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Hacking and spewing, I dragged myself to the doctor last week, fearing I had bronchitis. While she was listening with her stethoscope to the rattling sounds in my chest, I asked what she would do if I were really dying, instead of merely feeling like death. It is the conversation we should all be having with our primary care doctors – if we are lucky enough to have one – before fate deals its inevitable blow.

The new federal government has asked for an extension to the Supreme Court ruling that will decriminalize physician-assisted death in early February, one year after the top court handed down its unanimous decision granting patients, who are grievously and irremediably suffering, the right to ask a doctor to help them die. In this legislative vacuum, provincial and territorial Colleges of Physicians and Surgeons have been struggling to establish end-of-life care regulations for doctors.

Not surprisingly, there is a startling lack of consistency across the land and no official body is speaking on behalf of patients. That's why you should be doing your own inquiries while you are still healthy enough to change doctors if necessary.

Quebec will implement its medical aid in dying legislation in less than a month, offering a continuum of care from palliation through euthanasia. It's way ahead of the rest of the country. That doesn't mean that every doctor or even every publicly funded health-care institution is onside. At least two hospices, Maison Michel-Sarrazin in Quebec City and the West Island Palliative Care Residence near Montreal, have announced, in defiance of Quebec legislation, that they will not offer full service medical aid in dying. A shift may be starting with the recent decision by Maison Aube-Lumière in Sherbrooke to allow physician assisted death, although only in "exceptional circumstances," according to CEO Elizabeth Brière, and only for patients dying of cancer. That's a step in the right direction but one that is not in compliance with either the Supreme Court decision or Quebec legislation.

British Columbia is woefully behind, even though it is the home province of both Sue Rodriguez and Gloria Taylor, standard-bearers in the two historic legal challenges to allow suffering patients a choice in the timing and manner of their deaths. B.C. has yet to become an active member of the Ontario-initiated Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, the coalition that is trying to develop recommendations for a uniform system of end-of-life care services, across most of the country.

Late last month, B.C. Premier Christy Clark's majority government voted down the physician-assisted death recommendations of its own Select Committee on Health, including suggestions that the province assess whether its current legislation is legally binding and that it work with other provinces and territories to "ensure interjurisdictional harmonization" of physician-assisted death. As Judy Darcy, Opposition health critic and deputy chair of the committee said: "Within three months, patients and doctors may be faced with the most heart-rending decisions of their lives, with no government light to shine the way."

Fortunately, I live in Ontario, not B.C. (I also live in an urban centre, which offers me even more advantages over rural areas). That sounds smug, I know, but my point is to raise awareness about the deplorable inequity of choice and services in this country. My doctor, who admits to "still thinking through" her own position on physician-assisted death, directed me to her colleague, the redoubtable Jean Marmoreo, runner of marathons and community health advocate. At 73, Marmoreo has decided to switch her emphasis from birth to death. Beginning in January, she will be the go-to doctor in the practice for palliative care and physician-assisted death for the 12 other physicians in their family practice clinic in Toronto. She will take the time to have sensitive and sometimes difficult conversations with patients and families and be on call two days a week to help people die, as she once helped them deliver babies. She admits it will be a challenge. "The scope is enormous," Marmoreo says. "This is about doing really solid family care practice." And that's what got her into medicine in the first place.

Follow me on Twitter: @semartin71

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