Consultations on Physician-Assisted Dying - Summary of Results and Key Findings

Annex E: Abstracts of Individual Transcripts from Stakeholder and Expert consultations

Introduction

The External Panel met with 73 experts from across Canada and from Oregon, the Netherlands, Belgium and Switzerland. They also consulted with 92 representatives of groups including Carter interveners, medical regulatory authorities and stakeholder organizations. Discussions focussed mainly on eligibility criteria, defining key terms, the risks of physician-assisted dying to individuals and society, what safeguards can be used to address the risks and finally procedures for assessing requests for assistance in dying.

Issues of primary concern for stakeholders and experts included how to make physician-assisted dying as respectful as possible of the rights of all Canadians; ensuring palliative care is more widely available across the country; protecting the freedom of conscience of physicians, nurses, and other health care workers; referrals from physicians who oppose PAD; and how to strictly enforce and monitor safeguards. Many were also concerned about minimizing the risks to the most vulnerable members of our society, for example, people with mental and physical disabilities.

The following document provides abstracts and additional information for all transcripts prepared in relation to these meetings. Transcripts were prepared for all stakeholder consultations and 42 of 51 expert consultations as transcription services were not able to be coordinated for all European expert consultations.

Abstracts of Individual Transcripts
ID# Name(s) Organization(s) / Title City Date (M/D/Y) Transcript Abstract Language
1 Johan Legemaate University of Amsterdam Amsterdam 9-01-15 Key points from the meeting with Johan Legemaate include:
  • Health and social issues around autonomy and vulnerability;
  • Eligibility criteria surrounding the issues of age, mature minors, a grievous and irremediable medical condition, mental illness, enduring suffering, capacity to consent to medical treatment, advance directives, and voluntariness;
  • Procedural safeguards including consideration of additional consultations (with psychiatric, palliative, and vulnerability assessments), the role of the family, and the need for reporting;
  • System oversight with open data, periodic review and enforcement; and
  • Additional considerations for the involvement of other health care providers, rights in terms of conscientious objection, their duty to refer or inform, whether there should be training or licensing, and a possible good faith compliance that would provide them with additional protection.
English
2 Paul J. Lieverse Cancer Institute, Erasmus MC University Medical Center Rotterdam Rotterdam 9-01-15 Key points from the meeting with Paul J. Lieverse include:
  • An overview of physician-assisted death and palliative care in Holland;
  • Physician-assisted death is available in hospital and in independent clinics; some patients—especially younger ones—use clinics if they can't access physician-assisted death in hospital;
  • Conflict between physician-assisted death and palliative care when it's delivered in the same place;
  • Issues of uneven access—rich and well-connected people have better access to care; and
  • Supports distancing physician-assisted death from physicians and palliative care.
English
3 Renske Maria Leijten;
Linda Voortman
Parliamentary Committee on Health, Welfare and Sport The Hague 9-01-15 Key points from the meeting with the Parliamentary Committee on Health, Welfare and Sport include:
  • Health and social issues around vulnerability;
  • The comparison of euthanasia and assisted suicide;
  • Eligibility criteria surrounding the issues of age, mature minors, a grievous and irremediable medical condition, mental illness, capacity to consent to medical treatment, and advance directives;
  • Procedural safeguards including consideration for two or more physicians and the need for reporting;
  • System oversight with open anonymized data about the patient and periodic review; and
  • Additional considerations for the rights of physicians in terms of conscientious objection and their duty to refer or inform.
English
4 Rob Jonquière World Federation for Right to Die Societies Amsterdam 9-02-15 Key points from the meeting with Rob Jonquère include:
  • Health and social issues around autonomy and the inequality of access to health care;
  • The comparison of euthanasia and assisted suicide;
  • Eligibility criteria surrounding the issues of age, mature minors, a grievous and irremediable medical condition, mental illness, enduring suffering and ensuring voluntariness from the patient;
  • Procedural safeguards including consideration for two or more physicians, informed consent for the patient, the need for a formal request from the patient, having a witness present at the moment of death, consideration for additional psychiatric consultations, the role of the family, proportionate waiting periods and the need for reporting;
  • System oversight with periodic review;
  • Additional considerations for the involvement of other health care providers, rights in terms of conscientious objection, their duty to refer or inform, whether there should be training or licensing, the discussion of physician-assisted death between patient and physician, and a possible good faith compliance that would provide health care workers with additional protection; and
  • Risks around the issues of slippery slope and overly restrictive safeguards.
English
5 Étienne Montero Dean, Faculty of Law, Université de Namur Brussels 9-02-15 Key points from the meeting with Étienne Montero include:
  • How It's impossible to maintain and enforce strict conditions around physician-assisted death;
  • The Belgian control system does a review after the patient is dead. It's impossible to confirm if consent was given or if the patient had treatment options adequately explained. So in this sense, the legal requirements may be strict but without controls their effectiveness is unclear;
  • The Control Commission increasingly endorses cases of physician-assisted death for patients suffering with depression, dementia or psychiatric disorders; and
  • Sociocultural impact of the law transforms what was an exception in something which is trivial.
Bilingual
6 Benoit Mores Advisor to the Federal Minister of Affairs and Public Health Brussels 9-03-15 Key points from the meeting with Benoit Mores include:
  • The political evolution of physician-assisted death in Belgium;
  • Mature minors;
  • Problems with advance requests, five year-limit (Alzheimer's example);
  • Consequences for others: family, friends, doctors, health-care workers, society;
  • He doesn't perceive slippery slope;
  • Palliative sedation is not tracked;
  • No rights for a patient to transfer out of non- physician-assisted death facilities; and
  • Advises Canada to avoid making the debate about palliative care vs. physician-assisted death.
English
7 Joris Vandenberghe Professor of Psychiatry at KU Leuven and a member of the Belgian Advisory Committee on Bioethics Brussels 9-03-15 Key points from the meeting with Joris Vandenberghe include:
  • The role of psychiatrists in evaluating physician-assisted death requests from patients without a terminal illness;
  • Separate processes in Belgium for those with and without terminal illnesses;
  • A complex, multifaceted process to determine:
    1. competency to make decisions,
    2. whether to approve physician-assisted death;
  • The law assumes patients are competent; the onus lies on proving lack of competency. Must also decide whether patient suffering is intolerable with no possible relief;
  • Demarcation between normal and pathological is blurry and evolves continually;
  • Often hard to distinguish pathology from normal fear;
  • The role of the family;
  • Three approval stages: physicians, psychiatrist, ethics committee;
  • Important criterion of no possible medical alleviation of suffering; and
  • Guideline in Holland is that the patient cannot access physician-assisted death unless all alleviation options have been tried.
English
8 Kenneth Chambaere;
Luc Deliens
Mr. Deliens: Professor of Public Health and Palliative Care at the Free University of Brussels and Ghent University; and Mr. Chambaere: Sociologist, Researcher, End-of-life Care Research Group at the Free University of Brussels and Ghent University Brussels 9-03-15 Key points from the meeting with Kenneth Chambaere and Luc Deliens include:
  • Health and social issues around autonomy and the need for good palliative care;
  • The comparison of euthanasia and assisted suicide;
  • Procedural safeguards including consideration for informed consent for the patient, having a witness present at the moment of death, the role of the family, and the need for reporting;
  • System oversight with open anonymized data about the patient, data collection from both the patient and physician, specification for death records, and issues surrounding targeted funding; and
  • Additional considerations for the rights of physicians in terms of conscientious objection, their duty to refer or inform and whether there should be training or licensing.
English
9 Els Van Hoof Belgian Federal MP for the Flemish Christian-democratic party Brussels 9-04-15 Key points from the meeting with Els Van Hoof include:
  • Health and social issues around the need for good palliative care;
  • Eligibility criteria surrounding the issues of mental illness, a grievous and irremediable medical condition, enduring suffering, the capacity to consent to medical treatment and advance directives;
  • System oversight with open anonymized data about the patient, data collection from both the patient and physician, and periodic review; and
  • Risks around the issues of slippery slope.
English
10 Gert Huysmans Palliative care physician and President, Federation of Palliative Care Flanders Brussels 9-04-15 Key points from the meeting with Gert Hursmans include:
  • Keeping physician-assisted death and palliative care together;
  • Multidisciplinary consultations are best, also the inclusion of family;
  • Ongoing debate about how far the law should go;
  • Worries that inadequate palliative care drives demand for physician-assisted death;
  • Life End Information Forum: a movement to expand physician-assisted death and to train physicians about providing physician-assisted death advice;
  • The rights of the patient;
  • Divisions within the country; and
  • Flanders wants to liberalize access, older people have different attitudes about aging, doctors, and physician-assisted death.
English
11 Herman Nys Professor of Health Law at KU Leuvan Brussels 9-04-15 Key points from the meeting with Herman Nys include:
  • The evolution of physician-assisted death and how it's incorrect to label it as a slippery slope;
  • Under Belgian law, physicians are not obligated to provide physician-assisted death;
  • In Belgium and Holland there is no right to physician-assisted death; only a right to request physician-assisted death;
  • Belgium has a single Control and Evaluation Commission, and there's never been a case referred to the public prosecutor (which is required if two-thirds of Commission members believe there's a problem);
  • In Belgium, physician-assisted death is legally considered death by natural causes (affects insurance);
  • Aiding a suicide is not a crime in Belgium (not helping a person in grave danger is a crime);
  • Interpretations of the SCC decision, and how it's unusual to consider physician-assisted death as a right-to-life issue; disagrees with reasoning that equates withdrawal of treatment with aiding suicide; and
  • Don't make physician-assisted death a right. If you do, it removes a safeguard.
English
12 Jacqueline Herremans Member, Commission fédérale de controle de d'évaluation de l'euthanasie Brussels 9-04-15 Key points from the meeting with Jacqueline Herremans include:
  • Health and social issues around autonomy, inequality of access to health care, and the need for good palliative care;
  • Eligibility criteria surrounding the issues of mature minors, a grievous and irremediable medical condition, enduring suffering, advanced directives, substitute decision-making, and ensuring voluntariness from the patient;
  • Procedural safeguards including consideration for two or more physicians, additional consultations (with psychiatric physicians and specialists), ensuring that there is informed consent for the patient, proportionate waiting periods, and the need for reporting;
  • System oversight with periodic review; and
  • Additional considerations for the rights of physicians in terms of conscientious objection and their duty to refer or inform.
English
13 Senator Jean-Jacques De Gucht Member of the Belgian Senate and of the Flemish Parliament (Flemish Liberals) Brussels 9-04-15 Key points from the meeting with Senator Jean-Jacques De Gucht include:
  • Health and social issues around autonomy and the need for good palliative care;
  • Eligibility criteria surrounding the issues of mature minors, a grievous and irremediable medical condition, mental illness, enduring suffering and advance directives;
  • Procedural safeguards including consideration for two or more physicians, the need for a formal request from the patient, having a witness present at the moment of death, consideration for additional psychiatric consultations, the role of the family, and proportionate waiting periods;
  • System oversight with periodic review; and
  • Additional considerations for the rights of physicians in terms of conscientious objection, their duty to refer or inform, whether there should be training or licensing, and the risk of physician shopping.
English
14 Silvan Luley Executive Director of Dignitas Forch 9-07-15 Key points from the meeting with Silvan Luley include:
  • How the existence of Dignitas reflects the failure of Switzerland's legal and health-care systems to accommodate the wishes of its citizens;
  • Inhibitions, taboos and misunderstanding are the cause of many physician-assisted death -related problems;
  • A comprehensive background of the Swiss system;
  • How most Physician-assisted deaths are performed at home;
  • The role of Dignitas and how foreigners typically stay four-five days and have two physician visits; and
  • All cases are investigated by judicial authorities after the fact.
English
15 Bernhard Sutter Executive Director of Exit Zurich 9-07-15 Key points from the meeting with Bernhard Sutter include:
  • The role of Exit and how they counsel 3,000 people a year, assist about 600 suicides, prepare many living wills, and provide legal assistance to help enforce living wills;
  • It's impossible to forbid death, you can only make it more humane or make it less humane; and
  • How and why Exit works in Switzerland.
English
16 Georg Bosshard Head of Clinical Ethics, Zurich University Zurich 9-07-15 Key points from the meeting with Georg Bosshard include:
  • Health and social issues around autonomy, inequality of access to health care, and the need for good palliative care;
  • Eligibility criteria surrounding the issues of mature minors, a grievous and irremediable medical condition, mental illness, enduring suffering, advanced directives, and ensuring voluntariness from the patient;
  • Procedural safeguards including consideration for two or more physicians, additional consultations (with palliative care physicians and specialists), ensuring that there is informed consent for the patient, the role of the family, and proportionate waiting periods;
  • System oversight with enforcement and periodic review; and
  • Additional considerations for the rights of physicians and institutions in terms of conscientious objection, their duty to refer or inform and whether there should be training or licensing.
English
17 Corine Klöti;
Bernardo Stadelmann
Members of the Federal Justice Office of Swizerland Bern 9-08-15 Key points from the meeting with Corine Klöti and Bernardo Stadelmann include:
  • The different categories of euthanasia: direct active (deliberate killing) is illegal, while indirect active (palliative sedation) is generally regarded as permissible, passive euthanasia renunciation or discontinuation of life-prolonging measures is also legal; and
  • The lengthy exploration of potential selfish motivation among those who assist with suicides.
English
18 Karim Boubaker Canton Chief Public Health Officer Bern 9-08-15 Key points from the meeting with Karim Boubaker include:
  • The Historical context of physician-assisted death in Switzerland;
  • The evolution of medicine and its effect on society; and
  • The difference of opinions between one canton and the next.
English
19 Steffen Eychmüller Head of Palliative Care Center, Inselpital Bern 9-08-15 Key points from the meeting with Steffen Eychmüller include:
  • The polemics in Switzerland around the issue of physician-assisted death;
  • The use of advanced directives;
  • The Health care system's link with economics;
  • How physician-assisted death is disincentivized in Switzerland;
  • Assisted suicide discussions led to a national palliative-care strategy;
  • Cost is a big issue; insurance companies don't want to pay; training in palliative care is expensive; and
  • Swiss commission tried and failed to devise reliable criteria for assisted suicide.
English
20 Peter Korchnak;
Peg Sandeen;
Eli Stutsman
Death With Dignity National Center Oregon 10-01-15 Key points from the meeting with the Death with Dignity Nation Center include:
  • Legal discussion involving the division of powers between the federal and provincial governments in Canada, and the implementation of physician-assisted dying within the United States
  • Health and social issues around vulnerability;
  • Eligibility criteria surrounding the issues of residency, enduring suffering and terminal illness;
  • Procedural safeguards including consideration for two or more physicians, additional consultations (with psychiatric and palliative care physicians), informed consent for the patient, having a witness present at the moment of death, and the need for reporting;
  • System oversight with open anonymized data about the patient, data collection from both the patient and physician, targeted funding and specification for death records; and
  • Additional considerations for the involvement of other health care providers, rights in terms of conscientious objection, and the implementation of an independent institution that can help health care workers with referrals.
English
21 Kathryn Tucker Disability Rights Legal Center Oregon 10-01-15 Key points from the meeting with the Disability Rights Legal Center include:
  • Legal discussion involving the history of physician-assisted dying within the United States;
  • The comparison of the different types of physician-assisted dying;
  • Eligibility criteria surrounding the issues of mental illness, terminal illness, having a capacity to consent to medical treatment, and ensuring voluntariness from the patient;
  • Procedural safeguards including consideration for additional consultations (with psychiatric physicians and specialists), informed consent for the patient, the need for a formal request from the patient, having a witness present at the moment of death, and proportionate waiting periods;
  • System oversight with enforcement; and
  • Additional considerations for the rights of physicians in terms of conscientious objection and their duty to refer or inform.
English
22 Kelly Hagan Oregon Death With Dying Task Force Oregon 10-01-15 Key points from the meeting with Kelly Hagan include:
  • Health and social issues around autonomy;
  • The comparison of the different types of physician-assisted dying;
  • Eligibility criteria surrounding the issues of residency and terminal illness;
  • Procedural safeguards including consideration for two or more physicians, additional psychiatric consultations, the need for a formal request from the patient, having a witness present at the moment of death, proportionate waiting periods, and the implementation of a decision-making committee;
  • System oversight with specification for death records; and
  • Additional considerations for the involvement of other health care providers, rights in terms of conscientious objection, their duty to refer or inform, and the implementation of an independent institution that can help health care workers with referrals.
English
23 Barb Hansen Oregon Hospice Association Oregon 10-01-15 Key points from the meeting with Barb Hansen include:
  • Health and social issues around autonomy and the need for better home care;
  • The comparison of the different types of physician-assisted dying;
  • Eligibility criteria surrounding the issues of mental illness, terminal illness and enduring suffering;
  • Procedural safeguards including consideration for two or more physicians, additional consultations (with psychiatric and palliative care physicians), informed consent for the patient, the need for a formal request from the patient, having a witness present at the moment of death, the role of the family, and proportionate waiting periods;
  • Specification for death records; and
  • Additional considerations for the involvement of other health care providers, rights in terms of conscientious objection, their duty to refer or inform, and the implementation of an independent institution that can help health care workers with referrals.
English
24 Charles Bentz;
Kenneth Stevens Jr.
Physicians for Compassionate Care Education Foundation Oregon 10-01-15 Key points from the meeting with the Physicians for Compassionate Care Education Foundation include:
  • Health and social issues around autonomy and vulnerability;
  • Eligibility criteria surrounding the issues of terminal illness, mental illness, a grievous and irremediable medical condition, enduring suffering, and having a capacity to consent to medical treatment;
  • Procedural safeguards including consideration for two or more physicians, additional consultations (with psychiatric and palliative care physicians), and the need for reporting;
  • System oversight with open data collected from both the patient and physician, specification for death records, targeted funding, and enforcement; and
  • Additional considerations for the involvement of other health care providers, the involvement of the physician, their rights in terms of conscientious objection, their duty to refer or inform, and whether there should be licensing; and
  • The abuse of physician-assisted dying in Oregon and risks of a slippery slope.
English
25 Barbara Glidewell Former Director of Patient Relations at Oregon Health Sciences University Hospital Oregon 10-02-15 Key points from the meeting with Barbara Glidewell include:
  • Health and social issues around autonomy and vulnerability;
  • The comparison of the different types of physician-assisted dying;
  • Eligibility criteria surrounding the issues of terminal illness and ensuring voluntariness from the patient;
  • Procedural safeguards including consideration for two or more physicians, additional consultations with specialists, informed consent for the patient, the need for a formal request from the patient, having a witness present at the moment of death, the role of the family, and the need for reporting;
  • System oversight with open data collected from both the patient and physician, and specification for death records, and
  • Additional considerations for the involvement of other health care providers, rights in terms of conscientious objection, their duty to refer or inform, and whether there should be training or licensing.
English
26 Sue Porter;
Peter Reagan;
Kat West
Compassion & Choices Oregon 10-02-15 Key points from the meeting with Compassion & Choices include:
  • Health and social issues around autonomy, the inequality of access to health care, and the need for good palliative care;
  • Eligibility criteria surrounding the issues of terminal illness, a grievous and irremediable medical condition, and enduring suffering;
  • Procedural safeguards including consideration for two or more physicians, additional consultations with specialists, informed consent for the patient, the need for a formal request from the patient, having a witness present at the moment of death, and proportionate waiting periods;
  • System oversight with open anonymized data about the patient, and data collection from both the patient and physician; and
  • Additional considerations for the rights of physicians in terms of conscientious objection, their duty to refer or inform, the risk of physician shopping, and the implementation of an independent institution that can help provide health care workers with referrals.
English
27 Bob Joondeph Disability Rights Oregon Oregon 10-02-15 Key points from the meeting with Bob Joondeph include:
  • Health and social issues around autonomy, vulnerability and the inequality of access to health care;
  • Eligibility criteria surrounding the issues of terminal illness, mental illness, having a capacity to consent to medical treatment, advance directives, substitute decision-making, and ensuring voluntariness from the patient;
  • Procedural safeguards including consideration for additional consultations with psychiatrists, proportionate waiting periods, and the implementation of a decision-making committee; and
  • The need for system oversight.
English
28 Linda Ganzini Director of Geriatric Psychiatry, Portland Health Center System Oregon 10-03-15 Key points from the meeting with Linda Ganzini include:
  • Health and social issues around vulnerability, suicide prevention and the inequality of access to health care;
  • Eligibility criteria surrounding the issues of terminal illness, mental illness, having a capacity to consent to medical treatment, and ensuring voluntariness from the patient;
  • Procedural safeguards including consideration for additional consultations with psychiatrists, informed consent for the patient, having a witness present at the moment of death, proportionate waiting periods, and the need for reporting;
  • System oversight with open anonymized data about the patient, data collection from both the patient and physician, and targeted funding; and
  • Additional considerations for the rights of physicians in terms of conscientious objection.
English
29 Brian L. Mishara CRISE Director and Psychology Progessor at the University of Québec Montreal 10-07-15 Key points from the meeting with Brian Mishara include:
  • Health and social issues around autonomy, suicide prevention and the need for universal palliative care;
  • The comparison of the different types of physician-assisted dying;
  • Eligibility criteria surrounding the issues of advanced directives and ensuring voluntariness from the patient;
  • Procedural safeguards including the need for a formal request from the patient, having a witness present at the moment of death, and proportionate waiting periods; and
  • System oversight.
English
30 David J. Roy Chercheur titulaire, Faculté de médecine, Université de Montréal Montreal 10-07-15 Key points from the meeting with David J. Roy include:
  • Health and social issues around autonomy and the need for universal palliative care;
  • The comparison of the different types of physician-assisted dying;
  • Eligibility criteria surrounding the issues of capacity to consent to medical treatment, substitute decision-making and ensuring voluntariness from the patient;
  • Procedural safeguards including the need for reporting;
  • System oversight with specification for death records; and
  • Additional considerations for the involvement of other health care providers, rights in terms of conscientious objection, whether there should be training or licensing, and the implementation of an independent institution that can help health care workers with referrals.
English
31 Michelle Giroux;
Jean-Pierre Ménard
Ménard, Martin, Avocats; et Professeure titulaire a le Faculté de droit, Université d'Ottawa Montreal 10-07-15 Key points from the meeting with Jean-Pierre Ménard and Michelle Giroux include:
  • Legal discussion involving the Carter decision, Quebec's Bill-52, and the division of powers between the federal and provincial governments,
  • Health and social issues around autonomy, vulnerability and the need for universal palliative care;
  • The comparison of the different types of physician-assisted dying;
  • Eligibility criteria surrounding the issues of age, mature minors, residency, a grievous and irremediable medical condition, enduring suffering, capacity to consent to medical treatments, and advanced directives;
  • Procedural safeguards including consideration for two or more physicians, informed consent for the patient, the need for a formal request from the patient, having a witness present at the moment of death, consideration for additional consultations (with psychiatric and palliative care physicians), and proportionate waiting periods;
  • System oversight with data collected from both the patient and the physician, enforcement and specification for death records; and
  • Additional considerations for the rights of physicians in terms of conscientious objection and their duty to refer or inform.
Bilingual
32 Jocelyne St-Arnaud Professeure associée aux Programme de bioéthique, Département de médecine sociale et prévention, École de santé Publique de l'Université de Montréal (ESPUM) Montreal 10-07-15 Key points from the meeting with Jocelyne St-Arnaud include:
  • Legal discussion involving the Carter decision and relevant international law;
  • Health and social issues around autonomy, vulnerability, the need for better home care, and the need for universal palliative care;
  • The comparison of the different types of physician-assisted dying;
  • Eligibility criteria surrounding the issues of mature minors, enduring suffering, psychological suffering, capacity to consent to medical treatment, and advanced directives;
  • Procedural safeguards involving informed consent for the patient;
  • System oversight with data collected from both the patient and the physician, enforcement and specification for death records; and
  • Additional considerations for the involvement of other health care providers, rights in terms of conscientious objection, their duty to refer or inform, and whether there should be training or licensing.
Bilingual
33 Sharon Baxter;
Tamir Virani
Canadian Hospice Palliative Care Association Ottawa 10-20-15 Key points from the meeting with the Canadian Hospice Palliative Care Association include:
  • More investment in palliative/ home care needed;
  • Canadians not well-informed about the difference between palliative care and assisted dying. If they knew more about it, there would be less need for an assisted dying option;
  • Comprehensive palliative care could deal with many of the issues, e.g. depression, pain, and symptom managagment;
  • Considering those who are mentally handicapped as well; and
  • Interventions for those in crisis.
English
34 Cécile Bensimon;
Cindy Forbes;
Azin Moradhassel
Canadian Medical Association Ottawa 10-20-15 Key points from the meeting with the Canadian Medical Association include:
  • Eligibility criteria including competency, capacity, informed decision-making and voluntariness;
  • Safeguards including requirement to inform patient of all available treatment options, consideration of additional consultation needs (i.e., psychiatric, palliative, specialists, etc.), proportional wait times, multiple requests for assisted dying;
  • Conscientious objection for physicians; and
  • Comprehensive national guidelines to ensure consistency across the country.
English
35 Meagan Hatch;
Keith Wilson
Canadian Psychological Association Ottawa 10-20-15 Key points from the meeting with the Canadian Psychological Association include:
  • Issues in assessing patient eligibility, such as cognitive competence and unbearable psychological or physical pain;
  • Assessment of all other potentially treatable sources of suffering before considering assisted dying;
  • Need for patient requests to be voluntary;
  • Requiring two requests over a specified time period to assess patient's conviction; and
  • Mental and physical disorders equal reasons for desiring assisted dying option.
English
36 Anne Sutherland Boal;
Josette Roussel
Canadian Nurses Association Ottawa 10-21-15 Key points from the meeting with the Canadian Nurses Association include:
  • Need for nurses on this issue because they are key on health team and their direct relationships with patients give them perspective on policy supports needed;
  • Proper skills training and unencumbered access to information on regulations and resources for developing expertise in pain and symptom management;
  • Psychological support for providers;
  • Need for interdisciplinary team integral to care: social workers, nurses, pharmacists, psychologist, social workers, along with physicians;
  • Rigorous well-understood process and infrastructure that can be evaluated and analyzed;
  • Pan-Canadian approach; and
  • Need to know how and where to get additional support.
English
37 Thomas Foreman;
Michael Kekewich;
Josh Landry
Ottawa Hospital Ottawa 10-21-15 Key points from the meeting with Thomas Foreman, Michael Kekewich and Josh Landry include:
  • Use of terms of positive and negative rights to connect to practices where informed consent (a negative right) is used;
  • A lot of weight on individual autonomy in PAD;
  • How to address referrals and levels of moral culpability;
  • How to assess barriers to access for patients; e.g., elderly patients given website and no other information; they won't use that information;
  • Challenges in figuring out right to PAD in hospices and palliative care;
  • Definition of grievous and irremediable harm needs to be clear and objective, not just subjective;
  • Question of advance directives a challenge for ethicists; is the directive always valid when it is needed in PAD?;
  • Easily accessed palliative care; if not available, patient's self-determination for PAD impeded because they haven't been given the option;
  • Patients need to have and know they have the option of PAD whether they use it or not; and
  • Considering existential suffering as well as physical and emotional suffering in the context of a disease.
English
38 Katrina Hedberg Oregon Public Health Division Ottawa 10-21-15 Key points from the meeting with Katrina Hedberg include:
  • Reporting system in place; what to put in the death certificate; it's up to physicians what to write, and that is usually the underlying cause of death;
  • Standard of good faith used, i.e., did physician comply with law; physicians have never been sanctioned in Oregon in PAD situations;
  • Mandatory reporting for pharmacists;
  • No funds for analyzing information as a result of Death with Dignity Act;
  • Making sure people have access to hospice care and palliative care;
  • Collecting data on people who are participating in PAD to cover all end of life issues;
  • Provide more in-depth information for patients: what kind of support they need from time of diagnosis; and
  • Having more options for patients.
English
39 Andre Schutten;
John Sikkema
Association for Reformed Political Action Canada Ottawa 10-22-15 Key points from the meeting with the Association for Reformed Political Action Canada include:
  • Panel should consider putting forward notwithstanding clause to buy time;
  • Importance for Parliament of stating objective of prohibition on assisted suicide;
  • Restrictions to be applied in new law: keeping PAD within Criminal Code; not defining it as medical care; 3 year judicial review; panel of experts;
  • All terms need to be carefully and precisely defined;
  • Risks need to be minimized by carefully designed system imposing stringent limits scrupulously monitored and enforced;
  • Need for psychiatrists, not GPs, to assess patient competence to consent; and
  • Limit assisted suicide to defined terminal illness.
English
40 Elaine Borg;
Chantal Léonard;
Mei St-Cyr
Canadian Nurses Protective Society Ottawa 10-22-15 Key points from the meeting with the Canadian Nurses Protective Society include:
  • Multifaceted role of nurses in physician-assisted death, not only physicians;
  • The reality of teams: need for patient care team collaboration and coordination;
  • Having nurse practitioners play larger role as MRP (most responsible professional) and be first point of contact for patients;
  • Change in terms with developing role of NP as practitioner-assisted death;
  • Conditions of potential risk for nurses of criminal prosecution; and
  • Need for protection under the Criminal Code for all situations that could arise in interactions with patients.
English
41 Isabelle Marcoux University of Ottawa Ottawa 10-22-15 Key points from the meeting with Isabelle Marcoux include:
  • Health and social issues around autonomy and the inequality of access to health care;
  • The comparison of the different types of physician-assisted dying;
  • Eligibility criteria surrounding the issues of age, a grievous and irremediable medical condition, enduring suffering, psychological suffering, capacity to consent to medical treatments, advanced directives, and ensuring voluntariness from the patient;
  • Procedural safeguards including consideration for additional psychiatric consultations, informed consent for the patient, the need for a formal request from the patient, having a witness present at the moment of death, the role of the family, proportionate waiting periods, the implementation of a decision-making multidisciplinary team, and the need for reporting;
  • System oversight with anonymized data collected from both the patient and physician, and specification for death records; and
  • Additional considerations for the involvement of other health care providers, rights in terms of conscientious objection, and whether there should be training or licensing.
Bilingual
42 Marcel Boisvert;
Hélène Bolduc;
Nacia Faure;
Georges L'Espérance
Association Québécoise pour le droit de mourir dans la dignité Montreal 10-23-15 Key points from the meeting with the Association Québécoise pour le droit de mourir dans la dignité:
  • No conflict between palliative care/sedation and physician-assisted dying;
  • Request must come from patients themselves, never physicians;
  • No such thing as zero risk but major safeguard is that the Criminal Code should apply to any person who is not a physician;
  • A physician's primary duty is no longer to save lives at all costs but to respect the patient's freedom of choice; and
  • Patient's rights don't cease to exist just because they lose their cognitive faculties; advance medical directives important to use.
Bilingual
43 Catherine Ferrier;
Caroline Girouard;
Aubert Martin;
Michel Racicot;
Patrick Vinay
Physicians' Alliance Against Euthanasia / Collectif des médecins contre l'euthanasie & Living with Dignity Montreal 10-23-15 Key points from the meeting with the Collectif des médecins contre l'euthanasie & Vivre dans la dignité include:
  • Best for patients if physician-assisted death remains a criminal offence;
  • Eligibility criteria need to be defined very clearly and strictly;
  • Have doctors opt-in instead of opt-out so only those who freely choose to participate are involved in physician-assisted death;
  • Palliative care consultations should be available to all patients;
  • Only specialist physicians who have specific training and a special licence should be able to perform physician assisted death;
  • We should be finding ways to care for weakest members of our society, not see them as a burden; and
  • Use notwithstanding clause to give more time to think about issue.
Bilingual
44 Félix Couture;
Koray Demir;
Michael Lang;
Zachary Shefman;
Mark Woo
MedPASS Montreal 10-23-15 Key points from the meeting with MedPASS include:
  • Definition of what constitutes suffering in Carter is ambiguous, narrowly defined, vague, and could cause chill for doctors;
  • Ethical parameters post-Carter: ethic debate necessary; physicians have important role to play; autonomy is central ethical value; should be patient-centred;
  • No generally accepted definition of suffering in PAD context;
  • Important need for counselling of patient;
  • Pressures on patient that violate informed consent principle;
  • Physicians must play integral role in designing decision-making process;
  • Looked at international comparisons re issue of suffering and to find loopholes and shortcomings in legislation so Canada doesn't make same mistakes;
  • Secure accessible, complete, and universal palliative care; and
  • How to properly judge autonomy and right to consent.
English
45 Susan House;
Will Johnston
Euthanasia Prevention Coalition - British Columbia Vancouver 10-26-15 Key points from the meeting with the Euthanasia Prevention Coalition - BC include:
  • Transparent access and screening—no coerced cooperation of any health care worker or student, nothing done in secret;
  • Necessity of defining right to conscience clearly;
  • Looking for the law to provide a qualified exception to a criminal prohibition, not a right of general access to a newly created service;
  • The law should respect maintaining an extensive safe space in the health care system;
  • Taking a human life goes against the dignity of the human person; and
  • Legislation should focus on a reasonable person's apprehension of what constitutes an extreme medical situation.
English
46 Marilyn Golden Disability Rights Education and Defence Fund Vancouver 10-26-15 Key points from the meeting with Marilyn Golden include:
  • Safeguards in US weak and there is huge issue of elder abuse;
  • "Doctor shopping" a problem in the US, to get around safeguards;
  • Advances in palliative care can relieve symptoms in most patients;
  • Pitfalls of Oregon law on assisted suicide;
  • How to include safeguards that work: taking financial and emotional pressures into account; don't use good faith standard—can't be disproven;
  • A system needs to be set up to investigate abuse—e.g., hotline;
  • Psychiatric assessment of patients important to assess competence;
  • Consensus among US disability community against physician-assisted death; and
  • Oregon system shows no problems or abuse because it's set up not to find it.
English
47 Sherry Chan;
Luke Chen;
Margaret Cottle;
Ed Dubland;
Constant Leung;
Jennifer Tong
Network of BC Physicians Vancouver 10-26-15 Key points from the meeting with the Network of BC Physicians include:
  • Physician-hastened death poses great risk to vulnerable patients and to society at large; risks should be minimized;
  • Advocate carefully designed system that imposes strict limits, that is scrupulously monitored and enforced;
  • Important that there be legislation that protects physicians' freedom of conscience and professional judgment as a core element of a meaningful system of safeguards;
  • Patients may not access excellent palliative care resources because they'll connect it with physician-assisted death;
  • Keep PAD separate from regular health services; and
  • Access to a central agency for information, counselling, and referral.
English
48 Sean Murphy Protection of Conscience Project Vancouver 10-26-15 Key points from the meeting with the Protection of Conscience Project include:
  • Preserving freedom of conscience of health workers is essential;
  • Dealing with "obligation to kill" if euthanasia or assisted suicide don't work as expected;
  • Eligibility: need to include unspecified conditions beyond illness, disease and disability such as frailty;
  • Coerced referral presents unacceptable risks to people's fundamental freedoms;
  • Safeguards: a single standard, purely voluntary across the country;
  • The problem of referral if physician has conscientious objection—a violation of human dignity to propose a moral duty to do what one believes to be wrong; and
  • No one should be punished for refusing to participate in PAD.
English
49 Eike-Henner Kluge University of Victoria, Department of Philosophy Vancouver 10-27-15 Key points from the meeting with Eike-Henner Kluge include:
  • Focus on patients who have never been competent: include them in legislation;
  • Medically appropriate health care for patients in PAD necessary;
  • Position of substitute decision-makers needs to be clarified;
  • Need for checks and balances: concern that people who lack capacity not be discriminated against in any way or that anyone fall through the cracks;
  • Physicians not required to engage in PAD if it conflicts with their values;
  • Ethical implications of advance directives;
  • Judgment of suffering has to be guided by values of society via judges; and
  • System needs to be accountable with judicial oversight.
English
50 John Soles Society of Rural Physicians of Canada Vancouver 10-27-15 Key points from the meeting with the Society of Rural Physicians of Canada include:
  • Need for referral mechanism if physician objects to PAD; who to get? how far away to go?;
  • Safeguards include screening patients for depression etc. so clear they are making a rational decision, time to consider their decision, more than one person deciding;
  • Emotional consequences of what to do if physician objects but patient wants their help in PAD situation;
  • Demand for PAD less in rural areas because population older, poorer, less educated, less employed;
  • Professional responsibility to provide info and care regardless of beliefs; and
  • Physicians need proper education and training to deal with PAD.
English
51 Lee Carter;
Hollis Johnson;
Grace Pastine;
Josh Paterson;
Elayne Shapray;
Howard Shapray
BC Civil Liberties Association Vancouver 10-28-15 Key points from the meeting with the BC Civil Liberties Association include:
  • Canadians suffering unbearably at the end of life should have the right to choose a dignified and peaceful death;
  • Kay Carter story--about less tangible things than pain management;
  • Courts have done government's work for them—leave to provincial health legislative bodies;
  • Vulnerable people not at greater risk of PAD;
  • "Slippery slope" is illusory—no evidence to support it;
  • Decision should be between physician and patient;
  • No physician under any obligation to perform this service (since 1972); and
  • Publicly funded health care system should not be allowed to contract out any services to religious organizations that oppose PAD.
English
52 Carrie Bourassa First Nations University Vancouver 10-28-15 Key points from the meeting with Carrie Bourassa include:
  • No consensus in indigenous communities on PAD; just as divisive on this issue as it is anywhere else in Canada;
  • Very rare to discuss end of life in indigenous families;
  • PAD not on radar because of other overwhelming issues in communities;
  • Important to communicate the idea of PAD well because people want to die in a good way with as much dignity as possible;
  • Difficulty accessing Canadian health care because of racism so they won't access it unless they have to; and
  • Challenging to figure out how to access the kind of care they want because indigenous health care is fragmented and confusing.
English
53 Daniel Lussier;
Gordon Self;
Michael Shea
Catholic Health Alliance of Canada Winnipeg 10-29-15 Key points from the meeting with the Catholic Health Alliance of Canada include:
  • Deliberate taking of life goes against the dignity of the human person and not aligned with principles of Catholic health care;
  • Palliative care does not include physician assisted death;
  • Restrictions needed to minimize harm of PAD; license MDs who provide service;
  • Vulnerable people, health care providers, organizations must never feel coerced or threatened into making/participating in this decision;
  • Won't stop patient from accessing PAD, so set up separate system for self-referral;
  • Give patient more time to reflect on decision and provide support during that time; and
  • Important to restrict meaning of "grievous and irremediable".
English
54 Jim Derksen;
James Hicks;
Rhonda Wiebe
Council of Canadians with Disabilities Winnipeg 10-29-15 Key points from the meeting with the Council of Canadians with Disabilities include:
  • Preserve autonomy and dignity of persons with disabilities in all circumstances;
  • Legalization should only be about PAD, not euthanasia;
  • Set up independent review panel to determine if patient meets criteria for PAD;
  • Only make PADs available after palliative care plan presented to patient;
  • Interested party who thinks coercion a possibility must be allowed to intervene;
  • Put mandatory system in place to track requests across country; and
  • There are people with disabilities who value their autonomy and right to make these decisions.
English
55 Melanie MacKinnon University of Manitoba Winnipeg 10-29-15 Key points from the meeting with Melanie McKinnon include:
  • Giving indigenous communities more power and autonomy in health care;
  • Trying to convince policy-makers to invest in palliative care to bring back dying with dignity to indigenous communities;
  • Challenge of expressing free choice challenging because so recently allowed to practise traditional customs and beliefs;
  • Paradigm shift needed: govts spend too much money spent on band-aid solutions for indigenous communities; community health leaders want focus on behavioural and spiritual health to reconnect and heal; they need to be given authority to decide what health care they need;
  • Language—labels and definitions—key to embracing indigenous community; physician-assisted death, not suicide, since suicide has inflicted deep wounds;
  • Few auxiliary policy supports from federal and provincial govts; many services not insured; drugs and palliative care not covered because not core services; this needs to change; and
  • Nurses don't provide evening or home support if indigenous patient has terminal illness; rules don't allow patients options; often far away from home in hospital; have to fundraise to allow family member to travel to and from hospital.
English
56 Yude Henteleff University of Winnipeg Winnipeg 10-29-15 Key points from the meeting with Yude Henteleff include:
  • The need for ensuring meaningful access to integrated palliative care for patients with life-limiting illnesses;
  • Conceptual separation of end of life care from health care;
  • Having a uniform system across the country;
  • The need to have reasonable accommodation, otherwise we are diminished as a society;
  • Safeguards have to be reasonable, which depends on the circumstances of each case; doctors have to decide extent of patient suffering;
  • If palliative care not available, how can patient be fully informed and thus have the right to make their choice; and
  • Need to meet person's equality rights may require considering other issues, such as comparing to like groups.
English
57 Michael Bach Canadian Association of Community Living Toronto 11-02-15 Key points from the meeting with the Canadian Association of Community Living include:
  • Proposed framework for vulnerability assessment: how to identify and safeguard vulnerable people in times of weakness with access to PAD, from abuse and error;
  • Framework works in stages: patient makes request; assessed by trained physician, social worker, psychologist; stage 2: alternatives, unmet needs etc;
  • Current context of vulnerability: more and more people, 3.6 million now, with neurological conditions that are disability related;
  • Legislated safeguards would balance the perspective of those at risk against those who seek assistance in dying; and
  • Need process for nuanced considerations, like feeling one is a burden.
English
58 James Downar;
Shanaz Gokool;
Wanda Morris
Dying With Dignity Canada Toronto 11-02-15 Key points from the meeting with Dying With Dignity Canada include:
  • Canadians who are eligible must be able to access assisted dying wherever they live;
  • Robust system needed for physicians who are conscientious objectors;
  • Effective referrals must give patient access to treatment;
  • System must protect the weakest and most vulnerable;
  • Be careful about how language of palliative care is used—not synonymous with end of life care;
  • Safeguards: higher standard of scrutiny for those not terminally ill;
  • How to set up a hotline for patients who need access to information; and
  • Find out how many Canadians have access to palliative care.
English
59 Philip Emberley;
Joelle Walker
Canadian Pharmacists Association Toronto 11-03-15 Key points from the meeting with the Canadian Pharmacists Association include:
  • Eligibility criteria: pharmacists should have access to patient diagnosis and care plan before filling prescription; need to be protected and know extent of their liability if patient doesn't meet criteria;
  • One safeguard to address risks and procedures is by using triplicate forms;
  • Obligation to refer if pharmacist has moral or religious objection;
  • Most pharmacists disagree that they are obligated to participate;
  • See part of role as counselling patient to take medication correctly;
  • Only some medications tracked; no system for all medications; and
  • Interprovincial tracking system for drugs being started by Health Canada.
English
60 Monica Branigan;
Susan MacDonald
Canadian Society of Palliative Care Physicians Toronto 11-03-15 Key points from the meeting with the Canadian Society of Palliative Care Physicians include:
  • Palliative care is a priority and should be offered to all patients regardless of whether they wish PAD or not;
  • Important to reduce risk of premature death, by talking with patient and changing their mind; PCPs have these skills;
  • Most members don't think PAD should be provided by PCPs;
  • Conscience rights of all physicians need to be protected;
  • Distinguish language between practices that hasten death and practices that seek neither to hasten death nor prolong dying; and
  • Suggest separate panel process so patients can be referred; models exist for this, e.g. Trillium transplant agency.
English
61 Francine Lemire College of Family Physicians of Canada Toronto 11-03-15 Key points from the meeting with the College of Family Physicians of Canada include:
  • Family physicians responsible for ensuring patients have all the information they need to make informed decisions: potential risks;
  • Oppose actions that would abandon patient without options or direction;
  • Need to find a way not to abandon patients if physician objects to PAD;
  • Need to have a second physician to consult;
  • Possible skills training and assessment for PAD anticipated trying to figure out what additional skills needed to provide PAD: global, comprehensive, compassionate approach as well.
English
62 David Baker;
Rebecca Lauks
Disability Rights Lawyers Toronto 11-03-15 Key points from the meeting with David Baker and Rebecca Lauks include:
  • Provide review board process before PAD decision; will stand up to legal and constitutional scrutiny and provide provincial and federal responsibilities;
  • This provides safeguards against abuse while maximizing rights of person by ensuring supports available;
  • Assistance must then come from physician;
  • Definition of suffering needs to be both subjective and objective to work;
  • Second physician needs to be involved with specialty that address source of patient's suffering as basis for PAD;
  • Appropriate safeguards needed to address vulnerability;
  • PAD should not be seen as medically necessary treatment or therapeutic; and
  • Concern about increasing PAD deaths in Europe because criteria not clear.
English
63 Alex Schadenberg;
Hugh Scher
Euthanasia Prevention Coalition Toronto 11-03-15 Key points from the meeting with the Euthanasia Prevention Coalition include:
  • Assisted death should not be permitted;
  • See how law has worked in other jurisdictions to learn from their mistakes, e.g., ensuring physicians get second opinion, that patient makes request, no self-reporting;
  • Effective third-party judicial oversight needed to make sure requirements set out in law are met;
  • Assisted death should not be carried out by doctors, but by someone licensed and certified;
  • There needs to be a safe space so people know PAD won't happen there;
  • Need to have universal access to palliative care; and
  • Proper system of interviewing person to see why they're seeking PAD.
English
64 Alika Lafontaine Indigenous Physicians Association of Canada Toronto 11-03-15 Key points from the meeting with the Indigenous Physicians Association of Canada include:
  • Implications of law for indigenous people differ from general population: they have less access to facilities and expertise and distrust govts;
  • Law must apply across all jurisdictions: reserves are in different jurisdiction that falls into grey area; neither province or federal govt takes full responsibility for reserve health care;
  • Belief that it would be too hard to convince the local physician to get expertise in this or to convince the health authority that they needed access to PAD; and
  • Collective autonomy: need to have the family be part of the PAD process if it happens.
English
65 Thomas Bouchard;
Renata Leong
Canadian Federation of Catholic Physicians' Societies Toronto 11-04-15 Key points from the meeting with the Canadian Federation of Catholic Physicians' Societies include:
  • Language should be clear: use euthanasia and physician-assisted suicide so everyone is clear about what they are talking about;
  • Team evaluation: how to make sure patients' decisions are autonomous;
  • Safe spaces needed that are separate from hospitals;
  • Practical challenges in assessing capacity and voluntariness;
  • Would not withhold information but would not facilitate access;
  • Need to uphold conscience protection for doctors;
  • More home care availability important for caregivers;
  • Safeguards: life insurance policies shouldn't be affected;
  • National standard and oversight that is transparent and accountable; and
  • Physicians may move to other jurisdictions to avoid dealing with this.
English
66 Richard Elliott Canadian HIV/AIDS Legal Network Toronto 11-04-15 Key points from the meeting with the Canadian HIV/AIDS Legal Network include:
  • Question of patient autonomy important: free voluntary fully informed consent;
  • Law shouldn't reflect any religious teachings;
  • Eligibility: add mature minors if other conditions from Carter satisfied; legislation should set out national standards about eligibility;
  • Risks and safeguards: two separate health care professionals, one of whom experienced in assessing competence; short time period to reflect on request so patient doesn't suffer unnecessarily;
  • Safeguards to make sure patients aren't being pressured;
  • Patients need to have access to good palliative care and universal pharmacare; and
  • Second review to make sure all protocols followed.
English
67 Vyda Ng Canadian Unitarian Council Toronto 11-04-15 Key points from the meeting with the Cadian Unitarian Council include:
  • Don't delay implementation of legislation;
  • There should be easy access for patients who request PAD;
  • Make sure legislation ensures equal access across country;
  • Safeguards to protect vulnerable people have to be thorough and balanced; two physicians to make assessment in those cases;
  • Final decision up to patient if patient competent to decide; and
  • Canadians have the right to choose time and manner of their death.
English
68 Derek Ross;
John Sikkema
Christian Legal Fellowship Toronto 11-04-15 Key points from the meeting with the Christian Legal Fellowship include:
  • More time needed for wider consultation and study after Carter decision;
  • Optimal solution: a complete ban;
  • Safeguards must be scrupulously monitored but do not eliminate all risk;
  • Main risk is that patients may have life taken without their explicit consent;
  • Maintain a culture that discourages suicide as a way to end suffering;
  • Should not be easy to access: good palliative care should have been offered so patient has meaningful choice and choice is voluntary;
  • Don't allow psychiatric illness as reason to access PAD; and
  • Segregate PAD from health care services in separate place.
English
69 Marc Doucet Canadian Association for Spiritual Care Toronto 11-05-15 Key points from the meeting with the Canadian Association for Spiritual Care include:
  • Establish robust and clear processes and guidelines with strict limits that are scrupulously monitored and enforced;
  • Make sure adequate timing, sequencing, and assessment for vulnerable populations who are legally competent but whose capacity wavers;
  • Ensure independent review process to report and monitor decisions;
  • Encourage development of palliative and hospice care across country so PAD not default; and
  • Independent review of two or three people when patient makes decision.
English
70 Cara Faith Zwibel Canadian Civil Liberties Association Toronto 11-05-15 Key points from the meeting with the Canadian Civil Liberties Association include:
  • There should be a body that monitors best practices and informs public about how system is working;
  • Equality of access across country;
  • Need for safeguards of allowing more time, but not too much to act as deterrent to access;
  • Need to reconcile patient and physician rights, but physician should have to provide effective referral if no third party available; and
  • If patient in remote community, their right trumps physician's right to object.
English
71 Glenn Brimacombe;
Sonu Gaind
Canadian Psychiatric Association Toronto 11-05-15 Key points from the meeting with the Canadian Psychiatric Association include:
  • Focus on eligibility criteria: if patient accessing PAD has mental illness and medical illness, role of psychiatrist to ensure it is not impairing patient's capacity to make an informed decision;
  • Separate biomedical from psychosocial impacts; psychosocial rarely irremediable;
  • Risk in determining capacity: if patient undermined by mental illness, may be deemed not capable of making PAD decision; also risk if no clinical certainty in assessing capacity; and
  • Safeguards: spread evaluation into physical and mental components; six weeks between assessments, and multiple assessments from different experts.
English
72 Christian Domenic Elia;
Philip Horgan
Catholic Civil Rights League Toronto 11-05-15 Key points from the meeting with the Catholic Civil Rights League include:
  • Need better and more available palliative care;
  • Understanding conscience rights for all health care workers;
  • Best way of respecting the dignity of the human person is to affirm life;
  • Notwithstanding clause should be given serious consideration;
  • Safeguards illusory in other jurisdictions because of mistakes, inattention, so don't believe they will be effective;
  • No matter what happens it will lead to an innocent death; and
  • Jeopardy for health care providers who refuse to assist in patient suicide.
English
73 Julia Beazley;
Bruce Clemenger
Evangelical Fellowship of Canada Toronto 11-05-15 Key points from the meeting with the Evangelical Fellowship of Canada include:
  • Risks of PAD can be identified and minimized with carefully designed systems that impose strict limits and are scrupulously monitored and enforced through system of safeguards;
  • Concerned with threshold of risk set lower in Carter compared to opposition to capital punishment;
  • Prohibition on intentional killing is necessary and should remain;
  • No safeguards can eliminate risk of abuse;
  • Practice of assisted suicide should be federally licensed to minimize risk;
  • Physicians must have right to refuse to participate in PAD if they conscientiously object; and
  • Advocate for national strategy for high quality palliative care.
English
74 Donato Gugliotta;
Diane Haak;
Larry Worthen
Christian Medical and Dental Society of Canada Toronto 11-06-15 Key points from the meeting with the Christian Medical Dental Society of Canada include:
  • Concern that vulnerable patients will fall through the cracks and lose their autonomy; the criteria for who is vulnerable should be very broad;
  • Physicians must follow all protocols when they are established; revoke licenses or criminal charges if they don't;
  • Worry about people's Charter rights to life violated;
  • Legislation should clearly articulate the state's interest in protecting the life of every person regardless of circumstances; and
  • Patients need safe spaces where not at risk of wrongful death.
English
75 Lynne M. Arnason;
Rocco Gerace;
Douglas A. (Gus) Grant;
Linda Inkpen;
Graeme Keirstead;
Fleur-Ange Lefebvre;
Louise Marcus;
Cyril Moyse;
Michael Noseworthy;
Yves Robert;
Dr. Schollenberg;
Bryan Salte;
Sarah Thomas
Federation of Medical Regulatory Authorities of Canada Toronto 11-06-15 Key points from the meeting with the Federation of Medical Regulatory Authorities of Canada include:
  • Essential to have a national strategy and equal access;
  • Focus should be patients' rights, not physicians' rights;
  • Meaningful referral resource for patients to access;
  • Good faith protection for physicians;
  • How to handle conscientious objection without violating code of ethics;
  • The problem of effective referral needs to be addressed;
  • Discussed the issue of training physicians for PAD but not accrediting them;
  • The problem of determining and defining capacity and incapacity;
  • Amendments to Criminal Code should address other health care professionals; and
  • Need for an oversight body that would monitor and review retrospectively.
English
76 Kevin Imrie Royal College of Physicians and Surgeons of Canada Toronto 11-06-15 Key points from the meeting with the Royal College of Physicians and Surgeions of Canada include:
  • National standard needed to clarify physicians' roles and duties;
  • Need to have partnership among national medical organizations;
  • Need to identify core competencies of physicians in PAD: need to be communicators, collaborators, advocates for patients;
  • Commit to developing PAD educational materials for residents and physicians;
  • Consider PAD in context of more comprehensive strategy for palliative care; and
  • Have developed framework for PAD that encompasses all specialties.
English
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