Monday, June 6 is a day that has been circled on many Canadians’ calendars. On June 6 it will no longer be a crime for a physician to provide medical assistance in dying to those who fit the criteria as they were set out in the Supreme Court’s unanimous decision in Carter v. Canada. Many Canadians have been wondering what will happen if Bill C-14, the current piece of legislation addressing medical assistance in dying, is not passed by June 6. In this post I’d like to address some of those concerns.

In its decision, the court delayed striking down sections 14 and 241(b) of the Criminal Code to allow legislatures enough time to enact a Bill. The decision, however, does not say that legislatures are required to create legislation. As a result, the June 6 deadline is not the deadline for Parliament to pass Bill C-14 by. It is the date that the current sections of the Criminal Code will no longer be valid in cases of medical assistance in dying.

The Ministers of Health and Justice as well as some expert witnesses that we heard from insisted that it is necessary for a law to be in place by June 6. They have said that, otherwise, there will be a legal void and that there would be inadequate safeguards governing medical assistance in dying if Bill C-14 isn’t passed by June 6.

The Federation of Medical Regulatory Authorities of Canada, the colleges of physicians and surgeons in each province, and regulatory bodies of nurses and pharmacists have all been working on creating guidelines to address medical assistance in dying if Bill C-14 isn’t passed by June 6. The guidelines created by provincial medical regulators are detailed and comprehensive and give each organization’s members the guidance on how to move forward with medical assistance in dying.

Provincial regulations will govern how medical assistance in dying is administered until Bill C-14 passes. These regulations are based on the parameters set out in Carter vs. Canada. Some provincial guidelines include robust safeguards that are fairly similar to those outlined in Bill C-14. In British Columbia for example, two independent physicians must assess the patient and agree that the patient meets the criteria set out by the Supreme Court. Also, in British Columbia a formal written request must be signed by the patient and an independent witness must observe this.

Bill C-14 is a piece of legislation that is of enormous consequence. It is essential for Parliamentarians to give it the appropriate amount of time, effort, and rigorous study that it deserves. Although there won’t be any federal legislation governing medical assistance in dying if Bill C-14 does not pass by June 6, there will be considerable provincial regulations that outline eligibility criteria and safeguards.

Below you’ll find some key points that are included in the guidelines governing medical assistance in dying that have been established by provincial colleges of physicians and surgeons. These are broken down by province. Nunavut and the Northwest Territories are currently working on their guidelines.

Alberta:

  • Two doctors must independently agree the patient meets all criteria set out by the Supreme Court.
  • Patient must be “competent throughout the process.”
  • No advance requests.
  • The college notes that legal precedent recognizes mature minors as adults in their ability to consent but recommends “a careful and conservative approach” to mature minors.
  • Doctors may refuse to provide MAID but have “an obligation” to provide patients with timely referrals to doctors who will perform the service.
  • Requests must be in writing, signed by the patient and two witnesses, at least one of whom can not be related to the patient, entitled to any portion of the patient’s estate or involved in treatment of the patient.
  • Where capacity is unclear or where a person is suffering from depression or other mental illness, a psychiatric or psychological consult is required.
  • A period of reflection of 14 days from initial request to final consent is recommended.

British Columbia:

  • Two independent physicians must agree a patient meets the criteria set out by the Supreme Court.
  • The patient must be eligible for publicly funded health care, able to give free and informed consent throughout the process.
  • No advance requests.
  • The patient must consistently express a desire for MAID over a “reasonable period of time” — 15 days in most cases but dependent on each patient’s condition and circumstances.
  • Formal written request required, signed by the patient and one witness who is not related, entitled to a portion of the patient’s estate, or involved in treatment.
  • Physicians may refuse to provide MAID but they must provide “an effective transfer of care.”

Manitoba:

  • At least two physicians must independently agree the patient meets the Supreme Court’s criteria. Adult is defined as 18 years of age.
  • Independent psychiatric assessment required where a patient does not have a terminal illness (prognosis of less than six months) or is not suffering from a “catastrophic and irreversible physical injury” or intractable physical pain or an advanced state of irreversible, significantly impaired function or imminent decline to that state. The assessment must rule out a treatable psychiatric disorder that is impairing patient’s ability to tolerate suffering or assess treatment options.
  • Each doctor must meet at least once with the patient to ensure that the patient is competent, fully informed and that the decision to terminate life “a clear and settled” choice, without undue coercion or influence.
  • No advance requests.
  • A waiting period of at least seven days, except for those whose death is imminent.
  • Written consent, signed by the patient.
  • Physicians may refuse to provide MAID or to refer a patient to another doctor but must provide “timely access to a resource” that will provide the necessary information.

New Brunswick:

  • Patient must meet criteria set out by the Supreme Court, which is further defined as suffering from a grievous illness for which there is no cure and which will eventually cause death.
  • The college notes that MAID could theoretically be available to any patient who can legally consent. In N.B., the age of legal consent is 16.
  • Patients with progressive illnesses who are also suffering from “intractable depression” are not automatically ineligible but doctors should proceed with “extraordinary caution” in such cases.
  • Physicians may refuse to provide MAID or to make a direct referral but must provide patients with information on accessing MAID.
  • Doctor must be satisfied that patient’s wish is “persistent, consistent and unshakable,” documenting patient’s request for MAID at least twice, two weeks apart, and again just before administering MAID.
  • No advance requests.
  • Administering physician should obtain additional medical opinions as deemed appropriate to confirm prognosis, alternative options, and patient’s capacity to make a free, fully informed choice.

Newfoundland and Labrador:

  • Two doctors must agree a patient meets the criteria set out by the Supreme Court. Adult is defined as at least 19 years of age.
  • No advance requests.
  • Written request required, signed by patient and one independent witness.
  • Physicians may refuse to provide MAID but should provide “timely access” to another doctor or information resource that is available and accessible to the patient.

Nova Scotia:

  • Two doctors must agree a patient meets criteria set out by the Supreme Court. Adult is defined as at least 19 years of age.
  • No advance requests.
  • Physicians may refuse to provide MAID for reasons of conscience but college recommends they provide “an effective referral” to another doctor.

Ontario:

  • Two doctors must agree the patient meets criteria set out by the Supreme Court. College recommends that only patients in Canada, covered by publicly funded health care, be eligible. It notes that the court did not define the term “adult.”
  • No advance requests.
  • Physicians may refuse to provide MAID but must make an “effective referral” of the patient to an available, accessible physician or agency that will.
  • An unspecified waiting period is required, length depending on the patient’s condition.
  • A formal written request is required, signed by the patient, the attending physician and an independent witness.

Prince Edward Island:

  • Two doctors must agree the patient meets the criteria set out by the Supreme Court. Must have a current provincial health care card and the capacity to freely and repeatedly consent throughout the process, up to the time of dying. Adult is defined as at least 18 years of age.
  • Request must be in writing, witnessed by two independent persons with no connection to the patient.
  • Doctor must ensure patient has repeatedly expressed a desire for MAID “over a reasonable period of time,” which may vary depending on patient’s condition.
  • No advance requests.
  • Physicians may refuse to provide MAID but must provide, or arrange to be provided, the patient’s chart to other physicians.

Quebec:

  • Quebec is the only province that has enacted a law governing MAID. The law, drafted before the Supreme Court ruling, requires that:
  • A patient must be covered by provincial health care, be of “full age” and capable of giving consent, be at the end of life, suffering from a serious and incurable illness, in an advanced state of irreversible decline and experiencing constant and unbearable physical or psychological suffering which can’t be relieved in a manner acceptable to the patient.
  • Two doctors must agree patient meets the criteria for MAID.
  • Request must be made in writing.
  • No advance requests.
  • Physicians may refuse to provide MAID but must immediately notify authorities who will take steps to find another doctor.

Saskatchewan:

  • Two doctors must agree the patient meets the criteria set out by the Supreme Court. Adult is defined as at least 18 years of age.
  • Patient must repeatedly give free, informed consent throughout the process, up to the time of dying.
  • No advance requests.
  • Attending doctor must ensure the patient has consistently expressed a desire for MAID “over a reasonable period of time,” the length of which is dependent on the patient’s condition.
  • Physicians may refuse to provide MAID but must arrange “timely access” to another doctor or resource.
  • Patient must fill out a prescribed form confirming informed consent to receive MAID.

Yukon:

  • Two doctors must agree the patient meets criteria set out by the Supreme Court. The Yukon Medical Council notes that it is uncertain if MAID could be legally available to minors.
  • Patient must maintain decision-making capacity throughout the process, up to time of dying.
  • No advance requests.
  • Written request for MAID required, signed by patient and two witnesses, one of whom is not related, entitled to any benefit from the patient’s estate or involved in the provision of treatment.
  • If a physician believes the patient suffers from psychiatric or psychological disorder or depression that could impair capacity to make an informed choice, the patient must be referred for assessment.
  • A waiting period of 14 days is recommended.
  • Physicians may refuse to provide MAID but must arrange “timely access” to another doctor or resource.

Source: The Canadian Press

 

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