Change has arrived in the Canadian health care system in the form of the Supreme Court of Canada’s unanimous decision to amend section 241(b) of the Criminal Code. Before this decision, it was illegal for physicians to hasten a patient’s death, known nationally as medical assistance in dying (MAID). The legal changes, however, made it a possibility
During the court proceedings, it was suggested that MAID can be justified based on current palliative care practices, but is this truly the case?
One of the main arguments for the proposition that physician-assisted death can be an ethical practice is that physician-assisted death is ethically indistinguishable from conventionally ethical end-of-life practices such as withholding or withdrawing treatment or administering palliative sedation.2
The Canadian palliative care community has thus far expressed concerns about MAID, with most physicians stating they would not participate in the practice.3 The technical administration of MAID is unique in the traditional Canadian medical context, in that there is no existing specialist community to ensure appropriate training, standards of practice, competency, and expertise in troubleshooting (ie, the anticipation and management of adverse events). Physicians working in general practice rely heavily on guidelines and standards of care set out by subspecialty groups to manage various conditions. Canada’s rural and remote GPs manage a remarkably wide scope of practice, competently managing patient populations from birth to death. When rural and remote GPs decide to extend their scopes of practice to manage complex subacute or chronically ill
We argue that MAID presents a unique set of challenges to rural and remote physicians, particularly those who
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