Pubdate: Fri, 08 Aug 2014
Source: Montreal Gazette (CN QU)
Copyright: 2014 Postmedia Network Inc.
Contact:  http://www.montrealgazette.com/
Details: http://www.mapinc.org/media/274
Author: Sharon Kirkey
Page: A10

NEW HEAD OF DOCTORS' GROUP FACES SEVERAL CHALLENGES

MDs left with 'untenable' position on medical marijuana

While there "may well be" legitimate uses for medical marijuana,
doctors have been thrust into an "untenable" position by being made
the sole gatekeepers to legal pot, says the incoming president of the
nation's most powerful doctors' lobby.

"We have Health Canada telling us that marijuana is not a medicine, we
have our malpractice insurance company telling us to be very cautious
because nobody is taking responsibility for the safety of it," says
Queen's University cardiologist Dr. Chris Simpson, who will assume the
helm of the Canadian Medical Association at the organization's annual
general meeting in Ottawa later this month.

Simpson said that while he has heard "many compelling anecdotes" that
marijuana can help patients with hard to treat seizures, HIV and other
conditions, "we have people out there saying marijuana can cure
cancer, which seems quite improbable."

"Somewhere in between those two extremes is the truth, and I think we
need to find the truth, and the way to do that is with the appropriate
research."

His comments come after the CMA's outgoing president, Dr. Louis Hugo
Francescutti, drew ire from some doctors for telling a reporter that
people who seek the drug in a doctors' office are just looking for
"dope."

Simpson suggested it's time to regroup.

"We need to just back up, take a deep breath and talk about the
facts," he said. "Let's figure out what the appropriate role for
marijuana is, if there is one."

The controversy over medicinal pot will be high on the agenda at the
annual doctors' meeting, dubbed the "parliament of Canadian medicine,"
where confirmed speakers this year include Federal Health Minister
Rona Ambrose, NDP leader Tom Mulcair and former Quebec premier Jean
Charest.

Other issues to be tackled at the Aug. 17-20 meeting include medical
professionalism and end-of-life, including the highly charged debate
over euthanasia.

The CMA officially opposes euthanasia and doctor-assisted suicide in a
policy that has not been updated since 2007.

Some doctors are arguing it's time the CMA moved beyond the "yes" or
"no" arguments and prepare for a future where euthanasia is legalized
across the country, and not just in Quebec, which has passed into law
legislation permitting "medical aid in dying."

Simpson said doctors are divided, "just like society is split on
it."

Simpson is more concerned that the focus on euthanasia has taken much
needed attention away f rom palliative care and advance care
directives - legal documents that spell out life-prolonging treatments
people would and would not want should they ever lose the capacity to
speak for themselves.

Simpson's specialty is sudden cardiac death due to heart
arrhythmias.

"Obviously we put them in because we think their life isn't ready to
end and we want to prevent a preventable death," he said.

But he also discusses with patients the day the defibrillator should
be turned off - "when other conditions intervene and it's clear that
they are coming to the end of life and then it becomes no longer
appropriate to shock them and put tubes in their throat and do all
these aggressive things."

Those discussions help avoid the "furious, futile Code Blues," where
frail and dying patients are resuscitated if their heart stops and
they have not made clear in advance what they would have wanted.

Advance directives affect "magnitudes" more patients than the small
number who may request a doctor-hastened death, Simpson said.

Yet polls show the vast majority of Canadians don't have one; fewer
than half have even discussed the issue with their families. Without
any guideposts, the fallback for doctors is to keep going - provide
intensive and invasive care that ultimately prolongs dying.

"Our society is still so worried about talking about something as
completely natural as death," Simpson said. "But I'll tell you, when
you do it, patients are always thankful."

Born in Moncton and raised Nackawic, a small pulp mill town in New
Brunswick, Simpson obtained his medical degree from Dalhousie
University. He completed internal medicine and cardiology training at
Queen's University in Kingston, Ont., where he's now professor of
medicine and chief of cardiology.

Simpson chairs the Wait Time Alliance, an association of medical
societies lobbying to reduce wait times for surgery and medical care.
He has authored or co-authored more than 300 peer-reviewed papers and
abstracts.

He said the CMA's focus this year will be on pushing for federal
strategies for seniors' care and dementia, including tax incentives
and respite and community care to provide support to families looking
after relatives with the memory-robbing disease.
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MAP posted-by: Matt