Principles-based recommendations for a Canadian approach to assisted dying October 27, 2015 Louise Sweatman, CMA, Legal Counsel Cécile Bensimon, CMA, Director, Ethics

 Process  Principles  Recommendations OUTLINE 2

CMA Town Halls & Member Consultations  Five public Town Halls – St. John’s – Vancouver – Whitehorse – Regina – Mississauga  Six sessions with members – St. John’s – Edmonton – Vancouver – Whitehorse – Fredericton – Regina

 2014 – Key Resolution: The CMA supports the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying as defined in CMA’s policy on euthanasia and assisted suicide. GENERAL COUNCIL 4

 2015 – CMA Ethics Committee – CMA Membership – Medical and health stakeholders – In-person member forums – Online dialogue – Strategic session at General Council – Intervenor at Supreme Court of Canada FURTHER POLICY DEBATE & ACTIVITIES 5

INTERVENOR IN THE CARTER CASE  CMA Position: To assist the Court by providing its perspective on the rationale for the diverse views expressed by its membership, and to highlight practical considerations that must be assessed if the law were to change.

 Foundational Principles – Suite of ethical-legal principles  Recommendations – Attempt to address some of the unanswered or ambiguous issues of the SCC decision and fill in some of the important gaps relevant to physicians OUTCOME SOUGHT 7

 Respect for patient autonomy  Equity  Respect for physician values  Consent and capacity  Clarity  Dignity  Protection of patients  Accountability  Solidarity  Mutual respect 10 FOUNDATIONAL PRINCIPLES 8

 Patient eligibility for access  Patient eligibility for assessment  Role of the physician  Responsibilities of the consulting physician  Moral opposition to assisted dying 5 RECOMMENDATIONS 9

 Competent adult  Informed  Capacity – Communications  Voluntariness RECOMMENDATION #1: PATIENT ELIGIBILITY FOR ACCESS 10

 Stage 1: Requesting assisted dying  Stage 2: Before undertaking assisted dying  Stage 3: After undertaking assisted dying RECOMMENDATION #2: PATIENT ELIGIBILITY FOR ASSESSMENT 11

 Trained  Patient assessment  Consultation requirements  Opportunity to rescind  Documentation  Oversight body and reporting RECOMMENDATION #3: ROLE OF THE PHYSICIAN 12

 Verify patient’s qualifications  Review the patient’s records  Document RECOMMENDATION #4: RESPONSIBILITIES OF THE CONSULTING PHYSICIAN 13

 By health care facilities or health authorities – No discrimination against physicians who decide to provide assisted dying  Conscientious objection by a physician – Physicians are not obligated to fulfill requests – To reconcile physicians’ conscientious objection with a patient’s request for access, physicians are expected to provide complete information on all options and advise on how the patient can access information RECOMMENDATION #5: MORAL OPPOSITION 14

 Education materials  Thank you CONCLUSION 15