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U of A med school prepared to change curriculum quickly if assisted dying law changes

A dean at the University of Alberta’s MD program says the school is prepared to update its curriculum quickly if the federal government expands access to medical assistance in dying. 

Dean says curriculum is flexible and more sessions on MAID could be added

Medically assisted dying is only available to patients who are near death, but the federal government is re-examining its legislation after a Quebec court declared parts of it unconstitutional. (Richard Lyons/Shutterstock)

A dean in the University of Alberta's MD program says the school is prepared to update its curriculum if the federal government expands access to medical assistance in dying. 

The Superior Court of Quebec ruled in September that restricting medical assistance in dying (known as MAID) to just Canadians near death was unconstitutional. Its ruling would suspend the near-death provision in Quebec if the federal government does not change the law by March 11.

This week, the federal government asked for more time to update the legislation.

Dr. Tracey Hillier, associate dean of the U of A's faculty of medicine and dentistry, said the medical school curriculum is flexible enough to accommodate legislation changes quickly.

"If the population eligible for consideration for MAID increases, we may include more sessions around those disease processes or considerations or ethics, just to make sure that our students are as comfortable as they can be," Hillier said Wednesday in an interview with CBC's Radio Active.

How students learn about MAID

Hillier said U of A medical students learn the fundamentals of assisted death in first year, but they continue to revisit the topic throughout the four-year program.

Advanced communication training helps prepare future doctors for conversations about MAID with families, she said, and experts discuss it during panel interviews and presentations at the school.

Students are also encouraged to discuss assisted dying in small groups. 

Second-year U of A medical student Peter Holmes said structured peer groups provide a supportive forum to tackle a range of tough topics.

"I've certainly learned a lot from my peers about their views on things like medically assisted dying as well as other complex issues with chronic disease and ethical issues within medicine," he said.

Hillier added that students receive more training on MAID in residency and through continuing medical education.

Nursing students seek clarity too

Only physicians and nurse practitioners may administer medications for MAID, but registered nurses and registered practical nurses may participate in the process by helping patients and physicians.

As a nursing student at the University of Victoria two years ago, Cedar McMechan interviewed nine fourth-year nursing students about their perceptions of MAID.

Though she found the students were dedicated to supporting patients' autonomy, participants told her they were confused about their responsibilities in the provision of MAID and feared saying the wrong thing to patients.

"Students really struggled to know what their role was," said McMechan, who now works as a nurse in British Columbia.

In a paper published in Quality Advancement in Nursing Education last spring, McMechan listed participants' suggestions for improving educational preparation for MAID. Suggestions for educators included providing clear instructions on the process, using clinical simulation to role-play speaking with patients about MAID and bringing in speakers with first-hand experience.

Inspired by what she learned in her research, McMechan has started speaking to groups of nursing students in B.C. about the logistics of MAID.

"They wanted to know what medications are [patients] receiving, how fast does someone die, what does that feel like to witness, and how do you take care of yourself after?" she said.

Supports for doctors and nurses

"I think it's important that physicians are aware, as students and as residents and as practicing physicians, that there are supports out there for them," Hillier said.

Peer networks can be one form of support, she said. Others include counselling and guidance from the College of Physicians and Surgeons of Alberta.

McMechan said she values talking with the physician present to debrief after a complicated medically assisted death.

"It is such a complicated emotional experience," she said.

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