionalism at the Canadian Medical Association, spoke to Maclean’s this week about the complicated grey area in which doctors now find themselves when it comes to assisted death, and why it is difficult, if not impossible—ethically, professional and emotionally—for most physicians to contemplate helping their patients to end their lives.
Q: From the CMA’s point of view, what is the current landscape with no legislation in place and the Supreme Court deadline passed?
The parameters set forward in the Carter decision become the de facto law at the federal level. It’s really not reasonable to expect the Supreme Court of Canada to lay out the clinical parameters that physicians would be expected to follow—that’s really not part of their job. So to have to defer to a court judgment when it comes to something as serious as assisted dying and how that will be applied at the bedside is incredibly challenging for the vast majority of physicians.
Carter says this is reserved for competent adult persons, but it doesn’t say who an adult is. It doesn’t say if they have to be competent at the time of the request or the assisted dying, or both. And it says they have to have a “grievous and irremediable medical condition.” I’ve spoken to thousands—probably tens of thousands—of Canadian doctors on this issue, and I’ve asked every one of them, “Have you ever used ‘grievous’ in a clinical context?” And none of them have. So the first challenge is for doctors to figure out what those terms mean, and how to use those to determine who qualifies for assisted dying.
The second challenge in this interim period is the lack of clear legal protections. So if you’re a Canadian doctor and you go ahead in this interim period and help someone to die, and you think they met those criteria, and then you get taken to court and a judge finds that in fact the patient did not meet those very vague criteria, you will face federal sanctions. So we’re not talking about a slap on the wrist—we’re talking about jail time.
For the average physician who’s trying to navigate this ethical minefield, it’s just one bridge too far to say that not only am I going to participate in something that I’ve always been taught is anathema to the medical profession, but I’m going to do it without any federal law in place to protect me.
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