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For some doctors, the act is simply too distressing, he said.

“We’re seeing individuals, or groups of physicians who are participating and really feel like they’re alleviating pain, alleviating suffering,” Blackmer said.

And then we’re seeing doctors who go through one experience and it’s just overwhelming, it’s too difficult

“And then we’re seeing doctors who go through one experience and it’s just overwhelming, it’s too difficult, and those are the ones who say, ‘take my name off the list. I can’t do any more.’ ”

The act is performed out of care and compassion, Blackmer said. “But for most (doctors), it doesn’t make the psychological impact of that final, very definitive act, any less than it would be for anybody.”

However, eight months after legalized doctor-assisted suicide took effect in Canada, doctors who have carried out the act say the issue is far less about moral or psychological angst than it is about the legal ambiguities and uneasiness involved.

“I’m sure that there have been maybe a handful of physicians that have done this and decided they didn’t want to do it again — who, for moral reasons, on reflection said, ‘you know what? This isn’t something I’m comfortable with,’ ” said Dr. James Downar, a critical care and palliative care doctor with Toronto’s University Health Network.

However, Downar said the far bigger issues are the paperwork and bureaucracy involved, finding the medications and someone able to administer them, faith-based hospitals refusing to play any part in assisted-death requests, scrutiny and scorn from colleagues opposed to assisted dying and confusion over who, exactly, qualifies.