As stated by the CMA, the national dialogue on end-of-life care focused on three issues: advanced care planning, palliative care, and euthanasia and physician assisted dying. The secondary focus of the CMA national dialogue was to establish common definitions and terminology and to inform Canadians of the current legal and legislative framework on these issues.
The CMA document makes the following basic recommendations:
1. Canadians need to discuss end-of life wishes and they need to prepare appropriate and legally binding advanced care directives.
2. All Canadians should have access to palliative care services within a national palliative care strategy. Public and professional education concerning palliative care and its services is also required.
3. Canadians are divided on euthanasia and physician assisted dying. If the law is changed strict protocols and safeguards are required to protect vulnerable individuals and populations.
The terminology section on page 5 of the CMA document is helpful in clearing up confusion about euthanasia, assisted suicide, palliative care and medical aid in dying.
The CMA defines Euthanasia as:
Knowingly and intentionally performs and act, with or without consent, that is explicitly intended to end another person’s life.
The CMA definition for Physician-assisted dying is less helpful because the legal term is Physician-assisted suicide. The CMA definition is:
The process in which a physician knowingly and intentionally provides a person with the knowledge and/or means required to end his or her life, including counseling about lethal doses of drugs and prescribing such lethal doses or supplying the drugs.
The CMA's definition for Medical aid in dying acknowledges that the term encompasses both euthanasia and assisted suicide.
The CMA definition for palliative care states that:
it involves the prevention and relief of suffering and the treatment of pain and other physical, psychosocial and spiritual symptoms.
The definition of palliative care is incomplete because it omits that the intent is not to hasten death, but under the commentary by CMA ethicist, Dr Jeff Blackmer, the CMA document states:
The continuum of palliative care does not include euthanasia or physician-assisted death.
Blackmer’s statement on the continuum of palliative contradicts Québec’s euthanasia Bill 52that defines euthanasia as part of the continuum of end-of-life care that includes palliative care. The CMA definition for Palliative Sedation is helpful. The CMA states that Palliative Sedation is:
The use of sedative medications for patients who are terminally ill, with the intent of alleviating suffering and managing symptoms. The intent is not to hasten death, although this may be a foreseeable but unintended consequence of such action.
The CMA has clearly differentiated the proper use of Palliative Sedation from euthanasia and assisted suicide. Palliative Sedation is often abused creating confusion about its purpose and intent. The CMA document allows us to state that the proper use of palliative sedation is not euthanasia.
The section of the CMA document concerning Euthanasia and Physician-Assisted Death provided many comments from people who attended one of the National Dialogue sessions.
It was fitting that CMA ethicist Dr Jeff Blackmer pointed out that:
“Physicians go into the profession to relieve pain and suffering and the oath they take obliges them not to hasten death. Legalizing physician-assisted dying would blur the lines about what physicians are supposed to be doing.”
Blackmer then stated:
“Our philosophy is that of care and not killing.”
The Euthanasia Prevention Coalition (EPC) considers the CMA national dialogue on end-of-life care to have been a helpful process to all concerned.
EPC urges the CMA to look further into the actual experience with euthanasia that has occurred in Belgium especially since the Québec government passed euthanasia Bill 52, a law that is very similar to the language and design of the Belgian euthanasia law.