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Manitoba letter-writing toolkit

After completing the College’s online survey, you may wish to share additional comments by sending an e-mail to PAD@cpsm.mb.ca

We encourage all of our Manitoba supporters to participate and help influence the regulatory process for physician assisted death. Here is an outline to help you craft a powerful message to the College. Take a look.

"Dear College of Physicians and Surgeons of Manitoba,  

Summary of your letter (optional)

In two or three bullet points summarize your main thoughts on the CPSM’s Draft Statement .  Sample starter prompts may include:

“Manitoba residents deserve a compassionate and patient-centred approach to physician assisted dying.” 

OR

“I have some concerns that the Manitoba College’s approach in the Draft Statement may endanger a patient-centred approach to physician assisted dying.”

The body of your letter

Using clear, concise language, tell the College of Physicians and Surgeons of Manitoba that there are a few important considerations that need to be addressed in their Draft Statement with regards to physician assisted dying in the province. 

For more background on Dying With Dignity Canada’s proposals for legislation, please see our 2015 Draft Policy Framework.

In your own words, you may wish to highlight the following concerns, which relate specifically to the College’s Draft Statement

1. You are concerned that the College does not require doctors who decline to provide a physician assisted death when requested by a patient, with a duty to refer or to provide information to that patient about physician assisted dying.

At the very minimum, physicians who refuse to provide assisted death must be required to refer patients who request it to another doctor or referral agency (should one exist) to ensure their patients are not abandoned. 

Physicians cannot expect that someone who is grievously and irremediably ill will have the ability to find another willing doctor to help them end their suffering. Patients who are suffering intolerably generally do not have the physical wherewithal to seek out willing physician on their own. They should not be left to their own devices in their search for a peaceful end to their lives. Such a situation is tantamount to patient abandonment. No physician will be required to provide physician assisted dying against their will, but any person choosing to practice medicine has obligations to their patients. The physician’s right to conscience must be balanced with the patient’s right to a peaceful death.

It is a standard practice in health care for doctors to provide information about medical treatments and options if a patient requests. Therefore, it is troubling that the College’s Draft Statement implies that declining doctors may not have to provide information about physician assisted dying should a patient request it.

2. You would like the College to state where physician assisted dying can occur. It is discussed in the survey but not in the Draft Statement.

Patients who have a medical condition that causes them to face enduring and intolerable suffering should not have to move out of their home communities to access a peaceful death. We believe that patients should be able to receive a physician assisted death where they choose whether it is at an institution or at home.  

Some institutions will struggle with the thought of allowing a service they believe to be at odds with their mission or ideology. In the case of a clash between institution's rights and patient's rights, the rights of patients must come first. No publicly funded institution should be able to deny a patient or resident their right to access a peaceful death.

3. Ask The College to amend the responsibilities of the assisting physician not to include confirmation of diagnosis.

DWD Canada supports the requirement that two doctors separately assess the competency of any patient who requests a physician assisted death.

We have noted that the Draft Advice requires that a second physician also confirm a patient’s diagnosis and prognosis. 

DWD Canada believes that the role of the second physician includes confirming that the patient’s condition is grievous and irremediable. In some situations this will not be through diagnosis but through discussion with the attending physician and review of the medical records. This is critical because some diagnoses may require a specialist to be detected, and this could present an unreasonable barrier to timely access, particularly in remote locations.

As such, it is not appropriate that a new second diagnosis and prognosis be mandatory. It is sufficient that the first diagnosis be confirmed.

Use personal experience. Include a personal story to illustrate why you’re passionate about making sure the College’s approach to physician assisted dying is compassionate. Did you watch a loved one suffer in agony through a drawn-out terminal illness? Do you fear that you will face a similar fate? Or were you simply inspired by the late Gloria Taylor, who fought for years for British Columbians to have the right to die with dignity? We learned from Quebec that personal stories were crucial in motivating legislators to vote for choice.  

Include your professional qualifications or background, if appropriate. Do you have a background in healthcare? If so, note it. In addition, state how your work has shaped your perspective on end-of-life care. If you don’t work in healthcare, feel free to state your professional background too. The government is asking for the input from people from all walks of life — not just doctors and nurses.

Your conclusion

Briefly summarize the main points of your letter. In a sentence or short paragraph, reiterate the main points you made in the executive summary.

Finish your letter by thanking the Working Group with the College of Physicians and Surgeons of Manitoba for their consideration. A little kindness goes a long way.

Sincerely,

[Your name]

Did you find this useful? If so, please consider donating to DWD Canada so we can continue to create resources to help you Voice Your Choice.


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DWD Canada's 2015 Election Platform: A Call for Compassion

The time is tight and the stakes are high. What happens in the next few months will determine how Canadians die for decades to come. 

We need a federal government that will respect and uphold the decision of the Supreme Court in Carter v. Canada. We need a federal government that will protect the vulnerable without creating unreasonable barriers for individuals seeking access to dying with dignity. We need a federal government that will meet the Supreme Court’s deadline of February 6, 2016, so that those who are suffering unbearably need not endure agonies of waiting for relief that doesn’t come.

National Leadership

What We Need the Next Federal Government to Do

Canada’s next federal government must show strong support for the Supreme Court’s decision to allow physician assisted dying. It is not critical that the federal government legislate, but if they do legislate, it must be to uphold the Supreme Court’s decision, not undermine it. We need the next federal government to commit to working with the provinces to ensure universal access to assisted dying for the grievously ill. The next federal government needs to be guided by evidence, not ideology. If they do legislate, it must be to protect the vulnerable without creating unreasonable barriers for individuals seeking access to dying with dignity.

Timing is everything

February 2016 is drawing closer. There are too many people who have already waited too long for the chance to have a peaceful death. A few weeks or even months may not seem significant, but when you are suffering, even an hour can be an eternity. We need a federal government that commits to implementing assisted dying without further delay.

Despite their best efforts, it may not be possible for a new federal government to bring in legislation prior to the February 6, 2016 deadline. The next Parliament should do its best to table fair and just assisted dying laws in a timely manner, without asking the Supreme Court for an extension. 

If a new government cannot meet the court’s deadline, assisted dying can occur without federal legislation. This is a better option than increasing the burden on those who are grievously ill by making them wait even longer for a peaceful release from their suffering.

Background

A Landmark Decision from the Supreme Court

On February 6, 2015, the nine justices of the Supreme Court of Canada unanimously struck down the federal prohibition on physician assisted dying (PAD), arguing the old law violated the Canadian Charter of Rights and Freedoms

The Carter v. Canada ruling gave decision-makers until February 2016 to prepare for the decriminalization of assisted dying. It also established guidelines for determining who can access PAD and how it could be safely administered.

When the decision takes effect on February 6, 2016, it will no longer be illegal for a doctor to help a competent adult end his or her own life, so long as the patient is experiencing intolerable, incurable suffering as a result of a grievous medical condition that results from illness, injury or disability.

The Political Process to Date

Eight months have now passed since the Supreme Court’s decision. After months of inaction, the Conservative Government appointed a panel of three to consult with Canadians and report back. Two of the three members of the panel have been outspoken opponents of the right to die with dignity, providing testimony in the Carter case against it.

The Conservative government then released an “issues book” to obtain information from Canadians. DWD Canada asserts that this questionnaire is designed to manufacture fear, not to solicit information. For example, a question about eligibility asks whether someone should have access to assisted dying because they fear being a burden or if they are 16 years old. Both of these situations are clearly outside of the scope of the Supreme Court's decision.

The Supreme Court decision allows the federal government or the provinces to legislate; Both can, neither has to do so. If no legislation is forthcoming, physician assisted dying will be decriminalized but not legalized. The provinces can take the lead on legislating, but this may present some challenges to the right to access PAD if the they do not develop a harmonized approach.

Fortunately, the provinces have since joined forces in an Ontario-led initiative to create their own nation-wide consultation. Dying With Dignity Canada believes that the provincial panel provides a balanced approach to PAD with experts representing patients, doctors, nurses, lawyers and ethicists from across the country.

Where the Rubber Hits the Road

The Supreme Court’s decision was a tremendous boost for the cause of the right to die with dignity, but alone it is not enough.  The language from the Supreme Court’s decision must be clearly defined consistent with the spirit of the Court’s ruling.

The Supreme Court’s Decision must be affirmed, not undermined 

Dying With Dignity Canada has laid out a comprehensive policy framework that applies equally to federal and provincial legislation as well as to provincial and territorial regulators.

First and foremost, we need to ensure that any regime respects the principles laid out by the Supreme Court. This means that assistance to die must be available for competent adults with grievous and irremediable medical conditions who are suffering unbearably. Assistance must be available through the prescription of life-ending medication the patient takes themselves (sometimes called assisted suicide) or by the direct administration of life-ending medication (also known as voluntary euthanasia).

Any regime must also respect physicians’ rights of conscientious objection. No physician can be asked to prescribe or administer medication if they choose not to do so.

Definitions of interpretations of the Supreme Court’s language must be clear and objective:

How is competency assessed?

Physicians make assessments of competence every day. Do we need a higher standard of competency testing in the case of PAD?  We believe that an individual who is competent to make decisions regarding other aspects of healthcare and their life in general is also competent to make decisions about the end of their life.

In recognition of the special nature of PAD, we support the involvement of a second physician who also assesses the competency of the patient.

How do we define a grievous medical condition?

A “grievous” medical condition is one that results in unbearable suffering. The decision regarding what constitutes such suffering is for the individual to make. Suffering that for some people is ennobling, for others might be unbearable. To decide otherwise is to infringe on the autonomy of an individual.

How do we define an irremediable medical condition?

In order to fulfil the criterion of being ‘irremediable’ available options and remedies must have been explored to a reasonable extent and the person requesting PAD must have found them insufficient. It is normal practice for a physician to discuss options for treatment with any patient, and it is up to the patient to decide whether or not to agree to any of them.

The person requesting PAD must remain in control of this process and their final decision regarding whether the offered remedies are sufficient or acceptable must be respected. 

How do we define enduring suffering that is intolerable?

Enduring is a term open to some debate as it includes a component of time. This means that some people might argue that the suffering has to have gone on for some time before it becomes ‘enduring.’ At DWD Canada we believe this approach to be cruel. It is sufficient to know that the suffering has endured for an extended time or will endure for a long time or will endure until death. 

Suffering should be considered intolerable if it is deemed by the sufferer to be so. 

Legislation or regulation must address three critical areas of implementation:

In addition there are three key areas that must be addressed:

1. Safeguards should be reasonable, but not excessive.

Governments must not undermine the Supreme Court’s decision by legislating onerous barriers to access rather than reasonable safeguards. Having a second physician confirm a patient’s competence is a reasonable safeguard. Judicial reviews of every request, or requiring signoff from a patient’s entire family, are not.

2. Nonparticipating physicians and pharmacists must provide effective referrals.

Doctors may decline to provide assisted dying and pharmacists may opt out of filling prescriptions. But they cannot abandon their patients. The onus is on the healthcare provider to ensure the patient’s charter right to an assisted death is honoured.

3. Patients need to be able to die wherever they live.

Hospitals, hospices, long-term care facilities and seniors’ residences cannot be allowed to prevent a willing doctor from assisting an eligible patient who chooses to have assistance to die.

three-major-barriers.jpg

There are two types of risks to individuals which must be balanced:

Risks fall into two groups. Either access to PAD is so restricted that eligible individuals continue to suffer or it is too loose and individuals who choose PAD would not have done so under a more restrictive regime. These must be balanced and mitigated to the extent possible.

1. Risk of insufficient access to PAD

The first is the risk to those individuals who wish to have PAD but are denied it and suffer unnecessarily. This has been all too common over the years and is the reason so many thousands of Canadians are supporters of DWD Canada. This risk must not be ignored. It is one of the reasons the Supreme Court ruled unanimously on this issue. Any legislation must address this.

Any legislation must ensure that the person requesting PAD is not forced to suffer any longer than is absolutely necessary.

2. Risk of insufficient safeguards for PAD

The second risk is that individuals may die before they really want to. This can happen in three ways.

a. Individuals may be pressured into requesting PAD when they do not really want it. This risk is usually brought up by those concerned about pressure on people with disabilities or those with greedy or uncaring relatives. It must be noted that all of the people requesting PAD must be competent adults who are suffering. The individual requesting PAD is a competent adult and we must not devalue their expressed wishes.

Jehovah’s Witnesses currently claim their right to refuse blood products even when such procedures would easily extend their lives. We may not agree with their decision but we accept it as we recognize that autonomy is the cornerstone of our medical system.

b. Individuals may fall victim to a physician who ends their lives without their consent. This is extremely rare but serious. For this reason any case of PAD requires open record keeping and must be available for public scrutiny.

c. Individuals may request PAD during an acute illness which is likely to be short term; This is not possible given the SCC requirement of a condition being grievous and irremediable. Short term illnesses are, by definition, remediable.

 


Voice Your Choice on Nov. 4: Find a rally where you live

No more dithering. No more delays. No pleading to the Supreme Court to put off the implementation of its historic decision.

“Get your act together” will be the clear and unmistakable message we send to our political leaders on our National Day of Action on Nov. 4, 2015. While our supporters spread the word at rallies across the country, we will deliver our demands for new assisted dying legislation to the incoming Parliament.Voice Your Choice for fair and just assisted dying laws.

Spread the word online, attend a rally or host one of your own.

See all events

Election report card: Where the federal parties rank on physician assisted dying

Now we're beyond the halfway point of the 2015 federal election campaign, the major parties' positions on physician assisted dying are becoming clearer. Three of the four major players responded to DWD Canada's request for a position statement on end-of-life chance, and a couple of the leaders have answered reporters' questions about assisted dying on the campaign trail.

DWD Canada has assessed what the parties have (and haven't) said about assisted dying to come up with a grade for how they are performing. Higher marks were awarded to parties who have committed to prompt action on implementing the Supreme Court's decision on assisted dying and to those who state they will not ask the high court to postpone the date when the ruling is set to come into effect (beyond the current Feb. 6, 2016 deadline). Conversely, failing to respond to DWD Canada's request for a statement on assisted dying and their handling of the file in government earned the Conservatives the lowest mark of the pack.

Keep in mind the following while perusing the report card: grades can change because, for all the parties involved, there is always room for improvement.


Conservative Party of Canada

Prime Minister Stephen Harper

Prime Minister and Conservative Party leader Stephen Harper. (Photo: Remy Steinegger/Wikipedia)

The incumbent Conservatives have a poor track record on assisted dying, one that has persisted into the ongoing election campaign. After the Supreme Court’s Feb. 6 decision, the federal government waited five months to officially announce it had convened a panel of researchers to conduct a public consultation on end-of-life choice. The appointment of two panelists who had previously testified in court against the right to physician assisted dying raised alarm bells about the consultation’s credibility. And in August, the panel launched its “online issues book” to survey Canadians on their views on assisted dying — however, the documents appears to have been designed to manufacture fear rather than to gather a diverse array of experiences and opinions.

The Conservatives were the only major federal party that did not respond to DWD Canada’s request for a policy statement on physician assisted dying.

Key quote: “This is a sensitive issue for many Canadians, with deeply held beliefs on both sides. We will study the decision and consult widely with all perspectives on this difficult issue.” —Statement to CTV News, August 2015

Grade: D-


New Democratic Party

NDP leader Thomas Mulcair

NDP leader Thomas Mulcair. (Photo: New Democratic Party/Flickr)

The NDP’s position embeds physician assisted dying within the spectrum of healthcare at end of life and they have committed to making palliative care a priority as well. On Sept. 11, leader Thomas Mulcair said an NDP government would work as quickly as possible bring new assisted dying legislation to a free vote in Parliament.

However, Mulcair also said that, if elected Prime Minister, he may have to ask the Supreme Court to delay the implementation of its decision — a move our organization strongly opposes.

Key quote: “New Democrats have been clear that any discussion of physician-assisted death must include a broader conversation about end of life care.” – Statement to DWD Canada, August 2015

Grade: B+


Liberal Party of Canada

justin-trudeau-852.jpg

Liberal leader Justin Trudeau. (Photo: Alex Guibord/Flickr)

After the Supreme Court announced its ruling in Carter v. Canada, the Liberals introduced a motion to strike an all-party committee to study assisted dying and provide recommendations to Parliament. The motion was defeated by the governing Conservatives.

The Grits remain committed to striking a special committee of MPs to study the issue, which could further delay the tabling of new federal legislation. Leader Justin Trudeau has not said whether a Liberal government would ask the Supreme Court to delay the implementation of its ruling.

Key quote: “Quebec’s experience shows us, reassuringly, that respectful and responsible deliberation is possible. It reminds us that when political parties set aside their differences in service of the public good, cooperation can follow. Consensus can be found. Even on an issue as complex and sensitive as end-of-life care.” —Statement to DWD Canada, August 2015

Grade: B+

Green Party of Canada

Green Party leader Elizabeth May

Green Party leader Elizabeth May (Photo: Green Party of Canada/Wikipedia)

The Greens were the first federal party to adopt an official party position in support of physician assisted dying. In addition, leader Elizabeth May was a joint-seconder to two assisted dying Private Member’s Bills from Conservative Stephen Fletcher.

The party’s leadership on the issue has continued during the federal election. They have committed to reconvening Parliament immediately after the vote in order to draft new assisted dying legislation. And they have said there is no excuse for missing the Supreme Court’s deadline of February 6, 2016.

Key quote: “Green MPs will support changes to the Criminal Code to allow for physicians to assist death within the framework laid out by the Supreme Court of Canada.” —Statement to DWD Canada, September 2015

Grade: A

(Banner image: Adobe Stock)


Where do your candidates stand on physician assisted dying?

Help us find out where your local candidates stand on the issue of physician assisted dying.

DWD Canada has developed a questionnaire for you to use when you're talking with the contenders in your riding. Survey the candidates at a local debate, ask them over the phone or pose the questions by e-mail — whatever works. When you’ve received a response, send us the results and we’ll post the names of the candidates who have responded to this very page.

Here’s a step-by-step guide on what to do:

  1. Download the DWD Canada Candidate Questionnaire and print out several copies (one for each candidate you plan to ask.)
  2. Present your candidates with the questions and write down their answers on the sheet. You can do this in person — at a local debate or campaign office, for example — or you can pose the questions over the phone. Please let them know that the responses will be published on our website.
  3. If your candidates fill out the questionnaire (or you record their answers), please scan it and email it to the Dying With Dignity Canada office here at: political@dyingwithdignity.ca. You can also mail it directly to our office (but please send an email right away to let us know):

55 Eglinton Avenue East
Suite 802
Toronto, ON
M4P 1G8

We will add their name to our website and send out tweets thanking those candidates who have stepped up in support of enlightened and practical physician assisted dying.


Questions for candidates

Top questions:

1. If you are elected as my Member of Parliament and there is a free vote in the House of Commons, will you support legislation that reflects letter and the spirit of the Carter decision for the right to die with dignity?

2. Are you willing complete DWD Canada's Political Candidates Questionnaire?

Other questions to ask:

1. Will you oppose any delay in implementing physician assisted dying (PAD) beyond February 6, 2016, regardless of whether legislation has been passed?

Preferred Response: Yes, although legislation may not have been passed into law, it is important that on February 6, 2016, Canadians have access to PAD in accordance with the guidelines set out in the Supreme Court of Canada decision.

2. The Supreme Court of Canada’s decision allows for physician assisted dying by both: a) Physician administration of life-ending medication; and b) providing prescription for life-ending medication. Will you ensure that both of these options are available to all Canadians?

Preferred Response: Yes, both administration and prescription should be included in any written legislation. Some people will be unable to self-administer life-ending medication and others may simply prefer to have a doctor administer their medications directly. 

3. Will you support reasonable safeguards but oppose unreasonable barriers to access for physician assisted dying?

Preferred Response: Yes. While it is essential that we ensure the vulnerable are protected, it is also vital that eligible Canadians who want an assisted death can receive one in a timely manner.

An example of a reasonable safeguard would be the involvement of a second physician, or a reasonable waiting period (say three weeks) for non-terminal patients.

Unreasonable safeguards would include excessive waiting periods, reviews by external bodies or requirements for approval from anyone other than the individual themselves.

4. How will you ensure patient choice, patient care and equality of access?

Preferred Response: All individuals who qualify for physician assisted dying should have timely access. If an individual’s primary doctor chooses not to provide an assisted death, a duty to refer will be implemented. Eligible patients across Canada should be transferred into the care of a willing doctor in a timely manner, and they should not be required to travel in order to access PAD.

5. As you understand it, what are the core components that will be required legislatively to ensure the spirit of the Supreme Court of Canada decision in the Carter case?

Preferred Response: To uphold the spirit of the Carter decision, the following criteria must be met:

  • access for competent Canadians with a grievous and irremediable medical condition (including an illness, disability or disease)

  • the option for either the prescription or administration of life-ending medication

  • physician and pharmacists are required to make effective referrals so patients are not abandoned

  • reasonable, but not overly burdensome, safeguards

What are you prepared to do to ensure access to physician assisted dying?

Preferred Answer: (Open-ended question. Look for assurances that the candidate is interested in promoting PAD.)


Another group of resources


Advance Requests and Dementia

8 in 10 Canadians agree: You should have the right to make advance requests for assisted dying.


FAQ