Medical schools consider curricula changes with assisted dying law

Now that medical assisted dying is legal in Canada, Geneviève Moineau, president and CEO of the Association of Faculties of Medicine of Canada, said information about assisted dying will need to be incorporated into the curricula across Canada’s 17 medical schools.

“It is important that every medical student understand the legislation, understand what is expected of them by law, what their rights are,” Moineau said. “It is important that the curriculum for all of our medical schools in Canada be up-to-date and include information on new laws as they come about.”

Bill C-14, also known as the Medical Assistance in Dying bill (MAD), was assented  by the Senate on June 17. The legislation carves out an exception in the Criminal Code of Canada, allowing healthcare professionals to provide medical assistance in dying to patients whose natural death is “reasonably foreseeable.”

“We see medical school really as the time when you learn the basic components and you develop the core competencies in all areas,” Moineau said.

Nikita-Kiran Singh is a second-year medical student at the University of Alberta (U of A) and student representative on the Clinical Ethicist and Clinical Ethics Committee for the university. Singh said she conducted an informal, anonymous survey among her classmates about what they want to know about medical assistance in dying.

“In general, students are really curious about this issue and are looking forward to learning about [MAD],” Singh said. “I think what a lot of students are concerned about is, ‘Am I going to be forced to participate in something I’m not comfortable with?’”

Singh added she thinks students are interested in learning about what conscientious objection entails, what their responsibilities will be as physicians, and how to balance what their personal views are with what patients have every right to access.

In Quebec, assisted dying legislation was introduced in December 2015. Félix Couture, a medical student at McGill University and member and co-creator of the Medical Student Study Group on Physician-Assisted Suicide (MEDPASS), said some of his lectures are now dedicated to discussing MAD.

“Those lectures are providing as much information as they can on this topic for students to be aware of what’s going on,” Couture said. “Right now, not all the guidelines are necessarily drawn, so it’s really just to provide the information that we have, the framework as it is right now, and explain it to students so that they understand what the current situation is.”

MEDPASS is a non-partisan group that aims to look at the legislation and explore what the next steps are in approaching it as medical students.

Currently, MEDPASS is working on a formal survey for all medical students in Canada to gather data about student perspectives on medically assisted dying, and determine how medical school curricula are approaching the new MAD legislation, Couture said.

He added the goal of the survey is to contribute to the national discussion in the medical community and among policy makers.

Kristin Pon, a second-year medical student at U of A, said she isn’t sure if it is necessary to include in-depth information about MAD in medical school curricula.

“It’s a question of if it’s the school’s job to teach us every detail about every new development in medicine, or if it is their job to train medical professionals who know how to think critically and problem solve,” Pon said. “You can’t learn everything. Which is why there is residency and specialization and fellowships. Is [MAD] something that would better off to be learned in residency or as a staff physician later on in education?”

Anthea Lafreniere, president of the Canadian Federation of Medical Students, said she thinks Canadian medical school curricula won’t drastically change in the face of MAD.

“We’ve always been trained in having conversations with patients on their goals of care,” Lafreniere said. “At [the University of Ottawa] for example, we had sessions called PSD [or] physician skills development. In those sessions, that’s where you’d learn to do your cardiac exam and your lung exam, but you also learn to do history taking.”

Lafreniere said PSD sessions taught her to consider “difficult conversation about sexuality, sexual health, and goals of care.”

According to Jennifer Chandler, a law professor at the University of Ottawa who teaches a course on medical legal issues, medical schools have faced a similar challenge before: introducing abortion procedures into curricula.

Chandler said people often make the argument that MAD, like abortion, is something that all physicians should at least know about.

“If patients have a right of access to this, doctors, at a minimum, need to know the details of how is this done, what are the alternatives for patients in this situation? It’s part of complete medical competency, because this is now part of our medical practice in the country,” Chandler said.

Moineau said she thinks there has been a shift in the way medicine is taught and practiced, which has created a foundation in medical school curricula that teaches students how to have difficult conversations with their patients.

“What has changed over a generation or two is the fact that the medical profession understands more clearly now that we are there to support the patient. The patient is at the centre of the care, and we are there to help as we can,” Moineau said. “I think we do that better than perhaps a couple generations ago where it was a bit more, ‘the patient does what the doctor says.’”

Moineau added the focus on the importance of communication skills and early experience with patient care has increased in Canadian medical school curricula, which is why, she said, medical students may already feel comfortable with approaching MAD with their patients.

“In some ways, I think that this change may be more difficult for some physicians who are already in practice more so than for medical students or residents who have been hearing about and talking about this topic for a while now,” Moineau said. “When you’re used to one set of ethical parameters, and now the parameters in a sense have changed, that’s difficult.”