The 269 delegates voted to "support the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying."

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Barbara Sibbald, CMAJ

August 22, 2014

Medical marijuana and senior's care were extensively

 debated at the Canadian Medical Association (CMA) 147^th annual meeting in Ottawa Aug. 17–20, but physician-assisted death was the main action-item.

The 269 delegates voted to "support the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying." That resolution, which was approved by 91% of delegates, will now be considered by CMA's Board of Directors. 

CMA's 2007 policy states that doctors should not participate in euthanasia or assisted suicide. The new position prepares physicians for the possibility that laws may be changing in light of a recent Quebec bill and an upcoming case at the Supreme Court of Canada. 

In a related move, delegates asked CMA to develop a strategy to ensure there are enough doctors trained in palliative care.

The annual meeting began with the release of a survey and a call for a national seniors' health care strategy. The survey of 1000 Canadians (aged 45 and older) found that 95% saw the need for a pan-Canadian Seniors' care strategy — a percentage outgoing CMA president Louis Hugo Francescutti called "astonishing." "Federal politicians should worry about this if they want to stay federal politicians," he told CMAJ.

CMA's new president, Dr. Chris Simpson from Kingston, Ont., said the failure to address seniors' needs "impacts every single component of the health care system." For example, "warehousing of seniors in hospital beds" wastes about $2.3 billion annually. 

In his inaugural address, Simpson also slammed the federal government for its inaction on medicare. He cited a recent report from the Commonwealth Fund indicating that Canada's health system ranks second last on virtually every measure of quality and access. Top-ranked countries all have "strong leadership" from a committed federal government. He urged the federal government to begin with a comprehensive seniors care strategy. 

Federal Health Minister Rona Ambrose said a national strategy is "valid, but only possible if the provinces and territories want it." So far, "there's been no call for one, except from certain groups." 

Ambrose also spoke about the need for government and physicians to work on practical solutions to Canada's prescription drug abuse problem. A "frightening" number of Canadians — some 410 000 — abuse prescription drugs, she said. "Doctors are prescribing too much." 

She also responded to concerns about Canada's new medical marijuana law, which puts physicians in a "precarious situation." "The majority of doctors don't want to prescribe and I would encourage them not to do it if they don't want to," she said. At the same time, she insisted that doctors are the best gatekeepers to marijuana. 

Francescutti said the new law, which came into effect Apr. 1, 2014, "strains the physician-patient relationship."

"It's just plain bad medicine to prescribe a product when we don't know how it works; we don't know when it works, who it works for, how it interacts or how much to prescribe."

The CMA's long-standing position is that there is insufficient evidence supporting marijuana's use as a therapeutic agent. Delegates approved a motion calling for the CMA to speak out against smoking any plant material, clearly aimed at marijuana. Respirologist Dr. Deborah Hellyer noted that smoking one joint is the equivalent of up to 10 cigarettes.

A second motion called for licensing bodies to develop comprehensive regulatory standards to guide physicians in prescribing marijuana. Currently the information available and policies vary.  "We need clear and consistent standards," said Francescutti.

New president elect

Delegates confirmed the election of CMA President Elect Dr. Cindy Forbes, a family physician from Waverley, Nova Scotia. Her term as president begins August 2015. Forbes has practiced as a family physician for 28 years in Nova Scotia and British Columbia. 

"My goal as president is to identify and promote innovative solutions and positive change for health care," she stated in a media release. She identified seniors care and the health care transformation initiative as two areas of engagement.

Forbes is the former president of Doctors Nova Scotia (1996/97) and has chaired CMA's Council on Health Care and Promotion.

During the meeting, CMA also received the Canadian Forces Medallion for Distinguished Service. It recognizes CMA's long-time support for the Canadian Forces, from the creation of the first permanent military medical service in 1899 to recruitment of physicians during the recent mission in Afghanistan.

And last but not least, for the first time in 15 years, there will be no increase in CMA fees; they stand at $495 annually.

Visit cmaj.ca for extensive news coverage of the annual meeting.