Transcript Regulating medical assistance in dying in canada

Rels 300 / Nurs 330
March 2016
REGULATING MEDICAL
ASSISTANCE IN DYING IN
CANADA
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Chronological Overview
1.
6 February 2015 – SUPREME COURT OF
CANADA decision
◦ Carter v. Canada (Attorney General), 2015 SCC 5,
[2015] 1 S.C.R. 331
2.
10 December 2015 – GOVERNMENT OF
QUEBEC
◦ BILL 52, passed in Quebec's National Assembly in
June 2014, took effect in Dec. 10, 2015
3.
13 January 2016 – College of Physicians &
Surgeons of Nova Scotia
◦ Standard of Practice: Physician-Assisted Death
 Draft Guideline passed
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In the Courts
15 June 2012: British Columbia Supreme Court
decision – prohibition is unconstitutional
Carter v. Canada (Attorney General)
10 October 2013: British Columbia Court of
Appeal decision – prohibition is not
unconstitutional
Carter v. Canada (Attorney General)
6 February 2015: SUPREME COURT OF CANADA
decision – prohibition is unconstitutional
Carter v. Canada (Attorney General)
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1. Summary of the SCC Decision
“Section 241(b) and s.14 of the Criminal Code
unjustifiably infringe s.7 of the Charter [of Rights
and Freedoms]… for a competent adult person
who
1) clearly consents to the termination of life and
2) has a grievous and irremediable medical
condition (including and illness, disease or
disability) that causes enduring suffering that is
intolerable to the individual…”
Unanimous decision of all 9 SCC Justices
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CRIMINAL CODE OF CANADA
Suicide
Counselling or aiding suicide
241 Every one who
(a) counsels a person to commit suicide, or
(b) aids or abets a person to commit suicide,
whether suicide ensues or not, is guilty of an indictable
offence and liable to imprisonment for a term not
exceeding fourteen years.
R.S., 1985, c. C-46, s. 241; R.S., 1985, c. 27 (1st Supp.), s. 7.
http://laws-lois.justice.gc.ca/PDF/C-46.pdf
“The prohibition on physician-assisted dying
infringes the right to life, liberty and security of
the person in a manner that is not in
accordance with the principles of fundamental
justice.”
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CANADIAN CHARTER OF RIGHTS AND
FREEDOMS [1982]
s. 7. Everyone has the right to life, liberty and
security of the person and the right not to be
deprived thereof except in accordance with
the principles of fundamental justice.
http://laws-lois.justice.gc.ca/eng/const/page-15.html
“The prohibition on physician-assisted dying
infringes the right to life, liberty and security of
the person in a manner that is not in
accordance with the principles of fundamental
justice.”
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Therefore,
The law prohibiting physician-assisted dying is
invalid;
 The law contravenes the constitutional right to life,
liberty and security of the person and thus is
unconstitutional.
The Supreme Court of Canada issued a “declaration
of invalidity” which would be suspended [postponed]
for 12 months
 The Government of Canada had 12 months to
reintroduce a law which would not contravene
constitutional rights

◦ After the federal election, the government requested a 6month extension
◦ The Court allowed a 4-month extension
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Why did they make this ruling?



An individual’s “response to a grievous and
irremediable medical condition is a matter critical
to their dignity and autonomy”
There is no substantial difference between
requesting a physician’s assistance in dying and
requesting palliative sedation, or refusing artificial
nutrition and hydration, or requesting the removal
of life-sustaining medical equipment
If patients are able to make informed decisions
about withholding and withdrawing life-sustaining
interventions, then they are able to make similar
decisions about assistance in dying
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10 December 2015 –
GOVERNMENT OF
QUEBEC:
BILL 52
Bill 52
AN ACT RESPECTING END-OF-LIFE CARE
Parliament of Quebec
 Passed in the National Assembly in June 2014
 Came into effect on 10 December 2015
 Unsuccessfully appealed – Quebec’s Court of
Appeal decision rendered on 22 December
2015
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(excerpts)
[A] “person of full age who is capable of
consenting to care may, at any time, refuse to
receive, or withdraw consent to, a life-sustaining
treatment or procedure; the refusal or withdrawal
may be expressed by any means.
“The physician must ensure that such a decision is
made freely and provide the person with all
information needed to make an informed
decision, in particular information about other
therapeutic possibilities, including palliative care.”
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MEDICAL AID IN DYING
26. Only a patient who meets the following
criteria may obtain medical aid in dying:
(1) be of full age, be capable of giving consent
to care and be an insured person within the
meaning of the Health Insurance Act…;
(2) suffer from an incurable serious illness;
(3) suffer from an advanced state of irreversible
decline in capability; and
(4) suffer from constant and unbearable physical
or psychological pain which cannot be relieved
in a manner the person deems tolerable.”
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Responsibilities of the Physician
the patient meets the criteria
 the request is being made freely and without
any external pressure
 the request is informed
 persistence of suffering
 the wish to obtain medical aid in dying persists
 discuss the patient’s request with any members
of the care team who are in regular contact
with the patient
 discuss the patient’s request with the patient’s
close relations, if the patient so wishes
 consult with a 2nd physician

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Responsibilities of the Physician (cont’d)
“If a physician determines…that medical aid in
dying may be administered to a patient
requesting it, the physician must administer such
aid personally and take care of the patient until
their death.
“If the physician determines that medical aid in
dying cannot be administered, the physician
must inform the patient of the reasons for that
decision.”
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COLLEGE OF PHYSICIANS & SURGEONS OF
NOVA SCOTIA
STANDARD OF PRACTICE:
PHYSICIAN-ASSISTED DEATH
DRAFT GUIDELINE PASSED – 13 JANUARY 2016
http://www.cpsns.ns.ca/portals/0/pdfpoliciesguidelines/draft%20standard%20of%2
0practice%20-%20physician-assisted%20death.pdf
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(excerpts)
Patient criteria for physician-assisted death:
 The patient must be an adult;
 The patient must be capable of giving consent to
physician-assisted death;
 The patient’s decision…must be made freely,
without coercion or undue influence;
 The patient’s decision…must be informed;
 The patient must have a grievous and
irremediable medical condition;
 The grievous and irremediable medical condition
must cause enduring suffering that is intolerable
to the patient.
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(excerpts)
Patient’s fulfillment of criteria must be:

Confirmed by at least 2 physicians

If suffering is caused by a mental illness, one of
the physicians must be a psychiatrist

Request for assisted death must be in writing

Either of the 2 physicians may prescribe or
administer the medication to the patient
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“No physician can be compelled to
prescribe of administer medication for the
purpose of physician-assisted death.”
“If a physician is unable to participate in
physician-assisted death for reasons other than
conscience (such as for reasons of personal
illness, lack of availability, or lack of expertise),
the physician must make an effective referral for
any patient requesting physician-assisted
death.”
“If a physician is unwilling to participate in
physician-assisted death for reasons of
conscience, it is recommended that the
physician make an effective referral for any
patient requesting physician-assisted death.”
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Regarding CONSCIENCE…
Why do you think the draft guidelines say
that in cases of inability to participate in
physician-assisted death
A physician MUST make an effective
referral
Whereas in cases of unwillingness to
participate in physician-assisted death
due to conscience
It is RECOMMENDED that a physician
make an effective referral?
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Update: The Supreme Court
Ruling on Physician-Assisted
Death
By The Canadian Nurses Protective Society –
May 2015
https://canadiannurse.com/en/articles/issues
/2015/may-2015/update-thesupreme-court-ruling-onphysician-assisted-death
Once new legislation permitting medically assisted
death is enacted, “nurses will have to determine
whether their own ethical or religious values are
consistent with providing care to a patient who
has made the choice to end his or her life.”
In situations where there is a conflict of
conscience, “the nurse provides safe,
compassionate, competent and ethical care until
alternative care arrangements are in place to
meet the person’s needs and desires.”
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