Juliet Guichon, Christopher Doig and Ian Mitchell are professors in the Cumming School of Medicine, University of Calgary.
The Supreme Court of Canada’s unanimous decision on Friday means that soon doctors (and only doctors) may lawfully help competent adults, who are grievously and irremediably ill, to end their lives.
Even though this litigation began in 2011, and is likely to cause fewer than 1 per cent of all Canadian deaths annually, our country is probably not ready for this momentous event.
Symbolically, this decision changes Canada. It forces acceptance of the fact that for some people who suffer terribly and have no prospect of adequate relief, death is not feared but welcomed. Physicians, who have traditionally preserved life, may soon take the lives of consenting patients. Although many people – including many doctors – agree with the decision, others do not like this change and some people are afraid.
On a practical level, only Quebec has legislation to address such fear. The Supreme Court acknowledged that Parliament and the provincial legislatures may choose to respond by passing laws consistent with the judgment, reconciling the Charter rights of patients and physicians.
Ideally, these governments should work together to regulate assisted dying despite the challenges of developing legislation rapidly. Ordinarily, politicians might avoid such a politically contentious matter. But given the societal changes this judgment has engendered, politicians simply must act and physicians should help.
First, we must reduce fear. Since the litigation began, we have heard health care providers and some members of the public express significant fear. Some people incorrectly believe that this decision will disproportionately affect the elderly, and include the killing of infants or the mentally infirm.
Anecdotal health care stories report families where younger members attempt to make adverse surrogate medical decisions to gain access to the patient’s money sooner rather than later. Although many senior citizens are relieved to have choice at the end of life, others worry that the decision, if not properly legislated, could increase their vulnerability.
Some physicians are conscientiously opposed to physician assisted dying, and though the Supreme Court of Canada acknowledged their right to refuse, some doctors are afraid of being forced to participate.
Such fears will prove ill founded with proper regulation. Provincial legislatures must act quickly by stipulating through legislation and accompanying regulations how physician assisted dying will be conducted. At least five jurisdictions in the United States and Europe have experience and law that can serve as precedent.
This task will be daunting. According to the Canadian Medical Association (CMA), the challenges have been understated because the consequences are grave and resources are constrained. Nevertheless, the CMA has consulted the Canadian public and doctors, and medical associations in permissive jurisdictions to devise possible protocols for Canada.
Physicians should continue to be engaged because Canadians tend to have great confidence in the medical profession; they expect physicians to help devise wise, insightful and workable rules for health systems and would welcome their assistance to legislators here.
Given the enormity of the task of ensuring that those, and only those, who qualify under the Supreme Court decision actually receive medical aid in dying, we recommend the establishment of a joint medical committee to establish draft regulation and standards on physician assisted dying, which must meet immediately.
More specifically, we propose that:
1. The CMA collaborate with other national medical organizations such as the Canadian College of Family Physicians, the Royal College of Physicians and Surgeons of Canada and the Canadian Society of Palliative Care Physicians;
2. These physicians form a committee and include a representative from each of the Canadian Nurses Association, Canadian Pharmacists Association and the Canadian Bar Association;
3. The committee have between eight and 12 members, balancing a variety in professional background against the need to be timely in making concrete recommendations;
4. The CMA fund the work of the committee and a small secretariat;
5. The committee be independent of its funding source;
6. The committee members immediately make themselves knowledgeable about the judicial ruling and the evidence on which it was based, and the regulatory regimes in permissive jurisdictions, especially Quebec;
7. The committee propose regulation of physician assisted dying and medical standards for the provinces and territories other than Quebec;
8. The committee attend to the values expressed in the reasons for judgment of the majority of the Supreme Court of Canada judges (respecting autonomy, alleviating suffering and protecting the vulnerable, such as the bullied and the depressed); and
9. The committee offer draft regulations and standards for review or adoption by federal, provincial and territorial governments and colleges of physicians and surgeons.
We believe physician members of national medical organizations that represent and educate physicians should do what doctors do well – respond to a circumstance not of their making in a learned, professional, practical and timely way to protect the vulnerable, and welcome the help of other professionals.
Legislating physician assisted dying is bound to be difficult. Canadians will undoubtedly be comforted to know that politicians have been offered the assistance of physicians and other professionals to get this right.Report Typo/Error
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