Educating Canadian family medicine residents about medical assistance in dying

Susan E. MacDonald MD MHSc FCFP 1, Sarah LeBlanc MD MSc CCFP 2,

1 Associate Professor, Dept of Family Medicine, Queen’s Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada.  K7L 5E9
2 Resident, Dept of Family Medicine, Queen’s University (in practice, Picton, Ontario, Canada as of July 1, 2016)

Medical assistance in dying – both assisted suicide and euthanasia – ceased to be illegal in Canada on June 6, 2016 as directed by the Supreme Court of Canada.  Laws to legalize the practice, however, were not in place in time to meet this court-appointed deadline.   This vacuum of regulation created challenges for physicians in Canada, who were faced with requests for assistance in dying, temporarily without top-level guidance. Even when the law is passed (anticipated, but not yet accomplished at time of this submission) there will continue to be uncertainties as to access and process as well as to regulations imposed by the various regional physicians’ governing and regulatory bodies.

This lag in legislation and regulation was transmitted to those providing education for Canadian residents and medical students.  At present, medical schools and residency programs face the upcoming academic year, knowing that medical assistance in dying (“MAID” as it has come to be known) will be legalized in general, but not knowing the specifics that will allow for appropriate design of a curriculum.

The provision of, and the education about, MAID will continue to evolve over the course of 2016 and 2017.  This presentation will outline the journey taken by members of the Queen’s Department of Family Medicine in Kingston, Canada to design and implement a curriculum in medical assistance in dying.  This process will include an initial environmental survey and needs assessment, curriculum development, delivery of the teaching materials, and evaluation of the curriculum.  An update as to this undertaking, as of the time of the conference, will be presented.  Also addressed will be the challenges inherent in designing a curriculum sensitive to the needs of the participating learners and faculty, each of whom might individually fall anywhere on the wide breadth of spectrum of opinion regarding MAID.


Dr Susan MacDonald is a faculty member in the Department of Family Medicine, Queen’s University, Canada.  Susan teaches and is clinical preceptor to family medicine residents in the Queen’s Family Medicine Residency Program , teaches ethics to the  Undergraduate medical students and is  Academic Advisor in the Office of Student Affairs, Queen’s School of Medicine.  Susan’s first 20 years in practice focused on maternal health and intrapartum care.  In 2006 she completed a MHSc, Bioethics, and changed her academic and teaching focus.  She is a past Chair of the Ethics Committee of the College of Family Physicians of Canada.

Using portfolio as a tool for teaching ethics in an MD course

Dr. Zarrin S Siddiqui1,

1 The University of Western Australia, M515, 35 Stirling Highway, Crawley 6009,

A longitudinal e-portfolio has been introduced in the new 4-year MD program at the University of Western Australia. The e-portfolio is structured around six curricular themes where students are assessed at various points during the course. A number of activities have been designed around the ethics component of the curriculum. This presentation will focus on the teaching and assessment of Ethics within the Portfolio and how it has evolved during the course of last three years


Dr. Zarrin S Siddiqui PhD, MCPS (Psychiatry), MBBS joined the University of Western Australia in 2005 and has been involved in assessment and faculty development. She is a supervisor of postgraduate students and is also a visiting faculty at many institutions in Pakistan. Currently her role includes planning, development and implementation of a longitudinal portfolio in MD course. In the other hat she wears, she is actively involved in the research around migration and ethnic communities.

The medical graduate and the doctor as professional and leader – a critique

Malcolm Parker1

1 School of Medicine, University of Queensland, Herston Road, Herston, Qld 4006,

Continuing accreditation of medical education providers by the Australian Medical Council (AMC) requires them to define their graduate outcomes in consistency with the AMC’s Graduate Outcome Statements, a component of its ‘Accreditation Standards for Primary Medical Education Providers and their Program of Study (2012)’. The fourth domain of AMC graduate outcomes is ‘Professionalism and Leadership: the medical graduate as a professional and leader’. Graduates are required to describe the principles and practice of professionalism and leadership in health care, and to demonstrate qualities of leadership. Curriculum content must ensure that graduates are “effectively prepared for their roles as professionals and leaders”.

These requirements concerning leadership are inconsistent with, because they go considerably further than, the AMC’s stated purpose of accreditation as ‘the recognition of medical programs that produce graduates competent to practise safely and effectively under supervision as interns in Australia or New Zealand, and with an appropriate foundation for lifelong learning and for further training in any branch of medicine’. This inconsistency reflects misconceptions concerning leadership in general and medical leadership in particular. The presentation explores the motivations for introducing the requirement that all graduates demonstrate qualities of leadership through the provision of leadership training to all, and reasons to think that leadership in medicine, as in other spheres, cannot be taught, owing to its core moral nature and social structure.


Malcolm Parker was the inaugural Head of the Discipline of Medical Ethics, Law and Professional Practice in the School of Medicine UQ, coordinating the development and teaching of courses in ethics, law & professional practice in the MBBS/MD program from 1994 to 2015. He is the immediate past president of AABHL, served on committees of the Medical Board of Queensland and the Medical Board of Australia, and was a long-serving director of the Postgraduate Medical Council of Queensland. He has published nationally and internationally in philosophy of medicine, bioethics, medical ethics, health law, and medical education.

Bioethics in awe of technology: A proposal for addressing this bias

Paul Macneill1

1 Centre for Values, Ethics and the Law in Medicine, University of Sydney, NSW 2006

This address will take a critical approach to the emphasis given to  “advances in medical science and technology” and to “sophisticated diagnostic and therapeutic interventions.” The question proposed for the AABHL Conference—‘How do we go about making sound decisions in the face of these challenges?’—has to overcome this bias toward technology, before any well-rounded and practical answer can be found.

The claim is part of a more general criticism of bioethics and its predominant emphasis on “advances in medical science and technology”. Whilst these issues are important, they assume a significance that is out of proportion to their relevance in day-to-day health care practice. The concern is that the bioethics and health law community has become enthralled by sexy issues raised by science and technology and has been drawn away from commonplace ethical concerns which are more relevant to health care practice.

Part of the problem is in the understanding of ethics as being about ‘moral reasoning’ rather than ‘ethical practice.’ Another part of the problem is that it is easier to grapple with intellectual issues than it is to adequately address issues of practice. However, we do health care students and clinicians a disservice when we fail to address the ‘how’ of ethical practice.

One effective way to overcome this imbalance is to provide ‘workshop’ training that draws on the skills and methods of the arts. Examples of work of this kind—from the UK (Performing Medicine), from Singapore, and from Sydney (Sydney Arts and Health Collective) will be described. The use of aesthetic material (such as the bioethisphere) and insights from the medical humanities will also be discussed

The broader contention is that health care practice is an ‘art’, and that art and aesthetics are relevant to bioethics. The paper will draw on discussions in a published collection of essays that support this contention (Macneill, 2014).

Macneill, Paul (Editor)
2014. Ethics and the Arts. Springer: Amsterdam.


Paul Macneill has a long-standing interest in ethics and the arts. This is reflected in a number of publications including his edited book Ethics and the Arts (Springer: 2014) which includes explorations of all the arts—literature, visual arts, film, music, theatre, and dance—in relation to ethics.

For close to 30 years, he has taught ethics and law to medical students: at the National University of Singapore, the University of Sydney and the University of New South Wales.

Teaching medical ethics through popular culture

Evie Kendal1, Basia Diug2

1 Monash University, Alfred Centre, Melbourne VIC, 3004 
2 Monash University, Alfred Centre, Melbourne VIC, 3004 

It is known that medical and nursing students watch medical television dramas and comedies. One study from John Hopkins University cites 84% of medical students and 81% of nursing students reported watching medical television dramas (Czarny et al. 2008). A repeat of this study was done in Australia in 2011 in which 93.7% of medical students reported watching medical dramas (Weaver and Wilson, 2011). Among the shows specifically mentioned in these studies were Grey’s Anatomy, House M.D., Scrubs and E.R. Many students in these studies report discussing ethical issues arising in these programs with family and friends and seeking professional role models from among the fictional doctors depicted. This paper explores the relationship between healthcare career aspirations and consumption of medically-focused popular culture within first year medical, biomedical and health science students at Monash University. The aim of the project is to identify best practice for teaching medicine and medical ethics content in the tertiary education environment, taking into consideration that the above data indicates that incorporating popular culture references into medical and health education is likely to increase student engagement and represents a source of untapped potential for effective communication of medical information from lecturers to students and, further downstream, from doctors to patients. Medical teaching facilities engaging with this form of education have reported consistently positive results (from students and tutors) indicating the significant potential this mode of teaching has for enhancing student learning (Glasser et al., 2001).


Evie Kendal joined the Department of Epidemiology and Preventive Medicine at Monash in 2012 and currently works as an Assistant Lecturer for the School of Public Health and Preventive Medicine at the Alfred, teaching into the Bachelor of Medicine and Surgery, Bachelor of Health Science, and Bachelor of Biomedical Science degree programs. Evie also teaches bioethics, philosophy and literary studies at Monash.

Ethics education and the zone of parental discretion

A/Prof. Clare Delany1,2

1 The Royal Children’s Hospital, Children’s Bioethics Centre
2 The University of Melbourne, Department of Medical Education

A key pedagogical concept in current discussions about the role of higher education is that it helps students to construct their own knowledge and understanding of disciplinary concepts to promote their ongoing learning in the workplace (Boud & Falkichov, 2007). This pedagogical focus has profound implications for ethics teaching. It emphasises educators’ role to assist students and clinicians to learn how to view their own work and decisions in light of ethical concepts. It requires ethics educators to use accessible language, provide conceptual tools and devise learning tasks which encourage engagement with ethical standards, concepts and approaches to ethical deliberation.  In this paper I use the Zone of Parental Discretion (ZPD) (McDougall et al 2016) as an example of a conceptual ethics tool which encourages debate and discussion about ethical dimensions of clinical practice grounded in real questions raised by clinicians and families.

The ZPD was developed as a consequence of clinical ethics consultations where clinicians requested advice about the most ethically appropriate response in situations where parents disagreed with their recommendations, refused recommended treatment or requested treatment which clinicians regarded as suboptimal.  These clinical ethics discussions acknowledged clinicians’ experience and expertise in recognising ethical issues as the beginning point (Verkerk & Lindemann, 2012). The ZPD was then used as an explanatory concept to assist clinicians to frame, analyse and then decide how to respond to these situations. Clinical ethics consultations are not always proposed as an example of formal ethics education.  In this discussion, I draw from experience conducting ethics consultations where the ZPD was used. I highlight how such discussions enable pedagogical concepts including reflection, ethical deliberation, and ethics literacy, to flourish.


Clare is an Associate Professor in the Department of Medical Education, Melbourne Medical School. In this role, Clare is responsible for coordination of research higher degrees and the masters of clinical education.  Clare is also a clinical ethicist at the Royal Children’s Hospital Children’s Bioethics Centre in Melbourne. This role involves conducting clinical ethics consultations, education and research in paediatric bioethics.

About the Association

The Australasian Association of Bioethics and Health Law (AABHL) was formed in 2009.

It encourages open discussion and debate on a range of bioethical issues, providing a place where people can ask difficult questions about ideas and practices associated with health and illness, biomedical research and human values.

The AABHL seeks to foster a distinctive Australasian voice in bioethics, and provide opportunities for international engagement through its membership, journal and conferences.

Members come from all the contributing humanities, social science and science disciplines that make up contemporary bioethics.

Many members have cross-disciplinary interests and all seek to broaden the dialogues in which all members of the wider community ultimately have an interest.

The AABHL is a supportive, creative and challenging community that provides a rich source of continuing academic refreshment and renewal.

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