I'm also glad that I was here for the first part of this discussion, which has given me the flavour of the kinds of questions we may be discussing.
The College of Family Physicians of Canada represents 35,000 members across Canada. We are the professional organization that is responsible for establishing the standards of training and certification for family physicians. We also accredit continuing professional development programs, enabling family physicians to maintain certification in family medicine and meet licensing requirements regarding their commitment to lifelong learning.
We accredit the postgraduate family medicine residency training in each of Canada's 17 medical schools. We provide quality service, support family medicine teaching and research, and advocate for family physicians and the patients they serve.
As the voice of family medicine as an academic discipline, we are expected by physicians to reflect on and express an informed approach, expectations, needs, and concerns on important issues such as physician-assisted dying.
After listening to the first part of the presentations, I could say that my remarks could probably be summarized by saying that we believe it is important that this discussion be part of the context of a patient-physician relationship and not be purely a process-focused exercise. I'm not saying that process is not important, but I would say that the context of the relationship and how that fits is probably the most important element of this discussion.
In 2013 the college established a task force on end-of-life care. It examined ethical issues on which family doctors might require further education and guidance. The task force recently released a guide that addresses key ethical questions family physicians may have as a result of the recent changes in Canadian law affecting physician-assisted dying. This guide has been shared with the committee. I'm assuming that you can refer to it in your deliberations.
In these difficult situations, as in any clinical decision-making process, family doctors are responsible for ensuring that our patients have all the relevant information to make the most informed and consensual decision regarding their care. A patient's medical diagnosis, their prognosis, what their life expectancy is, the potential risks and consequences associated with treatment or the withholding thereof, as well as the procedure that would result in their death, are just a few examples of information that a patient will need. Because it is a component of comprehensive care that our members offer, family doctors will ensure support is available for the patient's family or other caregivers. The family physician will educate the patient about all other therapeutic options and their consequences and will stress that a patient is able to rescind a request at any time and in any manner.
As family physicians, we must also offer the patient time to discuss complex concerns about their medical condition. This process includes determining with the patient and their loved ones what values, hopes, and fears lie behind the request. These might not always be the same as the patient's stated reasons.
For this process to be meaningful, the physician needs to know his or her patient well and needs to engage in attentive non-judgmental listening. Family physicians know that they should not take over the decision-making of competent patients, nor should they project or impose their own values on their patients. They must always avoid allowing their own perceptions to prejudge the quality of their patients' lives.
Family doctors need to be attentive to signs of not only biological or psychological distress but also of existential suffering. These often arise when individuals face declining health, diminished function, or the reality of impending death. Because patients might not always be aware of or be able to articulate their thoughts regarding these struggles, physicians have to be adept at discussing feelings and interpreting behaviours, and they have to be able to draw on the expertise of others to do so. The physician's attentive and empathetic listening, availability to discuss issues of concern, offer of appropriate supports, and expression of commitment to continuing care throughout the patient's illness are in themselves important therapeutic responses for patients and their loved ones.
We recognize that no other group of practitioners in the Canadian health care system is better placed and better equipped to take on this important and difficult role with Canadians than family physicians working in communities, large and small, across our country. The college intends to leverage the knowledge of its members and experts in the area to develop appropriate education resources and ensure that appropriate guidance is available to our members.
A physician who refuses to fulfill a patient's request for physician-assisted death for reasons of conscience still holds some responsibilities to the patient. As the primary providers of care, family doctors can assist their patients in finding a willing physician. This can be done through directly referring the patient to a willing physician, providing their patient with advice on how to access a separate referral service, or notifying the medical administrator at an institution, who would arrange for another referral.
A central information system for patients would support this process and help a great deal to avoid feelings of abandonment and confusion. It would also improve the standardization of information available across Canada on this important issue. The objecting family physicians will provide continuity of care and transfer the patient's medical record promptly and effectively if requested. Above all, the CFPC opposes any action that would abandon a patient without any options or direction.
The college believes that Canadians should have access to quality palliative care in their communities. Permitting physician-assisted dying should not be considered a substitute for efforts to improve comprehensive medical, mental health, and palliative care. Rather, these efforts should be intensified.
Individual physicians and the medical profession should recognize and act to support patients who have serious illnesses or disabilities and those who are dying. Physicians need to consider the patient's assessment of the overall balance of benefits and burdens of life-sustaining interventions for himself or herself. They also need to be able to maintain continuity of care when referring patients to the appropriate specialized care, provide coordination of care among different parts of the health care system, and ensure that patients are cared for by physicians and a team of health care providers whom they trust and who know them well.
As with any medical changes that arise in the legal context, ethical issues will need to be deliberated within medical colleges and by individual physicians. We maintain that family physicians should, above all, remain committed to their relationships with their patients and their patients' loved ones during this last chapter of life. Recognizing that those who have serious illnesses or disabilities and those who are dying are among their most vulnerable patients, family doctors are expected to be health advocates on behalf of such patients.
We believe that in order to be able to provide consistent and compassionate care for patients in this exceptional context, Canadian family physicians need to have a simple and achievable expectation of the legal and licensing entities that touch this aspect of their practice. They need clarity and consistency in the standards and requirements that govern what they can and cannot do and how their discussions and decisions with patients need to be documented.
We recognize the complexity of the issue and the concerns it will raise among some of our members. Poll after poll, however, confirms that this is a service that the people of Canada find necessary, and we will work with the physicians willing to provide this service to deliver it in a compassionate, ethical, and professional manner.
I want to thank you once again for the opportunity to present a family medicine perspective on this issue. We look forward to the legislative framework that will emerge and we are ready to continue the collaboration and discussion in this important area.
Thank you.