The pace of normalisation of “medical assistance in dying” in Canada is picking up. A BioEdge reader noticed that McGill University in Montreal recently highlighted the contribution made by a distinguished alumna, Stefanie Green. Dr Green is the president of the Canadian Association of MAiD Assessors and Providers (CAMAP), which has more than 400 members.

“I continue to practice because this is very important and meaningful work,” she told McGill News. “When I help a person facilitate their final wishes, I feel I have done something good. I have given them something that nobody else can, and that is a privilege.”

CAMAP’s guidelines for advising people about MAiD surfaced in the news last week. The group says that doctors have a professional obligation to bring up MAID as an option for their patients, when it’s “medically relevant”.

Although advising someone to commit suicide is still illegal in Canada, “inducing, persuading, or convincing the patient to request MAiD” is not.

Conscientious objection does not excuse doctors from participating in MAiD, according to CAMAP. “Holding a conscientious objection to MAiD does not negate these obligations. Rather, it activates alternative duties to discuss the objection with the patient and to refer or transfer the care of the patient to a non-objecting clinician or other effective information-providing and access facilitating resource.”

CAMAP proposes that conscientious objectors observe the “Conventional Compromise” created by Harvard bioethicist Dan Brock. Rather than taking refuge in “an absolutist position of moral proximity”, they should agree to refer patients who ask about MAiD.

CAMAP’s vice president, Dr Konia Trouton, told PostMedia: “There shouldn’t be any ethical tension in bringing up with a patient that has a serious illness, disease, or disability, ‘What are your goals? What are your hopes? What are the things you want done and do not want done?Do you want to move to a nursing home? Do you want to be resuscitated? Do you want CP R? Do you want to be in the intensive care unit?’ And within that, ‘Is assistance to die something that is ethically abhorrent to you or acceptable to you? Is that something you want to explore more, or not?’”

In fact, not providing information about MAiD in a “timely manner” to someone who might be eligible can create harm, CAMAP believes.

But participants can also be harmed in the MAiD process, as advice on the website of the College of Nurse of Ontario acknowledges.

One of the paragraphs in an FAQ says: “After a recent experience caring for a patient receiving medical assistance in dying, i felt distressed and uncomfortable. How should i manage these emotions?”

The organisation responds that: “Providing Medical Assistance in Dying may pose a risk of increased moral distress, burnout, and trauma. To address these risks, it is critical for health care providers to have debriefings with their broader health care team … Take a step back and reflect on whether you feel your physical or mental health is impacting the care you are providing. If it is, it might be time to take care of yourself or seek help.”