Forced transfers for medical assistance in dying

We work to understand — and raise awareness about — the impacts of allowing healthcare facilities to ban assisted dying on their premises.

Assisted dying has been legal in Canada since 2016. It is important to note that it is the only medical treatment to have been recognized as a right by the Supreme Court, enshrined in federal legislation, and incorporated as an insured healthcare service in every province and territory. But we’re only now getting a glimpse of the challenges that stand in the way of Canadians looking to exercise their right to die with the help of a doctor or nurse practitioner.

One of the most significant barriers to access is the practice of forced transfers for assisted dying. That’s when a healthcare facility requires a person who requests assisted dying to go off-site to receive — or even be assessed for — medical assistance in dying (MAID).

What are the consequences of allowing public healthcare facilities to ban assisted dying on their premises? The major impacts on suffering people, their families, and their clinicians include:

Requiring already-suffering people to endure gruelling transfers. Keep in mind that people who qualify for medical assistance in dying are some of the most vulnerable, physically compromised patients in the healthcare system. These are usually people who, under different circumstances, would only be moved as a last resort. Yet, despite their fragile health, they are being transferred — sometimes over long distances — because the facility where they live refuses to allow the provision of MAID on-site.

Separating the person from their community of care. Forced transfers often strip the suffering person away from the team of people who are responsible for their day-to-day care. If the person is living at a long-term care residence, it means that they have to leave their home in order to access their right to an assisted death. This can be traumatic not only for the person requesting MAID, but also for their loved ones and caregivers.

Delaying — and sometimes denying — access to MAID. When a facility bans assisted dying on its premises, it can create unreasonable delays for residents who request MAID. That’s because coordinating transfers can be challenging, especially if the person is receiving complex care. It is not uncommon for the person to lose capacity, or die without medical assistance, while awaiting a transfer or while a transfer is in progress. In some regions, people are told that if they are very frail or ill they may not be able to receive medical assistance in dying due to the challenges associated with transferring people with complex healthcare needs. Thus, in some cases, forced transfers effectively deprive otherwise-eligible Canadians of their right to an assisted death and make access to that right more unequal.  

Violating clinicians’ rights by denying them the option of participating in MAID. Healthcare professionals with a conscientious or moral objection to assisted dying do not have to provide it. Forcing them to do so would contradict the values laid out in the Canadian Charter of Rights and Freedoms. But what about clinicians who feel a moral duty to participate in MAID but who work in a facility where it is not allowed? Are their rights being infringed upon and are they being discriminated against because of their beliefs? We don’t have the answer, but we believe it’s important for us to understand the ethical implications of preventing healthcare professionals from playing an active role in the legal provision of assisted dying.

Dying With Dignity Canada’s role

As the leading organization working to protect Canadians’ end-of-life rights, we continue our work to understand the prevalence and the impacts of forced transfers for assisted dying. These efforts include:

With your help, we will continue to study — and speak out about — the consequences of forced transfers for assisted dying, so the public and decision-makers are aware of the impacts on your rights.