THE INTERVIEW: CMA ethics director Dr Jeff Blackmer discusses euthanasia legalization

Yesterday, we reported on Bill C-562, which proposes to legalize physician-assisted suicide in Canada. The Canadian Medical Association's current ethics guidelines forbid doctors from taking part in any form of euthanasia, but Dr Jeff Blackmer, the executive director of the Canadian Medical Association's Office of Ethics, is nevertheless keeping tabs on Bill C-562 and how the public and physicians react to it.

The CMA's policy, he said in an interview this morning, could change in the future as legal circumstances and ethical debates progress. Here is Canadian Medicine's Q&A with Dr Blackmer:

What’s the CMA’s reaction to Bill C-562?

In terms of a reaction what we are really doing is keeping a close eye on these types of things, getting a sense from politicians on where this is headed. Private members’ bills generally don’t pass, so this is less an issue where we need to intervene directly than one where we need to gauge the feeling of the MPs and the House and whether this has support of the Canadian public.

So how would you gauge the feelings of Parliament and the public at the moment?

In polls there is a fair bit of support for the concept of a system whereby people can have more control over their time and place of death. The polls have increased a little bit -- they are stable, at least. What that means is difficult to gauge. There is no appetite, I think, for euthanasia on-demand right now, but instead for a more reasoned debate on how to deal with people at the ends of their lives who are ready to die, and should there be means to help them in a regulated, legislated way.

Has there been any change in physicians’ support for some form of legalized euthanasia?

My sense -- and it’s not based on solid numbers; just anecdotally -- is it has moved in that direction. I certainly don’t sense a huge upswell in the medical professio, but there is certainly more sympathy for that view. We have some physicians who are very vocal in their advocacy for euthanasia and physician-assisted suicide, and some are very opposed, but the majority think something somewhere in between. We have put a lot of focus on palliation and symptom care in end-of-life care, and we are doing a better job than five years ago on pain control. That focus will decrease the need for euthanasia and physician-assisted suicide, but we also realize there may be exceptional cases where we cannot have symptom control for various reasons. There is sympathy among physicians and public that there are cases where you can understand why people would request this. I have a relative in Nova Scotia who is dying of end-stage leukemia, and he is ready to go. His family says, ‘Isn’t it a shame that, if he were a pet, we could end his suffering?’ His family is saying they can now understand why there are proponents of people having more control over that dying process. At some point in the future I think we will do a little bit more research into this to find out how often this [physician-assisted suicide] does happen, but our sense is this is quite rare. We will have another look at that and engage the viewpoint of practising physicians, to ask would they be involved if it was legalized. One of the challenges is before you can do a study is you need some protection for physicians to get honest responses.

You believe there are doctors in Canada performing euthanasia?

I am not aware of any names. It would be a serious breach of ethics code and legislation. We have a sense, anecdotally, that it happens more on the basis of something where a physician prescribes a pain medication or an antidepressant and says, ‘If you took too many of these, here is what would happen.’ It is a warning, and some might it view as information that is required, or permission [to commit suicide]. That is more the concern rather than doctors going into people’s homes and administering an overdose. The last serious incident I remember was Nancy Morrison, in Halifax, who gave an overdose of KCl [potassium chloride] to a patient in the ICU. She was prosecuted and sanctioned by the College of Physicians and Surgeons as well, back in the 90s. There hasn’t been another high-profile case since that point in time.

Is the CMA’s policy on euthanasia and assisted suicide -- that physicians should not take part at all -- set in stone, or is it possible it could be amended in response to legislation like Bill C-562 or a change in public opinion?

Obviously that is a difficult question to answer. On these types of issues -- that is, a serious potential bill coming before the House or a serious development publicly -- we would reevaluate this policy closely. We reevaluate all ethics policies every year. If public feeling has shifted, we would ask if this is something we need to reconsider, to look at through another lens. This is an issue that has huge implications for Canadian physicians, so it would go through the CMA’s Council and committees, not just the ethics policy. We are not at that point yet but there have been enough rumblings over the past years that I could see that happening. But it is such a difficult issue on many levels that we wouldn’t reopen it to that extent unless there was a good cause or reason for it -- it is just so divisive for the public, doctors, nurses and patients that before you get into that debate, you want to make sure the time is right and it is necessary and helpful. We have a policy that is very clear, and we have no plans at the current point in time to change that policy. We wouldn’t change that simply based on a public opinion poll, but at this point we are watching to see what is happening, to decide when and if we want to reopen that debate. My sense is we are not there in the very near future, but things could happen that would cause us to have to go through some introspection.

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