Doctor-assisted dying has been legal in Canada for almost two years but, as with many other areas of the health-care system, access to it remains uneven.
One of the oft-cited barriers faced by the terminally ill or chronically suffering who wish to end their lives is the fact many doctors have a problem with taking part.
New research conducted at a regional health authority in Laval, Que., sought to understand the exact nature of the doctors' objections. The findings are surprising. The qualms most medical practitioners expressed in interviews turned out to have little to do with religious or moral beliefs.
Though the usual methodological and sample-size caveats apply to the study, which is based on a poll of 61 doctors who received 113 requests between January and September of this year (of which 53 were approved), the main takeaway is that education efforts about assisted dying would do well to target the medical community more forcefully.
Of those surveyed in Laval, 72 per cent said they support medically assisted dying. Coincidentally, that's almost exactly the proportion of doctors – 77 per cent – who turned down requests from patients and referred them to a colleague. In other words, a lot of physicians strongly back assisted dying but don't want to be directly involved.
As to the specific reasons why, 59 per cent of the recalcitrant doctors in Laval said they struggled with the emotional burden of ending a life. A third said they lacked the requisite clinical expertise. A quarter alluded to worries they would be stigmatized by their peers.
Only 22 per cent of the physicians cited what the researchers qualified as a moral objection or religious conviction.
External factors like workload, lack of time and the prospect of being sued, even though the procedure is now legal, were also raised by nearly half the respondents.
The research was first published in a magazine owned by the association representing Quebec's specialist physicians.
"Additional training is needed to make the practice more acceptable, and specifically to integrate it into doctors' clinical practice," Hélène Bouthillier, a medical ethicist and one of the study's authors, told Le Devoir recently.
It is a conclusion that should merit careful consideration by medical and public-health officials across the country.
Health-care administrators should soon have a more detailed statistical picture of who is requesting medical assistance in dying, and how many of those applications are accepted, thanks to draft federal regulations on a national monitoring system that will be in place by the end of 2018.
According to the most recent Health Canada figures, more than 2,000 Canadians have availed themselves of the end-of-life option that Bill C-14 created on June 6, 2016.
It's a big number, though it represents only 0.6 per cent of annual deaths nationwide.
The numbers would likely be larger were it not for what Dying with Dignity Canada, an advocacy group, says are unacceptably high structural obstacles that often prolong pain and suffering.
While much of the effort to lower those barriers has focused on lobbying government, Ms. Bouthillier and her co-author, Dr. Lucie Opatrny, suggest the surest way to improve Canadians' access to assisted dying is by changing the medical community's mindset through education and mentoring.
Advocacy groups criticized Ottawa's timidity when the federal law passed, but while it isn't perfect – show us a law that is – on an issue of life and death, Parliament was right to take a cautious approach.
The Supreme Court has established assisted dying as a Charter-protected right for competent, consenting adults with "a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition."
But that right, which may be asserted with greater frequency as Canada's population ages, can only become operative after clearing substantial hurdles. Assisted death must never become a matter of routine.
However, for someone whose health allows them to legitimately invoke the right, it is an insured medical service. Individual clinicians may decline to deliver it, for reasons of ethics or religion, but the health-care system as a whole, namely all state-contracted nurse-practitioners and physicians as a group, are obliged to provide it, and should.
The good news for people who have trouble getting help in ending their suffering is that we now have at least some evidence that those practitioners whose objections are moral likely constitute a small minority of the medical community.