Euthanasia Survey Results2015

Question 1:Should the Canadian Society of Palliative Care Physicians continue to take a public position on the legalization of euthanasia and physician assisted suicide? Yes: 224Comments:

Because we are also in a position to make people aware that there are alternatives.

It depends what that position is. I think it may be better to have a more balanced position. One that emphasizes safe guards but is not 100% opposed.

A Public statement that is balanced and reflects the evidence and views of the entire membersip

but not strongly against euthanasia including the complexity involved It is imperative we have a national voice on this matter As palliative care is often in the "mix" as the discussion ensues, we

definitely need to make our position public. The public needs to know what experts in Palliative Care think about

these issues, not only legislators and lobbyists. It should be to express our strong opposition It has a wide breadth of experience. It should be involved actively in

these discussions and in helping both its membership and the people understand the questions, the issues involved, and some of the potential implications of decisions.

Opportunity to emphasize the importance of access to palliative care. I certainly think some sort of statement needs to be made, as it will be

expected of us by the media and public. Yes, contrary to popular and professional opinion, these issues fall

outside the parameters of palliative care. that they are not part of palliative care but a choice by a tiny

percentage of the public We have experience which is vital to the issue that we need to share

with the public all community organization that would feel "aligned" with the Canadian

Society of PCP (ie. the hospices, the palliative care teams, the palliative care networks etc) are looking to the CSPCP for guidance --EVERYONE has to take a position and sharing it publicly is an obligation of theCSPCP (in my opinion)

We should say we are for it It is vital that the CSPCP promote educational development and the

development of services - euthanasia goes contrary to this

This is a well-timed survey. The Society should take a public position on this topic only if that position is supported by a majority of the membership. A public position that is perceived as too stridently against PAS risks erecting barriers between us and the patients we wish to serve. My personal opinion is that the society's public position should be: 1. Euthanasia/assisted suicide are not part of palliative medicine. If Canadian society wishes to create a mechanism for legalized euthanasia & assisted suicide, its practitioners should not be physicians. If medicine chooses to take on this task, the practitioners should come from a discipline other than palliative medicine.

I do feel that some conciliatory moves are in order, and in contrast to the past exclamations of Dr. Barwich the comments I have heard from Dr.MacDonald are more reasonable. I see a spectrum of public decisions and choices going from independent suicide, assisted suicide by lay counselling, then physician assisted suicide, and full end-of-life clinical palliative care either in an institution or at home with hastening as an option. Its rather like the police force in more some situations - each cop when faced with sudden and immediate decisions becomes by public assent the diagnostician, judge, and jury, and the outcome varies from one officer to the next. We need to continue the discussion.

We have an important voice in this discussion since we understand the vulnerability of our patients and their families and how complex the issues can be around end of life care.

HOWEVER, THE SOCIETY SHOULD BE against IT!!!!!! I feel that the CSPCP as a group should take a position of "studied

neutrality" similar to the CMA. Given the importance of the issue and the strength of feeling on both sides, I don't think it is appropriate to be strongly for or against AS A SOCIETY (as opposed to individuals, who can speak as individuals). Our interests as palliative care physicians are to ensure that PC is well supported and that Canadians continue to have access to a comprehensive range of high-quality EOLC options. Whether or not PAD is legal, the CSPCP should work to ensure that nobody ever feels like they have to take PAD because there are no other options available to them.

if it is possible to represent the membership in a position against euthanasia and PAS. If the membership does not continue to hold this position as a majoirity then I believe the CSPCP should NOT take a public position on either side.

as long as we remain firmly against euthanasian and PAS as a part of palliative care delivery.

Should clarify that to give a toxic dose of a drug or medication you do not need a physician as he/she trained to give a therapeutic dose of medication.

hate the terms used

We should consider including in this statement not only what who we are and the definitions of palliative care but also that this type of care helps to relieve patient's (and their families and loved ones) physical, emotiona, social, financial, cultural and spriutual suffering related to their end of life illnesses.

I understand that the concept of assisted dying is difficult for some members so I don't insist that even if we have greater than 50% in favour, we come out with a statement supporting it. However if this is the case then I would want the current policy to be rescinded and a statement similar to that of the CMA wrt the conscience of the individual physician.

as physician I respect life and at the end of life I give to the patients the better quality of life I can with all the therapies (medicines, psychological, anesthesiological and spiritual therapies)

Although it should not be in favor and instead promote access to palliative care instead, we must admit that access is limited to a great part of Canada.

This is an ambiguous question. My opinion is the CSPCP should take a public position against the legalization of euthanasia and PAS and a more public position on the provision of funding to integrate palliative medicine across all domains of care

As a group, our voice has a better chance to be heard than as individuals.

but does not have to be a black and white answer palliative sedation is already available as an option for intorelable

suffering

No: 32Comments:

Should be left to individual provider Absolutely not,unless it supports pt right to choose I feel we should support people's right to choose how they want to die

when they are suffering from a terminal illness. Heck, that's what I want for myself!

the euthanasia question doesn't impact or impair the work we do, and should be independent of our work and roles in supporting dying patients and their families. We should engage in public awarenss / media blitz etc to reinforce this face, and promote the important work we do irrespective of the ultimate decision taken on the issue by supreme court of Canada

If the Canadian Society of Palliative Care Physicians is going to take a public position, it should be to support physician assisted death not to be against it.

I am not sure, This is an issue that will be heavily dependent on the individual conscience and a formal position may be problematic

I think we should continue to ensure barriers to accessing palliative care do not lead people towards euthanasia / physician-assisted suicide, but I think these particular issues are so polarizing and individual physicians may have differing personal views, I'd feel more comfortable if the society didn't take a public position on them.

I don't feel there is consensus within the group therefore we should not have an official position

I would prefer the society's public focus on ensuring access to quality palliative care as a pre-requisite to legalization of assisted dying.

Actually, my sentiment on this depends on what position the Society wants to take. I believe strongly in freedom of the individual in being able to take actions so long as those actions are not harmful to others.

If we truly feel that euthanasia/PAS does not fall within the scope.of practice of palliative care physicians, then I think in the end we should accept the decision of the Canadian public on whether it is acceptable. I think our role is to make sure that the Canadian public is informed about what palliative care is and does, so that they can make this decision in an informed way, and I think our national palliative care organizations are trying hard to do that

I think that good palliative care is not the answer to the question of legalization of PAS. I think this question is a matter of control over one's destiny. So in the face of a terminal illness, some, like Dr. Don Lowe, would argue that the right to die and not suffer AT ALL is the issue at hand.

We have an important voice in this discussion since we understand the vulnerability of our patients and their families and how complex the issues can be around end of life care.

palliative care has nothing to do with assisted suicide. we should be promoting highest level of quality of life, which would not include suicide.

leave it to CMA.unless comment invited I think the CSPCP should continue to contribute to the national debate

discussing the pros and cons of all options but not necessarily take one side or another svn if a majority of members support one position. There are always other members who support a different position.

I'm actually undecided about this as what I feel the society's focus should be on strategies for building a sense of national palliative care community, irrespective of these separate issues.

Question 2:If you answered yes to question 1, should the Canadian Society of Palliative Care Physicians continue to publicly oppose the legalization of euthanasia?Yes: 174Comments:

To keep this issue in people's minds

Absolutely Yes, and we should also say that if it is legalized, no physician should be obligated to perform it

In the context of patient rights, physician-assisted death (euthanasia; phys assisted suicide; etc), is supportable. However, in the face of inadequate funding for palliative care services, physician assisted death becomes a potential money saver for governments under the guise of human rights.

The antithesis of what we stand for. It may be useful to have an unsure or maybe box here to see if there is

a body of fence sitters out there the goal of medicine is to help not to kill I believe the CSPCP fundamental position is to focus on improving

palliative care service/provision and quality of life to all Canadians --not in the autonomy to choose when we die. Opposition of euthanasia vs. Advocation of Palliative Care in my opinion are obvious ying and yang...

And this is an urgent matter I would argue that we should publicly oppose the medicalization of

euthanasia. Definitely. The evidence from jurisdictions where these practices have

become legal is quite clear: patients are being killed without consent and without a terminal diagnosis in its final stages. Despite the lack of proper investigative journalism on the part of the media, there are flagrant abuses and the practices are not limited to patients at the end of life.

It is a societal issue and if such legislation is passes in a sovereign state it will be a facilitated death and caregivers should not be part of it but the sovereign state may train people to achieve such an end to the client by non-caregivers.

Along with promoting our philosophy of care. in palliative care we must respect life The CSPCP's need to impress on the public Canadians are pro

euthanasia and PAS because of the poor experiences of friends and families have had in not being aware or not having access to palliative care because of its unavailability

Definitely. The evidence from jurisdictions where these practices have become legal is quite clear: patients are being killed without consent and without a terminal diagnosis in its final stages. Despite the lack of proper investigative journalism on the part of the media, there are flagrant abuses and the practices are not limited to patients at the end of life.

No: 64Comments:

We should lobby for safeguards.

Don't oppose legalization (this is not the hill we want to die on), but oppose it being a physician-centric intervention.

At the same time, don't take it on. I believe that there is a place for this, but must have very specific

pathways in place. I think legislation is inevitable and will meet the needs of a tiny nomber

of people who would otherwise find ways to end their lives As a member of the society, I am not opposed to legalisation of

physician assisted suicide (similar to Oregon), therefore I think the society needs to promote discussion and represent the majority of its members opinion, but also be clear that some of its members may support specific legislation

Given the overwhelming number of people who support being given the choice, we may want to change our stance to ensuring choice can be made but palliative care should always be offerred (which means available to the pt and family)

There are problems with the definition of euthanasia. Members of the public are always exploring options for therapy, especially in surgery choices. They are not usually worried about evil acts of murder taking place although certainly there are fatal hospital errors occurring all the time. Due diligence should be sufficient to monitor events. Generally large institutions such as Sunnybrook Hospital have competent committees in place to regulate palliative care activities just as they have for surgery.

We have a responsibility to support all palliative care patients no matter what their values and aspirations may be. We have not the right to use a platform to advance our own perspective. We are not palliative care patients.

See above. as per #1. should make clear that palliative care and euthanasia are mutually

exclusive and that palliative care practitioners will not be the physicians who will necessarily facilitate PAD it should be a rare exception.Also terminal sedation, in spite of what Patrick Vinay and others write, is, in my view, euthanasia.

No, doesn't mean come out in favour of it either. Rather, a dialogue is more appropriate.

should support legalization of euthanasia not to oppose it I think the society should focus on access to palliative care as a

priority, rather than advocating for a position on assisted dying I know you didn't want my answer here, since I answered "no" to #1,

but it was a qualified no. I myself remain ambivalent about the topic, having followed the

legalization in Oregon since the inception of PAS there. My main concern is the slippery slope argument, and i do think it will open all kinds of other sequellae, including euthanasia of children, when

parents feel their child has the same right to death in terminal illness as they do themselves, and also issue of intractable mental illness, for which other jurisdictions have also allowed PAS. It really is a question for society, I think, not just professional groups

N/A: 17Comments:

I don't know if it's central messsage should be opposition. It's central message should be that we understand the issues and that there is something we can do about it.1. we understand the suffering people have faced 2. unaddressed suffering is unacceptable 3. that we have ways to provide care

I think that this is a debate that we require to undertake as a society. However, as a physician I do NOT wish to involve myself in the provision of euthanasia.We need greater access to palliative care however, once we have enough palliative care, there will be circumstances when palliative care may not be enough. In thiose circumstances, euthanasia might be necessary.

neutral

Question 3: If you answered yes to question 1, should the Canadian Society of Palliative Care Physicians continue to publicly oppose the legalization of physician assisted suicide? Yes: 165Comments:

Because there alternatives the public needs to be aware of see previous answer. Based on an Ethics framework I do not see a

distinction between PAS and Euthanasia, although at a personal level one can "feel" the distinction.

Physicians are in the healing business not the killing business look at stephen hawking, he could easily have ended his life

earlier.peopleare afraid of being vulnerable and suffering yet both are a part of being human.

but must acknowledge CMA position that "allows physicians to follow their conscience"

same reasons but the use of PAS as a term --still autonomy to choose when we die

We should publicly oppose the medicalization (i.e. the adoption of medical responsibility for) assisted suicide.

There is just as much chance for coersion in PAS as there is in euthanasia even though the form it takes may be more subtle. The states of WA and OR in the US keep almost no records, so it is disingenous to say that there is "no reported abuse"--that is because there are no reports. The Oregon government's own website states that they have no way of knowing if the doctors are following the

guidelines or not. Reassurances about only competent, willing, terminally ill patients in the final stages of dying ring very false when the evidence is examined with any scrutiny. There is absolutely no oversight after the lethal dose leaves the pharmacy.

Absolutely. This is facilitated death and physicians should stick to care giving and therapeutic use of medications and not toxic doses in the form of advise or action..

But remain open with the possibility if/when PAS is legalized a group of physicians including palliative MDs may want to incorporate euthanasia in their practice

No: 59Comments:

Again, we should lobby for safeguards, including the protection for providers who do not wish to personally participate.

see previous need to acnowledge the incredible complexity as per last question. Needs rigid pathways to ensure Palliative referral,

Psychiatric assessment, family and patient counselling. for the same reasons. we should be neutral I say keep the patient choices open. If 80% of palliative care physicians

feel that they are unable to cope with the small percentage of terminal patients with intractable pain and suffering, then they should declare themselves and in the same institution or community refer these patients to the 20% who are willing to deal with such problems. There needs to be an atmosphere of tolerance just as there now exists for different approaches in therapy.

No. See question 1. We should not be mandated to perform euthanasia but we should support those who may choose to exercise this action

But I believe the messaging and wording around it needs to shift from the notion of "physician assisted suicide". The word suicide is very alarming to many. Even the word "assisted" can be perceived from many perspectives...

not sure that we have adequate info to distinguish between euthanasia and assisted dying. Certainly it seems more acceptable to help a patient to administer an overdose themselves but I would not abandon those who are unable to participate yet are clearly wanting an end of their suffering .

as above the choice is litteraly in the hand of the patient, not the physician

N/A: 9Comments:

The Society need to avoid rhetoric and hsow that it understands that people are suffering. It has to work to change the system to one where palliative care is accessible and provided at a high level. It needs to

speak about the need for family physicians, for home care, for skill, for a comunity that is inclusive rather than marginalizes. It need to talk about the fact that some segments in our community die earlier and worse. It needs to work towards solutions.

This is a societal issue, not unlike the abortion debate. I am beginning to think that the CSPCP should promote a national debate on euthanasia. It may be difficult to have an intelligent discourse because it is such an emotional issue to many.

don't know, I think we have to acceppt that it is coming and just be really clear that it won't be us doing it

Question 4:If legalized, should euthanasia and physician assisted suicide be provided by palliative care services or physicians?Yes: 46Comments:

I don't know. I can't think of any other group who would be appropriate to do it, however. I think anyone who does this would have to have expertise in palliative care, as I would think they would wish to be satisfied that this was in fact the best option for a particular patient and they would have to have the skills to have the appropriate conversations.

Worried that physcians will not feel they are able to decline if they are not comfortable or disagree with providing this type of care. Especially in areas with limited access to other health care professionals.

with proper guidelines, with support and independent second opinion from a physician who has a special focus and in-depth knowledge of issues and procedures related to euthanasia/physician assisted death

Unfortunately, IF this is legalized, I think that palliative physicians/ clinicians are the few members of the health professions with the training and skill to undertake a meaningful advance care planning discussion with patients. Such discussion may result in a patient choosing physician assisted death

yes - only if physician comfortable, it should not be mandatory for a physician to have to provide euthanasia services

Just NOT palliative Physicians My simple answer would be no. There are a number of reasons that

physicians should not be involved. On the other hand, will we have death technicians. So maybe, like abortion, the decision should be left to the individual physician.

Don't know - even though we might disapprove, if not us , then who? For the very reason that we would be least likely to opt for this road as

we have so many other tools and techniques to provide comfort and relief!!!!!!

This should be the decision of each physician. Should not be forced on anyone. I personally do not want to provide services, but potentially

could change my mind if I felt proper support and pathways were in place. A lot of education and work needs to be done before this should go ahead.

Yes, but I don't think it should be mandated to be provided by us. Ok for those of us that agree with the law and feel comfortable administering PAS.

I'd prefer not to be active in euthanasia personally but it's a bit of a cop out to call in somebody else

I answered "yes" to this question only because the survey requires an answer. Truthfully, the best answer for me is "I don't know."

Should be provided by any physician who wants to provide the service.\

Again the definition of terms is confusing. Perhaps in the small percentage of intractable cases it would be more correct to call the process assisted homicide since most of these patients are well beyond any kind of active suicide measures. The wording of your question belies your real intentions - it sounds like the PM and Minister of health calling it "killing". What it comes down to is whether leaving such patients to their so-called "natural" death is best or to alleviate their suffering with adequate relief. As with surgery, most people would prefer some type of anesthesia even if risks are increased. Doesn't matter whether palliative care physicians or physicians do the work - Canada is comprised of cities, rural areas and isolated communities. Kind of a vacuous question which should be ignored but in order to continue I have to check either yes or no. What does "yes" mean and what does "no" mean?

Maybe, as physicians feel able to do so. Alternatively, after full palliative care and home support, a separate regulated health professional of nurses/physicians who feel able, could perform physician assisted suicide

In the same way that I, as a palliative care physician, offer my patients a choice in many aspects of their terminal care (hospice or home? antibiotics for a pneumonia or not? another round of chemo or not? DNR or not?), so I think I should be able to legally offer them this, the ultimate of choices.

** with a robust structure for preserving the right of conscientious objection without affecting a patient's ability to access PAD if they wish.

There is no other profession currently in health care that would have the required clinical skills to properly assess a patient for their approprateness for consideration of euthanasia

For those who ethically feel they should offer it I'm opposed to physician assisted suicide being legalized because I

think that palliative care is sufficient in the vast majority of (if not all) cases, and quality palliative care has yet to be available to all canadians. So in my mind, legalizing euthanasia/assisted suicide is not

a priority while improving access to palliative care for all canadians, is. If it were legalized, I believe that all patients who would desire physician assisted suicide/euthanasia, should see a Palliative Care Physician first and if with appropriate Palliative Care, they still desire/require it, then I think the Palliative Care Physician may be the best one to provide it. If they refuse Palliative Care first, then I don't think it should be the role of the Palliative Care physician to assist in their death.

I think that it goes without saying. Are we to admonish our PC patients who chose this route and turn our backs to them. I see Palliative care as a contract with our patients to see them through to the end and without any judgement on our part.

It depends: Yes if provided as part of a comprehensive continuum of end of life care and within the confines of the law and morally acceptable to specific physician and competent patient, no if not

I think this should not be solely provided by palliative care physicians. I believe that only physicians who morally support this should offer it.

No: 177Comments:

If legalized, euthanasia and physician assisted suicide should be provided out of palliative care services. If some physicians working in palliative care is comfortable to offer those interventions, they should be provided outside palliative care hospices or units.

I don't believe euthanasia and physician assisted suicide is part of palliative care.

Palliative Care physicians should be involved in the provision of excellent palliative care and should advocate for the provision of these services throughout the country in an equitable way. However this also includes increased provision of home care and other resources that complement physician care to have patients die in the setting of their choice. If PAS is legalized, and physicians were to be involved in the provision of these services, it should be not be provided by palliative care physicians and services.

I feel it is our duty to offer optimum support for patient and family and optimum symptom control to ease burden of suffering and therby reduce the feeling of need for assisted suicide. To have the same physician offering assisted suicide would be a conflict I feel and have patients and families wondering.

This could be a delegated act that is offered after careful consideration and assessment, under defined circumstance and with continual audit and clear lines of accountability

I will never support euthanasia or assisted suicide. If legalized, then ANY physician could perform this. It should not be restricted to a particular group of physicians. Palliative care physicians who support

this legalized practice would be among the general body of physicians who would participate in this.

Nobody should do it on their own, this should be some kind of a team approach.what is the difference between palliative care services and those provided by physicians?

It would be within a physician's rights to decide if they provide the service or not. Palliative care physicians would probably be involved in the discussion leading to the decision for ending the patient's life, since we are skilled at having those discussions, but that does not mean a palliative care physician is obligated to provide the service.

Emphatically no I think it should be the physician's personal choice whether or not to

provide such services. I don't think it should be mandated that a specific specialty of physicians (or other health care professionals, for that matter) to provide these services.

I have no interest in providing this service I think it should be a separate service

ABSOLUTELY not. This is not and should not ever be considered part of the spectrum of palliative care. Should not ever be provided by physicians. And should not be part of medicine as a whole.

Indicated no as I do not believe that palliative care should ever be providing euthanasia. However, could consider physician assisted suicide as possibly being offered under the umbrella of palliative care.

If my palliative care service was to start offering PAS or Euthanasia, I could not continue working with that service.

Never. It would undermine what we do and patients would no longer trust us if they knew that euthanasia was one of our 'treatment' options.

No, neither by palliative care services nor by physicians. My understanding is that palliative care services in Quebec could

choose not to offer euthanasia with the recent Bill 52 This is a difficult question that more probably deserves a ?. I have

already seen statements from physicians who say they are palliative care physicians who state they would agree and supply the service so I am not sure we can speak for everyone.

This to me is a conflict of interest and it should not be done by PC doctors if legalized.

it should not be part of a program but should be available to patients if that is their wish

Our mandate is to help not kill. I am sure others could be trained to provide this service. People are afraid as it is to enter palliative care. This would make it even scarier. We live in a world with increasing needs of resources and limited resources. The pressure on us as physicians to manage resources will grow. What will happen to individual care needs.

Like PAD and euthanasia, I think this question can only be answered with a referendum.

certainly NOTHING should be mandatory I don't believe many community organizations with a focus on palliative care (ie. hospices, PCTs and PCNs etc) nor the physicians that have chosen to work in PC medicine will be interested in providing this service. I believe fundamentally providing euthanasia in a setting like a hospice, contradicts the principles of care.

Just cuz its legal, doesn't mean any one should be compelled to perform it. Abortion is a similar issue; its legal, but only a select few who are experts perform it

Palliative Care Services should function as an advisory position to ensure that certain and exceptional cases may be supported, also, should continue to take initiatives in researching and educating public and medical community about the palliative sedation.

Although individuals may elect to do as they wish I would hope that "institutionally" these practices would not be part of palliative care

It should be the domain of MDs or care providers but NOT exclusively to palliative doctors only.

I would refuse to provide this even if it was legalized. No. If Canadians wish to access such services, it should not be through

palliative medicine. I believe we should be involved in review and support of applications.

But I do not think we can not should be the ones performing the action itself. In spite of this opinion, I still think that individual physician autonomy should prevail.

It will muddle our message. Palliative care needs to stay away from physician-assisted suicide. Let another group, such as anesthesia, or a new speciality yet uncreated, deal with this issue.

This should never be done in the first place, but if society decides that it is part of "health care" then there should be an entirely different group of people trained to do this. Patients need to have a physician whom they can trust when they are facing the end of their lives. They need to have the freedom to say, "I wish I were dead!" to their doctors and have their doctors recognize it as a cry for help and significance and not a desire to die. Patients and families are not well-served by having palliative care professionals involved in killing. We have spent decades trying to counteract the idea that we are "Dr. Death"--why would we ever want to be involved in something that would confirm those suspicions and make patients fearful of being truly honest about the struggles they are feeling? We should definitively refuse to be involved in any aspect of this whatsoever and should demand that any legislation dealing with this affords very broad conscience protection rights to all health care professionals who believe that killing is never an option for any healer.

My duty is to care, not to harm.

WHO definition of palliative care, the second bullet states that palliative care is life sustaining care and not life shortening or assisted suicide. Canada is a a signatory to UN charter and WHO is part of such charter. The word physician should be removed from any such assisted or facilitated death or suicide. Some physicians palliative or non palliative appear to be keen on participating and it is sad that they carry such opinion and use poisonous doses or poison to end life in the name of compassion while good care is possible including palliative sedation in therapeutic doses.

Consultanting one should be mandatory but ideally provided by another separate physician.

Nor should it be performed on palliative units, but elsewhere I will respect life for all my life! not always, should be left to doctor's own opinion not de facto or by definition should be up to the individual physician and not mandated as to be

done by Palliative Care services/MDs under no circumstance I believe in the separation of palliative care and PAD/euthanasia. The

latter is not a natural continuation of care. Why not have it a legal process, where you apply to a judge who oks

the application. You then go to a pharmacy and get your phenobarb and dilaudid.

Physicians should never perform euthanasia. If chosen by society that it be legal, there should be non physicians trained in the techniques of euthanasia and assisted suicide..

I do not believe it should be considered the area/domain of palliative care to provide Euthanasia/PAS, however if palliative physicians wish to provide it then I think it should be acceptable for them to do so.

It may be that PC staff may wish to be involved, but it should not be the expectation of care. Rather, I think that independent organizations with MDs as employees might provide this service.

Absolutely not as it will further confuse our role with patients and further erode their confidence in us and our relationship with them

not sure. how is this dealt with in other legalized countries?Absolutely no - the demand for euthanasia and PAS is due to the lack of palliative medicine and the inadequate funding to support associated services e.g. psychology, psychiatry, anaesthesia for pain management etc, etc

I think MDs accepting to participate in these acts should practice outside of pall care services.

that's optional although PC physicians would have the most expertise Can be provided by palliative care physicians but that would be the

individual physician's decision. should not be a part of palliative care services

I have no problem with palliative sedation, but I won't be involved in any way in PAS or euthanasia, it goes against all my beliefs and i rather quit

N/A: 1Comments:None.

Additional Comments: to become the purvyers of assisted suicide or euthanasia will

compromise our ability to serve the patients we care for they will not trust us. For us who work in palliative care internationally there is already a perception that we are just there to help people die quicker and this is not the association we want

I support, giving every possible method to reduce pain and suffering to a dying person, I am comfortable possibly expediating death with these methods, but not administering Euthanasia.

Public policy allowing euthanasia/physician assisted suicide should not precede public policy requiring ready and equitable access to expertise in palliative care throughout the country.

I think legalization is inevitable. A significant portion of our membership likely supports this. We may lose our voice in the process entirely if we do not soften our stance. We also risk dividing the organization.

we palliate patients appropriately and legalizing euthanasia and PAS is a very slippery slope with endpoints that most likely will not be acceptable but it will be impossible to turn the clock back

I believe that increased access and better public awareness of what pall care really means (and more resources devoted to it) would result in less interest/ demand for euthanasia or assisted suicide. I think patients and families need a sense of control over their EOL decisions and that as well as ignorance re what to expect leads them to want to choose death before it is imminent. One challenge is to increase public commitment to quality of life while living with life limiting disease. I see a lack of this commitment even among non pall physicians! Thanks for doing this survey. Susan Gick

I feel quite frustrated that so much medical, public and media attention is being given to this particular aspect of medicine that really only benefits/applies to a tiny proportion of the patient population and yet palliative care which covers a much more significant population isn't deemed as important by the same group. I am not against it in principle - I just don't understand the attention it receives and I think it will make things harder for us in palliative care if we are associated with PAS/euthanasia in any way. We don't need additional barriers.

This debate continues to allow the public to scritinize the availability of P Care services which must be addressed at the same time as any legal action regarding euthanasia

this is going to be reality. need to formulate a plan to work with the reality coming

I think that it is an individual decision. I would not want to be the one to calculate a lethal dose of medication and ask my nursing colleagues to administer it.

I don't think providing physician assisted suicide should be on the spectrum of care for most palliative care physicians including myself. I would rather focus my resources on giving the best palliative care possible to the most people we can reach.However I do think if the public wants it as an option for extreme circumstance we should collaborate rather than oppose. If it is legalized we should participate in the process to establish the best protocols possible even if we wouldn't actually offer the service. I am sure there will be some centres or physicians who will step up to provide this service to the very small # of Canadians who will ultimately need it.

Important for each palliative care practice to work through this issue internally too. Legalization will mean anxiety and additional burden in providing palliative care, so palliative care practitioners need to be adequately supported. At our centre, we have formed a working group to grapple with our anxieties, ethical concerns and response in anticipation of changes in legislation.

The CSPCP should be kept up-to-date on the current CMA initative to develop a response regarding palliative care in Canada based on the physician-assisted death debate.

Thank you for asking we must convey to Canadians and government, law makers that the

current Euthanasia discussion is the wrong conversation. We ALL want to relieve suffering but we havent had a fullsome full citizenry dialogue or exploration of human suffering. proposing a "solution" without understanding the problem is derelect for any society

I strongly opposed euthanasia personally and professionally God gives Life. Only HE takes it away ! complex topic but I think it is "already out of the barn"..... we can

therefore either be in the discussion or out of the discussion .... a more balanced statement that doesn't 100% say opposed but still urges for improved and adequate palliative care

If proper palliative care is available to ALL patients we would not need physician assisted suicide.

Our policy should not be just what we are against but what we are for and what we advocate

I understand the need for clear input in order to present a public face. I didn't complete the survey four years ago because I found it too black and white. I find this survey the same. This organization has a great deal of knowledge and experience with this issue. This need to be reflected in thoughtful dialogue.

We should continue to work ethically and provide excellent palliative care. With palliative sedation as it is outlined and justified ethically, I can see no need for assisted suicide or euthanasia and certainly would not participate

I do think this is coming, but I think it is outside the scope of care that I am willing to provide. We as a society should develop a plan for how to deal with patients under our care who ask for MAD.

If euthanasia and/or physician assisted suicide are legalised in Canada, I will refuse to participate under any circumstances

Excellent questions! We keep people alive on ventilators with no chance of

recoverybecause of their vlaues and beliefs, This is against my personal beliefs. We refuse to support people requesting assisted death. I watch terminal sedation without checks balances now. I support the right to assisted death with proper protocols regardless of my person views

This becomes one of those ethical issues if it is legalized. In the eyes of the law, would any physician be able to say 'no'. Much like the issue of abortion of even prescribing BCP where a physician is obligated, at least by my College, to then refer to someone who will supply the service. This makes us complicit in the action. This is where we may need to take a stand if it is legalized.

Thank you for addressing this exceedingly important issue. I think that this is coming , see recent People magazine article on

young lady who was euthanized (brain cancer). We need to support and educate, or it will be done without our input (my opinion).

palliative care and death with dignity are living together in Oregon quite easily.

No. We need to be honest and not afraid to challenge what others think. In

20 yrs in palliative care killing a patient was never required. We have the

knowledge to keep people comfortable. This issue is really about the worldview of society and that of the goals of medicine. We need to be strong to maintain the integrity of what it means to be a doctor. We have a lot of work to do in education and helping MD's be comfortable in helping patients deal with the reality of death, dying and living.

I feel most comfortable with Oregon's approach to PAS but not Quebec's or Belgium's approach.

The time has come for Canada to legalize this. In countries where this is legal the palliative services are better: Switzerland ranks No 1 in end of life services: Canada 20th

I think mandatory palliative care team assessment and a suitable waiting period rare key to a "safe" process, but it will always be an ethical conflict. I think there have been and probably will be individuals in whom it is a good choice, but the risk of harm to others by having

that possibility available may well outweigh the benefit to those in whom it may be acceptable. The challenge will be to get the good without the bad.

We need to provide comprehensive and quality palliative care across the country. This should be the priority of both federal and provincial health bodies.

I think the society should have a role in ensuring that the process for euthanasia and physician assisted suicide is well thought through and based on research and experience from other jurisdictions. Otherwise, there is a risk that it won't be done well.

Most Canadians are in favour of these services, so it's time for us to align our position with public opinion.

Thank you for your help in this important matter. Things are happening too fast!

Thank you for doing this survey. No I would like to see a breakdown of PC mds opinion on euthanasia

stratified to age,sex and religion. I believe that there is significant bias amongst the group that Needs to be exposed and understood.

Palliative physicians are trained to assess and evaluate patient's goals of care and their prognosis and symptoms. Palliative physicians should be at least consulted if euthanasia is legalized, but the CSPCP should not be the 'gatekeeper' to euthanasia.

We don't really need assisted suicide or euthanasia, it is "needed" by sooooo few people that the whole concept does more harm than good. It wrongfully scares people afraid of death away from palliative care and open end of life conversations. Again, sooooo few people "need" assisted suicide or euthanasia, it is just a waste of money debating in parliament.

More cases of requests for palliative sedation are present recently... added strain on hospice staff?? Uncertain

I hope that the leadership and our society of palliative care physicians will not be intimidated by the media and by a few academics who seem to think that killing patients is a good idea, even if it is in very limited circumstances with so-called strict controls. The controls have not worked anywhere in the world where this is legal. Expansion is continuing both in the numbers of patients having termination and in the broadening of the eligibility criteria. Belgium now has euthanasia for children and both Belgium and the Netherlands have euthanasia for minors and newborns. One study in Acta Paediatrica in 2007 showed that parents were only consulted 81% of the time before newborns were euthanized. That means that one of five of those children was killed without even asking the parents if they would like to take the child home and provide a loving home. Where is "choice" in that? To make autonomy the "highest good" for our medical system is ridiculous and harmful to our entire society. We place many limits on

autonomy--one cannot smoke in a public outdoor park in my city because of the potential of harm from second hand smoke for others. Eliminating the 2400 year prohibition of physicians being involved in killing patients is a very risky gamble that is not playing out well where it is being tried. Prudence would suggest that we hold the line against euthanasia and PAS. For those who want to see it legalized because it is a patient's "autonomous right" to decide about his or her own death, here is a question: "Is there anyone you would say 'no' to? and if so, to whom and on what basis will you deny this person's autonomous wish?" Once this door is opened due to an autonomous wish to avoid existential suffering, how is it ever possible to quantify or compare one person's suffering over another's? Who decides which requests are to be granted and which denied and on what grounds? Every place where this has been legalized the arguments have centered around the very hard, very rare cases and those seeking legalization have pushed those tragic stories to the limit. The Dutch medical society was adamant when the Netherlands passed the law legalizing euthanasia that the practice would only be for patients at the very end of life who had terrible physical suffering. Now they support euthanasia for anyone over 70 who might have a few minor ailments making the person "tired of life." Euthanasia has been used in Belgium and the Netherlands for patients with : a young person with a botched sex-change operation; twins who were deaf and had the "possibility" of going blind in the future; a prisoner who would rather die that face life in prison; a severely depressed woman (whose son found out about her euthanasia when he was asked by the hospital to collect her belongings) and the CMAJ study from June 2010 that showed that physicians in Belgium who had reported that they had hastened patients' deaths had done so without explicit consent in 32% of the cases--1 in 5--and that in 8.9% of those, the physicians themselves gave the reasons for not obtaining consent that it would be "too stressful for patient" to ask! The physicians decided that the person was better off dead and thought it would be too stressful to ask the patient. We do not need to be mixed up in this risky societal experiment. Our job is to cure and treat when we can and to comfort always--never to kill. In order to kill, we would have to agree with the person asking that there are some lives that are not worth living or protecting. I hope that we as the Canadian people and as the medical profession have more creativity and imagination in the face of suffering than to simply eliminate the sufferer. This takes skill, determination and compassion, all of which the physicians who practice good palliative care have been dedicated to providing since the beginning of our discipline. Please do not abdicate our responsibility to protect our vulnerable patients and families and also our society in general from this harm. Thank you.

CSPCP should not outright oppose this in my opinion. We should be pro-palliative care, but recognize for 1-5% of the population, they desire this. Perhaps a separate regulated health care provider could provide this service. Full palliative care should be provided to Canadians regardless; however in reality, access is poor, hence some desperation for PAS

With the progress of PC and proper use palliative sedation, I think the difference between euthanasia is narrowing. Probably in a closed futur, only assisted suicide will be requested

safeguards are needed - second opinion, waiting time, . . . Thanks for re-polling people. I am a little concerned about this poll,

because the questions do not provide nuance or context, or speak about the different indications for PAD. Thus, it may be challenging to interpret the results. Also, did you put some sort of safeguard in place to ensure that only one response would be allowed per computer?

We should present an understanding that opinions in favour of legalized PAS and euthanasia are valid and reasonable, but that the societal risks outweigh the benefits.

Many health care treatments occur at end of life that are outside of palliative care. Patients/families and providers need a safe place to seek out care for dying patients without the fear that someone might deliberately end their lives. Pallaitive Care would service the vast majority the population that do not want to deliberately end their lives.

As a physician organization and palliative medicine we must articulate well and let the governments decide whether lawyers, police or judges should be trained to use poisons or toxic doses of medications which pharmacologists or biochemists have come up with such molecules and compounds. Physicians and other care givers have been learning & practicing therapeutic use of medications invented by other scientists.

We do need to make a stronger statement about this issue as a growing number of Canadians are seeking this option.

Thank you for revisiting this important issue. I think that life must be respected everywhere and everytime, in all

countries, comunities and religions. My overall view is that assisted death is arguably not within the scope

of medical practice but is certainly not consistent with the philosophy of palliative care. The CSPCP should continue to stress this point as the justification for its position on opposing assisted death. The Society should, however, be careful to advocate for open and free discussion within the profession and by the general public regarding this issue. When I state my opinion in public discussion, I stress that providing access to assisted death would not be a decision of medical providers, but of society as a whole, and that my role in managing the suffering of individuals confronted with advancing illness would not

change if assisted death was available. If good palliative care is not a sufficient tool for managing an individual's suffering, then they may look for other tools, but don't make those tools part of palliative care.

I have a high regard for the legitimate concerns expressed on both sides of the assisted death debate. My views on the issue have changed significantly over the course of my career. I believe that with timely access to skilled palliative care, the vast majority of people can die with dignity and without need for assisted death. But I also acknowledge that even the best palliative care cannot adequately address the suffering of some dying patients. I believe that everyone should have the option to exercise choice over how they live their lives and how they die and that where skillfully and compassionately practiced, assisted death can be part of the continuum of high quality hospice and palliative care provided to all Canadians.

The board and chair of the CSPCP have been doing an outstanding job on this file. Thank you.

Physicians who desire to become euthanists should establish their own standards and principles of practice rather than redifining what palliative medicine is and should be.

Palliative sedation therapy continues to be an important and appropriate part of the spectrum of therapies that can be offered to patients by palliative care physicians.

I appreciate the sentiment that Euthanasia/PAS is not what palliative care is about, and that we need to invest more in palliative care so that Euthanasia/PAS are not the "only way out". I personally feel Euthanasia/PAS is not morally or ethically unacceptable, particular in the Oregon model, and I do believe there is suffering that is unrelieved/unrelievable by palliative care and where palliative sedation is not an acceptable option. I strongly believe Euthanasia/PAS will become legalized in the next few years. I think CSPCP should explain the difference between palliative care and Euthanasia/PAS but not take a position whether palliative physicians would also provide Euthanasia/PAS.

I think it will become difficult if not impossible to practice palliative medicine if legalized

The CSPCP's position need to be clear, available, accessible and public The hospice where I work as Medical director will have to decide

whether or not to allow physician assisted suicide on its premises. If it decides to do so, I will resign. If it decides NOT to do so, what are we expected to do with our patients who demand it? Transfer them in their last days? Will we be violating their rights if we refuse?

Thanks for continuing your work! Again, I don't think it's a yes no answer. And members should not be

forced into one camp or another. Not unlike hydration in palliative care. Sometimes it's appropriate and it should not be black and white policy 'we don't do any hydration or transfusion'.

Once PAS is legalized, access to palliation will suffer, as sadly it will be more convenient/faster solution for stressed out and overcrouded HC system. Palliative care services/physicians if involved in any way, will then be viewed again as "angels of death", image that we are trying to shake off!