I attended a presentation to the community on physician-assisted death. The panelists included Sudbury lawyer Michael Hennessy and Health Sciences North bioethicist Mary Huska. It also included Dr. Rachel Haliburton, an associate professor of philosophy at the University of Sudbury.
The audience had many questions. In fact, eventually, the moderator had to tell the audience that they were free to go home.
Let me bring you up to date. In a 9-0 decision, the Supreme Court struck down the nation’s century-old law against assisted suicide 12 months ago. But it suspended its ruling for one year, until Feb. 7, 2016, to allow the federal and provincial governments time to come up with legislation, rules and regulations.
Hopefully, differences between provinces will be minimal so people will not have to go to other provinces because they offer better options. Quebec’s legislation takes effect at the beginning of December.
The court limited physician-assisted death to individuals who consent to the termination of life and have a grievous and unalterable medical condition or disability that causes enduring suffering that is intolerable to the individual.
The nature of the suffering may include physical or psychological pain. The person’s condition need not be at the end of life. The patient must be competent. If the patient is not competent, no one else may give consent.
In contrast, in 1993, the Supreme Court of Canada denied Sue Rodriguez’s appeal for assistance with taking her own life by a vote of five to four — what a dramatic change in legal opinion over 22 years.
Some physicians are conscientiously opposed to physician-assisted dying. The court acknowledged the right of physicians to refuse to give aid in committing suicide.
Canadian law already allows the administration of pain medication and sedatives with the intent of relieving pain and distress. It is already legal to refuse artificial feeding and fluids, to refuse life-sustaining medical treatment and if begun, for its removal.
All these acts need to be done with the approval of the patient or his/her substitute decision-maker. The treatment team cannot initiate them unilaterally.
The availability of physician-assisted suicide provided peace of mind to many dying people in Oregon, Washington and Vermont, where assisted death is legal. It turned out many individuals never actually found it necessary to resort to taking the drugs that were provided.
The drugs were there in case they could no longer cope with the pain and distress of their medical condition.
Most of the time what was needed, and is still needed, is the ensured availability of first-class palliative care. It is ironic Canadians will soon have a right to assisted suicide, but no right to quality palliative care.
It is all about the the lack of guaranteed access to trained health-care professionals to manage the pain, as well as the psychological, social and spiritual distress caused by illness.
The majority of Canadians do not have access to such care. Most will have to die in hospital due to inadequate community resources to support death at home.
It is a scary prospect that prompts the call for assisted suicide. If all individuals with terminal illness received quality end-of-life care, the incentive to shorten lives would be greatly reduced.
Update on Physician-Assisted Death
Historically, it has been a crime in Canada to assist another person to end his or her own life. The Supreme Court of Canada unanimously determined that a total prohibition on physician-assisted death was unconstitutional. This ruling goes into effect on Feb. 6, 2016.
The federal government has just asked the Supreme Court for a six-month delay, in order to draft new laws on doctor-assisted dying. Lawyers for the Attorney General of Canada pleaded for more time, saying that drafting new laws will be a top priority for the government.
Not to be left behind, the College of Physicians and Surgeons of Ontario has just issued guidance for physicians. The physician must be satisfied that the patient’s decision has been made freely, without undue influence. He must assess the patient, whether he/she meets the criteria for physician-assisted death. A waiting period of 15 days, followed by a second request for physician-assisted death, is advised.
Once the decision is made to proceed, the assisting physician may provide the patient with instructions and pills to end his/her own life. Alternately, the physician may be directly involved in administering injections that will end life rapidly.
Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective.
