This consultation closed on Jan. 11, 2023.
About the standard
CPSA issued the Medical Assistance in Dying (MAID) standard of practice in 2016 when MAID was first legalized in Canada for individuals with terminal illnesses. In 2021, Bill C-7 came into effect, which expanded the eligibility of MAID to include individuals with non-terminal physical conditions. On March 17, 2023, individuals whose sole underlying medical condition is mental illness will become eligible for MAID under Bill C-7. To comply with this upcoming change, CPSA updated our Medical Assistance in Dying (MAID) standard of practice.
What’s changed?
- Additional information added to ensure the patient’s capacity and consent for MAID;
- Requirement added to ensure awareness of the safeguards outlined in the Criminal Code of Canada when determining a patient’s eligibility; and
- Included the use of AHS reporting form to fulfill federal reporting requirements.
View the draft standard
For your convenience, the draft standard has clean and marked copies available.
All ResourcesYour opinion matters
Changes to CPSA’s Standards of Practice impact your day-to-day practice. Your feedback is important to us as it helps us develop clear, reasonable expectations and helpful, applicable resources. We appreciate the time you took and the input you provided.
CPSA members, partner organizations, other healthcare professionals and Albertans were invited to provide feedback on this consultation from Dec. 12, 2022 to Jan. 11, 2023.
Anonymized feedback will be considered by Council at their February meeting. Once amendments are finalized and approved by Council, members will be notified by email and The Messenger newsletter.
We respect your privacy
All feedback is subject to CPSA’s Privacy Statement. CPSA reviews all comments before publication to ensure there is no offensive language, personal attacks or unsubstantiated allegations.
Other feedback on this standard
I am focussing on Mental Health issues alone. I may have also missed information that could have answered this question as there was a lot of information to review. Is there some type of Form/Document available in this process where it can be demonstrated that the patient has undergone sufficient different types of therapies associated with their Mental Health disorder. Should they be encouraged to try other potential pioneering treatments eg Ketamine, micro dosing of psilocybin for "treatment resistant depression"? It reads as if, once the request is made, the physician has to comply with the instructions outlined. Does trying to suggest other therapies make the physician appear as if he/she is contravening this legal process?
The requirement for members who object to MAID, either by way of conscience or religious beliefs, but still having to provide full information and also to refer the patient to resources who will provide MAID, is coercive and heavy-handed, and is unacceptable to many members of the profession, and also to citizens of Alberta. This province has had a strong Christian history which has positively influenced our society's laws, politics, industry, and daily life in so many intangible ways. Leaders, lawmakers, and academics who look down on or scorn such beliefs, run roughshod over a moral foundation that underlies our free and just society, and the medical profession's ancient Code dating back to the Hippocratic Oath, and the Church's influence throughout the ages. The CPSA must respect the beliefs of Albertans, and not force its members to collaborate in the provision of MAID in any way.
Furthermore, provision of MAID to persons with mental health disorders is fraught with dangers to all members of our society, especially those struggling with these ubiquitous disorders, who rather need our support, care, love, and compassion, rather than offers of assistance in suicide! So many, both diagnosed with mental disorders or not, feel isolated, lonely, and a loss of connectedness with family, friends, and the medical profession, in this Pandemic. We need to reach out to our fellow citizens who are struggling with mental disorders, not with offers for MAID, but with a combined medical, social, employment, and economic hand of support and compassion, like the Good Samaritan. Despair can change to Hope.
The Liberal Government has indicated they will delay implementation of the mental health clause scheduled for March 2023. Therefore, this revised standard should be put on hold until the result of the legislation delay (and possible revision) is known. Otherwise we are putting the cart before the horse.
How are we to distinguish who gets suicide prevention and who gets suicide assistance? Allowing physician assisted suicide, particularly for mental health conditions alone, is a dangerous path. Saying “I can’t live like this” is a cry of lament and distress, but now it could be taken as a request for suicide. Just because the government pushes a philosophy to deal with suffering does not mean physicians should promote it if it is wrong. You can’t mask moral failure with legal cover.
At the very least, Item 2.a should read “abide by the safeguards…” rather than just “consider”. Safeguards are put in place to prevent abuse, yet if one is to only “consider” the safeguards, there is no way to hold members to account for inappropriate administration. “Abide” is stronger language that can actually be upheld.
Paragraph 3 of the Preamble is unnecessary and is already covered by the conscience objection standard. Placing it here further isolates physicians with a moral construct who consider killing a patient on purpose to be contrary to the traditional physician role of healing and comfort and true care, and contrary to the oath they took. A physician’s role is to journey with patients to their natural end, not to speed it up and end suffering by ending the sufferer.
This standard should fully protect physicians who want no part in killing since being involved in physician assisted suicide can compromise their integrity. Patients do not want their physician to be without integrity. We need to protect that.