Council Update

September 10-11, 2015

Dr. Andrew Stadnyk, Council Award recipient; Sexual Abuse Prevention; Updated Policy: Planning for and Providing Quality End-of-Life Care; Physician-assisted Dying; Consultation on Revised Blood Borne Viruses Policy; Preliminary Consultation on Block Fees and Uninsured Services Policy; 2014 Annual Report

Sep 18, 2015

Council Honours Dr. Andrew Stadnyk

Dr. Andrew Stadnyk, who has served generations of patients as a family physician in his rural Manitoulin Island community for 33 years, was presented with the Council Award in September.

As one of six doctors in group practice, Dr. Stadnyk does a bit of everything, including, stabilizing critically ill or injured patients before sending them to a tertiary centre, managing a 14-bed inpatient hospital, acting as an advocate for the community's medical needs, and until recently, covering 24-hour shifts in the emergency room. He also used to deliver babies.

In addition to his clinical duties, Dr. Stadnyk supervises and mentors medical interns from the Northern Ontario School of Medicine, as well as family practice residents from Ottawa, Toronto and London.

The volume of letters of support the College's Council Award selection committee received on behalf of Dr. Stadnyk is a testament to how much he is admired, valued and loved by patients, colleagues and residents in Mindemoya.

Dr. Kevin O'Connor, a colleague, described Dr. Stadnyk's bedside manner, ethics and patience with patients as "legendary."

"Most nights when I am going home, he is still on the phone with patients, discussing complex problems in easily understood language and answering their questions with kindness and the patience of Job ... To say he is a great pillar of the community is not overstating the case," said Dr. O'Connor.

Sexual Abuse Prevention:

An Update on the College's Initiative

Council continues to propose a number of changes - both to the legislation which governs us, and to our own processes and practices - that will better protect and support patients from physician sexual abuse.

Many of the actions taken at the September meeting build on the initiatives announced at previous meetings of Council. The actions range from developing initiatives to improve education and training to seeking new powers in our governing legislation. For example, we will ask for a change that allows the Inquiries, Complaints and Reports Committee to re-open certain investigations if significant new information comes to light. We will also ask for a number of enhancements to the funding program that pays for therapy and counselling for survivors of physician sexual abuse.

Other actions included:

More information is available on our Sexual Abuse Initiative webpage, and watch for an in-depth report in the upcoming issue of Dialogue.

Updated Policy:

Planning for and Providing Quality End-of-Life Care

Council has approved a policy that sets out the College's expectations of physicians regarding quality care at the end of life.

The Planning for and Providing Quality End-of-Life Care policy reflects feedback heard during the consultation, with revisions on the topics of advance care planning, palliative care, life-saving and life-sustaining treatment, euthanasia and assisted suicide, and managing conflicts.

In the draft version of the policy, there was a requirement that consent be obtained for a no-CPR order. This requirement has been revised. The policy now emphasizes good and effective communication and a robust conflict resolution process. In particular, physicians are required to engage patients or substitute decision-makers in a discussion before writing a no-CPR order and engage in conflict resolution if the patient or substitute decision-maker disagrees and insists that CPR be provided.

As the requirements regarding no-CPR orders were an area of significant controversy in the consultation and leading up to the Council meeting, these requirements were the subject of considerable discussion and deliberation by Council members. In particular, one key issue Council debated was the requirement that physicians provide CPR, should the patient arrest, while conflict resolution regarding a no-CPR order is underway.

Members of Council recognized the difficult position associated with this requirement. Ultimately, however, Council determined that the policy position was the best compromise position the College could achieve. Council members reflected that:

  • The policy requirements place an important emphasis on early, good and thorough communication and education to avoid conflicts regarding no-CPR orders;
  • The policy respects patient autonomy in decision-making regarding end-of-life care and is responsive to the public's expectation that they be involved in these types of decisions;
  • To allow physicians to not provide CPR during conflict resolution regarding a no-CPR order would significantly undermine the conflict resolution process and the public may wonder how genuine or sincere the conflict resolution process is when physicians can make a decision at the bedside to just not provide CPR.

Read the policy online, or in the next issue of Dialogue.

Physician-assisted Dying

The Supreme Court of Canada handed down a landmark ruling earlier this year on physician assisted death. In Carter v Canada the Courtfound that the Criminal Code provisions that prohibit physician-assisted death are constitutionally invalid, in circumstances where a competent adult:

  1. Clearly consents to the termination of life; and
  2. Has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

Several experts were invited to speak to Council on the clinical, legal and ethical issues related to physician-assisted death.

The presentations provided important context for future Council discussion and decision-making on this issue, in anticipation of the federal government's development of a framework for permitting physician-assisted death.

Sheila Tucker, who represented the plaintiffs in the Carter v Canada decision, told Council that the Supreme Court of Canada found that the Constitution gives Canadians the choice to seek what they consider to be a good death, including the option of a physician-assisted death for seriously and incurably ill, mentally competent adults.

"This is not an on-demand option," she said. "Physicians are still entitled to exercise their medical judgment, and will have a role in determining whether the patient's condition is grievous and irremediable".

Council also heard from Dr. Charles Blanke, a medical oncologist from Portland, who provides assistance to patients in the context of Oregon's Death with Dignity Act.

Since the Death with Dignity Act was enacted in 1997, more than 1,300 people have obtained life-ending prescriptions, but only 860 have used them. Many people, he said, took a great deal of comfort in having the prescription, even if it was not ultimately used. Most people were dying of cancer and most feared a loss of autonomy, and dignity, he said.

Other presenters on the subject included Dr. David Lussier, Director, Geriatric Pain Clinic, McGill University Health Centre, who provided an overview of Quebec's new law relating to end of life care, and Dr. Jennifer Gibson, Director, Joint Centre for Bioethics, University of Toronto. Dr. Gibson is the recently-appointed co-chair of the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying.

We have an article about the presentations in the upcoming Dialogue.

Provide Your Feedback

Consultation on Revised Blood Borne Viruses Policy

A draft policy that sets expectations for physicians who perform or assist in performing exposure prone procedures with respect to reducing the risk of acquiring or transmitting Hepatitis B, Hepatitis C and HIV is now out for consultation.

The most significant proposed change in the draft policy is with respect to routine testing. The draft policy changes the requirement for HIV testing and HCV testing from every year to every three years.

It strongly recommends that physicians be immunized for HBV and tested to confirm the presence of an effective antibody response. Annual testing for HBV is only required for those physicians who have not been confirmed immune to HBV. Read more.

Preliminary Consultation on Block Fees and Uninsured Services Policy

We are inviting comments on the current Block Fees and Uninsured Services policy at this early stage of the review process to help determine what policy changes may be required. Once a revised draft policy has been developed, we will hold a second consultation to invite feedback on the draft before it is considered for final approval by College Council. The deadline to provide feedback is November 20, 2015.

2014 Annual Report

2014-Annual-ReportIn the CPSO's 2014 year, we furthered the emphasis on patient-centred interactions with changes in the Professional Obligations and Human Rights policy; looked for new ways to provide information about physicians and the process of medical regulation to the public; launched a process of reassessing our assessments to provide physicians with new tools and insights to deliver even higher quality care; and continued our joint effort with Cancer Care Ontario to develop a provincial quality management program.

In addition, the stats that led to the College's inclusion in the Office of the Fairness Commissioner's exemplary practice list, and trends in investigations are summarized in an Infographic, which includes links to the dynamic PDF annual report for further detail.