 Medical marijuana: Medical Declaration and Release from Liability Forms
Marijuana is not approved for use as a drug in Canada. Health Canada states that “no marihuana product has been issued a notice of compliance” and notes that indications, safety and risks have not been adequately studied and the appropriate dosage is unclear. While some regulatory authorities (Colleges) have clearly stated that physicians should not support an application for the medical use of marijuana, others have chosen only to remind their members of the importance of evidence-based medicine and the lack of evidence about the benefits and risks of this substance. Patients who believe that marijuana is an effective treatment for certain symptoms from which they suffer can apply to Health Canada for authorization to possess and use marijuana under the Marihuana Medical Access Regulations (the Regulations). These Regulations require the patient to submit two declarations, one of which is the patient’s and the other a Medical Declaration signed by the patient’s physician. Symptom categories Under the Regulations, the symptoms patients may want to treat by using marijuana are grouped into two categories:
Medical Declaration forms The first page of the Medical Declaration has the following note: “It is within the professional purview of the medical practitioner to decide to support an application to access marihuana for medical purposes. A medical practitioner is not obliged to sign in support of an application.” A physician who decides to support an application should complete only the appropriate Medical Declaration: Form B1 for Category 1 symptoms or Form B2 for Category 2 symptoms. Both forms require the physician to state the symptoms being treated and the condition with which they are associated. The physician also must confirm that conventional treatments have been ineffective or are not appropriate for this particular patient. Form B2 also requires the physician to state that the patient has been assessed by a specialist in a field of medicine relevant to the patient’s condition. This includes the specialist’s name, specialty and date of assessment. The physician must also confirm that the specialist is aware that treatment with marijuana is being considered. If the physician signing the Declaration is a specialist in the appropriate field, then only the physician’s specialty designation needs to be provided. Under the current Regulations, physicians are required to indicate in their Medical Declaration the daily amount, form and route of administration that the applicant [patient] intends to use. The physician is also required to sign a photograph of the patient, certifying it a true likeness of the individual. CMPA’s Release from Liability form The Regulations require applicants (patients) to declare they have discussed the risks with the physician who signs the Medical Declaration. Some physicians may not be comfortable with this approach, from a process or a knowledge standpoint. The CMPA recommends that physicians who complete the Medical Declaration request the patient to sign the CMPA's “Release from Liability” form. Physicians may want to retain a copy of this form for future use. Important notice to Québec physicians: The College in Québec recommends Québec physicians limit their involvement in Health Canada's access to marijuana program to the signature of medical certificates setting out the patient's health condition. The CMPA's “release from liability” form is not applicable to Québec physicians in light of article 11 of the Québec's Code of Ethics of Physicians, which states: 11. A physician must, in the practice of his profession, assume full civil liability at all times. He may not elude or attempt to elude, nor request that a patient or person renounce any recourse taken in a case of professional negligence on his part. Should you require additional information regarding the College’s position regarding physician participation in the program or the implications of article 11 of the Code of Ethics, please contact the College in Québec. Risks to physicians College investigations and notification The Regulations permit the federal minister of health to provide information to the physician’s provincial or territorial College in response to a request from the College. This can also be done if the minister believes, on reasonable grounds, that the physician has contravened a rule of practice of his/her College; has been convicted of an offence involving a specified drug; or has made a false statement on a Medical Declaration. A College may also ask for and receive information about a physician who has simply made an application for licensure. Patient complaints Despite the note on the first page of the Declaration indicating that a physician is not obliged to support the application, patients may still complain or try to take other action against physicians who do not support the use of medicinal marijuana for the patient. Furthermore, even if a physician explains the risks and uncertainty regarding the use of marijuana, patients who later believe they have suffered harm associated with the use of marijuana might still try to blame their physician. Physicians should document the rationale for decisions taken and of any consent discussions. Additionally, the CMPA recommends member physicians request the patient to sign a “Release from Liability” form as described above. Minimizing risk Physicians are not obliged to prescribe, recommend, or assist patients to obtain treatments that they believe, on sound medical grounds, to be inappropriate. Physicians are expected to know and comply with the regulations and policies of their College. Physicians contemplating providing the Medical Declaration for a patient may wish to consider the following: Before deciding to support the application for use:
If the physician supports the application:
Documentation:
The bottom line
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DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.
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