Carl E Ulrich

I believe there is a need for a clear and unambiguous statement on the responsibilities of clinicians with respect to patients end of life desires and their reproductive health needs. Neither the present statement nor the proposed statement provide clear and unambiguous guidance on the right to conscious for clinicians. The Canadian Association of MAiD Assessors and Providers (CAMAP) have prepared Nine Key Messages that outlines how to respect a clinician’s right to conscious. Court cases have established that clinicians cannot abandon patients who request help in accessing MAiD. It is established that there is a duty to refer when a clinician has a conscientious objection. Patients cannot be abandoned. Below are the Nine Key Messages of CAMAP that provide a clear statement on the responsibilities of clinicians. 1. High-quality palliative care should be available to all patients who desire it at the end of life. CAMAP strongly supports the development, extension and proper funding of excellent palliative care services in all communities across Canada. This includes ensuring support for all clinicians who provide these services for their patients. 2. All clinicians participating in MAiD work should be knowledgeable about palliative care options and other potential supports available to the patient. All clinicians who provide end of life care, including palliative care clinicians, should be knowledgeable about MAiD and the resources available in their locality for patients seeking information about and/or referral for MAID. 3. Respect for patient autonomy should be the foundation of all end of life care; there should be a clear understanding of and respect for the patient’s goals of care. Should a patient choose to pursue MAiD they should be supported in their decision. All medical care, including palliative care if involved, should be continued. 4. MAiD should be included as an option in all end of life goals of care conversations with potentially eligible patients. 5. For patients wishing to pursue MAiD, CAMAP strongly supports full access to all MAiD services regardless of geography, facility or institution. 6. All health care providers who wish to participate in MAiD should have access to training and be respected, permitted and supported in the work of assisted dying. 7. All health care providers who do not wish to participate in MAiD should be respected and supported in their decision. 8. Conscience-based objection should not impair patient care. If a clinician objects to MAiD on the basis of conscience and is unwilling to carry out a MAiD assessment, CAMAP strongly supports the professional requirement of an effective referral to a clinician known to provide MAiD or to a local or provincial MAiD coordination service. 9. Recognizing the primacy of patient-centred care and outcomes, CAMAP acknowledges and appreciates the value of inter-professional teams and especially encourages the integration of palliative care and MAiD

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