Dr. David Amies: Many questions loom over assisted dying bill, but it's not all bad

June 6 has come and gone, but the doom and gloom that was threatened if Bill C-14 was not passed by the deadline has yet to arise. While questions still remain over assisted dying in Canada, provincial regulators have stepped forward to provide leadership and guidance in the midst of so much uncertainty. In his latest blog post, Dr. David Amies outlines how each province is regulating assisted dying and what might be next for Bill C-14.

O Canada! June 6 has come and gone, and Bill C-14, the Liberal government’s proposed new law surrounding medical aid in dying (MAID), is bogged down in the Senate. Some colleges of physicians and surgeons across the country have issued advisories for their members on the wisdom of providing MAID in the absence of federal law. The Canadian Medical Association and the Canadian Medical Protective Association are counselling great caution lest their members get caught up in criminal prosecutions. The Alberta provincial government has issued a directive stating that physicians who provide MAID in accordance with the Carter decision will not be prosecuted. So, three days later, we have a situation that is both good and bad in parts. To coin a phrase, all of this was reasonably foreseeable!

Provinces step in

At the time of writing, Alberta is leading the way in clarity. Its government has instructed prosecutors and police not to attack any member of the medical team involved in an assisted death of a mentally competent and severely ill adult. Perhaps the most important part of this directive is the phrase, “any member of the medical team.” This wording should fully allay the fears of pharmacists who supply the drugs necessary and nurses who are called in to assist the physician.

The registrar and chief executive officer of the College of Physicians and Surgeons of Manitoba issued statements to its members on June 6, urging its members to consider obtaining legal advice should they be asked to provide MAID. The college also suggests that its members who belong to the Canadian Medical Protective Association seek its advice before acting. Of course, nothing in this statement has any bearing on the conduct of nurses or pharmacists in the matter. In short, it is advising Manitoba doctors to be very cautious in the absence of federal legislation.

On June 6, Ontario's Minister of Health and its Attorney General acknowledged that medical assistance in dying (MAID) is now permissible in Ontario by reason of the Supreme Court of Canada’s Carter decision. They counselled all healthcare providers to consult with their regulatory bodies about rules surrounding MAID before going ahead. Generously, they said that the province would pay for any necessary drugs. They promised to establish a referral service that would enable healthcare professionals who are reluctant to take part in MAID for personal reasons to connect patients with other professionals who have no such qualms. Lastly, they advised patients seeking MAID and healthcare professionals willing to provide the service to apply to the Ontario Superior Court of Justice to ensure that the circumstances surrounding the particular case are compliant with the Carter decision.

Newspaper reports dated June 9 indicate that the governments of British Columbia and Newfoundland and Labrador are working on statements similar to that of Alberta’s. Of course, Québec has already introduced its own made-in-Québec laws.

Tremendous uncertainty

Thus, the situation across the country is very mixed. It is one thing to have physicians ready, willing and enabled to provide MAID, but without the pharmacists on board, doctors would be stymied because they would not be able to obtain the necessary drugs. Ontario's suggestion that seriously ill patients seek clarification from the courts is very easy to say but not nearly as easy to do. The costs involved could be very considerable. Were I faced with seeking an escape from a hopeless medical position, the last thing I would need is a complex and costly legal palaver. Moreover, I doubt I would be alone in holding this point of view.

It is impossible to say how long the parliament is going to take to resolve the quandary with Bill C-14. The Senate is meant to be the chamber of sober, second thought and in this case it looks as if that is how it is behaving. The Senate has every right to amend the bill given to it by the lower house, which in turn, has every right to reject or amend the amendments. In which case, the Senate is obliged to review the changed bill once more. Several journalists have described such a dance macabre as legal ping pong. Apparently, there is a process, very seldom used, where the two houses could meet jointly to consider the bill. 

We live in interesting times! Watch this space!

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.

(Photo credit: Véronique Debord-Lazaro/Flickr)


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