Will access to assisted dying be consistent across Canada?

A lack of leadership on the part of the outgoing federal government left Canada's provincial governments and medical regulators to corral themselves in developing new rules for assisted dying. The result, writes DWD Canada Physicians Advisory Council member Dr. David Amies, may be a regulatory patchwork in which residents in some provinces have fair access to their right to die with dignity, while others do not.

The situation that has arisen following the Carter v. Canada Supreme Court decision, handed down in February this year, leaves matters surrounding physician assisted dying (PAD) in a right mess. The former federal government was obviously unhappy with the Supreme Court’s perceived activism and chose to do nothing for several months. In July it appointed a panel to look into the matter and loaded its membership with known opponents of PAD. Almost immediately afterwards, the writ was dropped for the general election. That set off the longest campaign for generations and effectively stymied the work of the panel.

The election is now over and a new Liberal government is in process of being formed. The Liberals have been out of power for nearly 10 years; they have a new, very young and untried leader; all kinds of very important overseas conferences on the agenda and several other pressing matters that must be dealt with as soon as possible. Quite naturally, our new masters will be running round finding out how the levers of powers work and deciding who is going to feed the Parliament Hill cats and be responsible for turning the lights on and off. The Supreme Court’s February 6 2016 deadline for new legislation looks highly unlikely to be met.

Different jurisdictions, different rules

The Canadian Medical Association and several provincial Colleges of Physicians and Surgeons have issued advice to the medical profession about how PAD might work. It is hardly surprising that these separate pieces of advice to the profession do not coincide precisely. The Province of Quebec has drafted its own legislation, which is ready to roll. Consequently, we are in grave danger of having a regulatory bugger’s muddle in place when February 6 next rolls round. For instance, there could be a situation where a person, desirous of availing herself of PAD, lives in one part of Lloydminister and can find suitable and willing physicians when her friend living on the other side of town cannot, simply because the city sits astride a provincial boundary and different rules might apply in neighbouring administrations.

Dying with Dignity Canada has spent a good deal of time and effort trawling through the various pronouncements and recommendations uttered by the CMA and the Colleges and has found a number of disturbing positions. It looks as if many in the medical profession will be unwilling to be part of PAD. This is unsurprising for physicians have been taught that disease is an enemy that must be fought and that death represents a failure of technology. Many in the profession consider that the Hippocratic oath forbids them to deliberately take the life of a patient. Several may claim that they have been enjoined, "First, do no harm." In fact, that saying forms no part of the oath and was coined by English surgeon and author Thomas Inman in the Nineteenth Century. Anyhow, for whatever reason, there are bound to be many who will refuse to be a party to the process of PAD. Their views must be respected.

Unfortunately, there is no close agreement among the colleges about how unwilling physicians should act when faced with a request from a patient for help with dying. It would be callous indeed, just to tell the patient to go elsewhere. On the other hand, the unwilling physicians might consider that he or she was being coerced if they found themselves under some regulatory obligation to refer to an amenable colleague.

Should institutions have a right to opt out?

There is little clarity about how the moral views, held by operators of healthcare institutions, may impact their patients seeking PAD. Consequently, a person who is being cared for in a Catholic-run facility, for example, might find that those in charge were just not prepared to allow PAD to take place in their premises. The consequences for a gravely sick person who happens to be in such an institution could be most distressing. 


Dr. David Amies.

No reasonable person can deny that all should be entitled to hold their own moral, ethical or religious views on PAD. Managers of Catholic institutions will undoubtedly have special ideas about the probity of PAD. However, their institutions may well be in receipt of public funds, which funds come with no special sectarian strings attached. The question then arises about the hierarchy of rights accruing to the patients in such institutions and those who are running them. Surely, it would not be reasonable for the managers of a dissenting facility to insist on the transfer of a terminally sick person simply on doctrinal grounds.

In summary, then, Colleges, the Canadian Medical Association and provincial health care facility regulators have not yet managed to frame coherent policies to cope with the problems posed by reluctant physicians or health care institutions, whose managements have ethical objections to PAD. Persons at the end of their tether due to serious, terminal illness do not wish to face complex rules and regulations in order to secure their desire to end their lives. There is a need governments and regulatory bodies to work together and produce a simple, straightforward policy that can be understood by all and that does not require a parcel of lawyers to step forward to make sense of it. The original constitution of the United States of America was contained by seven pages. Surely, the various governments and licensing authorities in Canada can draft an even shorter document to cover the necessary rules, regulations and provisions necessary to ensure that dying with dignity can be safely and legally available to all who desire it.

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

(Header photo credit: Samuel Duval/Wikipedia)

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