Assisted dying in Canada: How have physicians fared so far?

Most Canadians visit their doctor to help prolong their lives, but since bill C-14, the Assisted Dying Bill, passed in June 2016, a rising number are visiting specialized physicians to do just the opposite.

But there has been talk that the process is causing detrimental effects on doctors. In a Maclean’s article published in June, Dr. Jeff Blackmer, vice-president of professionalism at the Canadian Medical Association (CMA), noted that eight out of ten medical assistance in dying (MAiD) physicians in the Netherlands experienced anxiety or other mental health issues. Blackmer more recently told Metro Ottawa that doctors have told him their MAiD experiences have been “traumatizing psychologically.”

Doctors divided

Dr. Gerald Ashe is a family practitioner in Brockville who has helped nine patients die since June. He describes the operation as a “very sacred experience,” and said he has not felt any ill effects so far.

“In general I have certainly not suffered any kind of PTSD or whatever,” Ashe said. “The sad thing is that these people got terrible diseases that they didn’t deserve, and this was their choice to take that exit.”

MAiD has long been an option in other countries, like Switzerland, which have allowed patients with terminal illnesses to end their lives peacefully since 1942. The first instance of North American assisted dying happened in Oregon in 1997; Quebec was the first Canadian province to allow the process in 2015.

“These are individuals who are suffering greatly and have no prospect of getting better, and have made this decision of sound mind and requested this procedure, and generally are very appreciative before the event occurs, and the whole thing tends to be a very positive experience,” Ashe said.

Ottawa Civic Hospital. [Photo by Karissa Gall]

Even if difficulties ever arise, he already has a solid support network of MAiD doctors across the country.

“We are developing groups of physicians nation-wide who do provide this and we’re communicating with each other, so I think there will be more of a feeling of pride and less of a concern.”

Euthanasia’s rising rates

Since June 2016, more than 744 people have opted to end their lives. Only those whose deaths are reasonably foreseeable are eligible for the operation, and a rigorous series of documents and consent must be provided with a sound mind.

Ashe said he worries about the restrictiveness of the current system.

“I think one of the things that was complicated and still is, is the amount of paperwork that’s involved.”

The foreseeable death requirement is one of the biggest barriers to accessing the system, and has led some Canadians to visit Switzerland where requirements are less strict. According to a CBC report, five people travelled to Switzerland in 2016 to end their lives.

Those eligible for MAiD in Canada have the choice of taking an oral prescription or a series of injections. According to Ashe, most people opt for the latter.

While physicians are not legally required to perform the operation, some provinces have guidelines that encourage unwilling doctors to refer their patients to other practitioners or institutions. The legislation has been generally well received by physicians thus far: a CMA survey from June indicated that 89.7 per cent of CMA members were in support of the new law. Still, only 25 per cent of them said they were willing to participate in MAiD.

Advocacy aid

Cory Ruf is the communications co-ordinator of Dying With Dignity, an advocacy group based in Toronto that focuses on spreading awareness for medical assisted dying and providing support to physicians in Canada.

“There are a number [of physicians] connected to the organization who have spoken out about feeling compelled to help patients achieve what in the mind of the patient is a dignified death,” Ruf said. “Others may not feel comfortable yet, this is something that’s very new in Canada and I think that you’re going to see more physicians come out and say that they’re involved as medical assistance in dying is recognized for what it is.”

Still, Ruf said those that do participate find it to be very valuable work.

“A lot of the doctors say that it’s a difficult thing to go through but they feel that it’s an honour to help people achieve a better end of life experience than what would’ve been available to them otherwise and that is very meaningful work,” Ruf said.

Medically assisted dying is still new in Canada but it has already proven popular enough with both patients and physicians that it could change the way Canadians choose to end their lives.

“You know, I’m getting up there myself in age,” Dr. Ashe said. “So someday I might need it … I know that someday I might want it.”