Intended for healthcare professionals

  1. Sandy Buchman, palliative care physician, president elect12
  1. 1Toronto, Canada
  2. 2Canadian Medical Association
  1. sandy.buchman{at}

As the Royal College of Physicians polls its members in the UK this February, Sandy Buchman, the Canadian Medical Association's president elect, explains how accepting terminally ill patients’ autonomy led him to provide medical assistance in dying. See for more opinions—for, against, and neutral

The introduction of legal assisted dying and voluntary euthanasia in strictly defined circumstances in Canada in June 2016 represented a fundamental shift in the medical profession’s role, and in doctors’ understanding of what it really means to alleviate patients’ suffering (box). As a palliative care physician in Canada, I faced the reality of this shift: would I be a conscientious objector or a provider of medical assistance in dying (MAID)?

The debate among physicians and the public continues. The Canadian Medical Association (CMA) adopted a neutral stance in 2013, enabling it to support both conscientious objectors and providers. This helped me to decide to become a provider, because I knew the profession would support my choice.

Deep personal reflection

MAID’s complexities pose ethical challenges for the profession and for individual physicians. I began deep personal reflection. What are the goals and values of medicine? Can hastening death be an ethical and legitimate goal? What is the nature of suffering? What is the role of the physician in relieving suffering? What does it mean truly to respect patient autonomy?

I continue to reflect on these questions. I make the choice to provide assisted death to my patients because I believe it is a compassionate response that fully respects patient autonomy.

It was not an easy decision. I had been a family physician for more than 35 years, and a palliative care physician for the past 11 years, before MAID became legal. My education and beliefs had led me to seek to extend life whenever possible and appropriate, and …

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