Physician-Assisted Dying & the Michael Garron Hospital: Let’s Start a Conversation

By Dr. Kevin Workentin, Maureen Taylor, PA & Lorrie Hamilton, RN
 
Many of you will have followed the story last week of the Ontario man known only as A.B., who had advanced lymphoma and applied to the courts for the right to have a physician help him die. He was granted that right on March 17, 2016. He exercised it the very next day, which spoke to the intolerable suffering he experienced.
 
Carter Decision
With the Supreme Court of Canada’s (SCC) ruling on physician-assisted dying (PAD), now widely known as the Carter decision, Canada will join the ranks of other jurisdictions in Europe and the United States where patients who meet certain strict criteria will have the right to access medicines that will end their life.
 
The ruling comes into effect for all Canadians on June 6th, although medically-assisted deaths have been allowed to proceed in Quebec since January, as that province had already passed provincial legislation. In addition, the SCC said that patients in other provinces who meet the criteria for an assisted death now, and feel they cannot wait until June 6th, could apply to the courts for an exemption. This is how A.B. had his request granted.
 
Protecting the Vulnerable
While this is unchartered territory for Canadians, there are almost two decades of experience with assisted dying in Oregon, Switzerland and the Netherlands. The SCC relied heavily on evidence from those other jurisdictions when it ruled unanimously to strike down the Canadian law prohibiting medical aid in dying. The SCC was satisfied that there was no evidence of a so-called “slippery slope” in those jurisdictions and that law makers in Canada could come up with adequate safeguards to protect the vulnerable.
 
Two panels of experts, one federal and one provincial/territorial, have issued reports to provide governments and regulatory colleges with recommendations on how medically assisted dying should be implemented. The federal department of justice is currently reviewing all of the recommendations as well as the SCC decision and it’s expected that Ottawa will table legislation in the House of Commons in the next few weeks.
 
The MGH Task Force
Here at MGH there was recognition that while the Carter decision presents many challenges, both morally and operationally, the reality is that after June 6th, this will be a legal option for patients who meet the criteria. While this is certainly a time to pause and reflect on our own perceptions of what it means to die with dignity, we must also begin to prepare for the legalization in a few months.
 
With an emphasis on responding to the changing health needs of our community, a Task Force was struck to consult, explore and create a framework on how PAD could be delivered to patients once the new law comes into effect.
 
Recently we engaged clinical staff, including physicians, nurses, interprofessional health providers and medical learners at MGH in an online survey. We are gathering their views and perspectives on this issue.
 
We wish to stress that the SCC decision protects the religious and conscience rights of individual health care professionals who do not want to participate in the provision of PAD. Our Task Force will certainly be recommending that these rights be respected.
 
At the core, Patients
All of us at MGH have the best interests of patients uppermost in mind when we provide care.
 
We respect patients’ autonomy when it comes to decision-making.
 
We support their decisions even when they may not be in sync with our personal beliefs.
 
And we have every confidence that as we face the challenges of honouring the wishes of patients who seek assistance in dying, we can do so with the same spirit of respect and caring as we do in other ethically-difficult medical situations.
 
As patients approach the end of their life, the Carter decision has required us all to reassess our responsibilities as a health care community. Physician-assisted death can only exist in the context of a system that has accessible, timely and expert palliative care. As a result, a main focus of the PAD Task Force is to ensure improved access, awareness and use of this very important service.
 
Over the next few weeks our Task Force will be holding a series of one hour discussions for staff on PAD and how it will be accommodated at our hospital. As we head into this unfamiliar territory, it will be a time to review how PAD works in other jurisdictions and share updates on the federal and provincial legislative developments.
 
Most importantly, it will be a chance for all of us to reflect on how we can provide the best patient-centred care to our community.
 
More Information
If you would like to read more about physician-assisted death, please see:
 
Special Joint Committee on Physician Assisted Dying
 
Provincial/Territorial Report
 
Federal Expert Panel on Options for a Legislation Response to Carter vs. Canada
 
College of Physicians and Surgeons of Ontario Interim Guidelines on Physician Assisted Death
 
Guidelines for Nurses from the College of Nurses of Ontario
 
Guidance to Pharmacists from the Ontario College of Pharmacists