In February of 2015, the Supreme Court of Canada ruled that the ban on physician-assisted dying violated the constitutional rights of grievously, irremediably ill people who are dealing with enduring suffering. They gave the federal government one year to create legislation guiding access to physician-assisted death. The ban currently stands until February 6, 2016, although the government has just received a four-month extension from the Supreme Court in order to allow the recently elected government to conduct more extensive consultations in preparation for eventual legislation.

While 84% of Canadians have said they support physician-assisted dying, and a majority of CARP members are also supportive, it is important for governments to consult various stakeholders and draft legislation that balances issues of rights, access, and safeguards.

Provincial Expert Advisory Group Report on Physician-Assisted Dying

The federal government’s legislative development process is ongoing, but provincial and territorial governments have already conducted consultations on the issue. In order to hear from a broad variety of stakeholders, the provinces and territories appointed an advisory group of clinical, legal, and ethical experts to provide non-binding advice to Ministers of Health and Justice.  On November 30, 2015, this advisory group released its report through Ontario’s Ministry of Health & Long-Term Care, including 43 recommendations on how governments can best implement physician-assisted dying. The report is available in full here, and a summary of key recommendations can be found below.

The panel also sought submissions from over 250 stakeholder groups, representing health care providers’ associations, health institutions, professional regulators, faith-based organizations, patients’ rights groups, academic experts, and other social and legal advocates, including CARP. The ultimate goal of these consultations was to hear as many perspectives as possible, reviewing key questions and concerns related to issues such as eligibility criteria, conscientious objection, procedural safeguards, access, and oversight.

Key Recommendations from Expert Advisory Group on Physician-Assisted Dying

Many of the advisory group’s recommendations focus on issues of equity and access, with the ultimate goal of ensuring that Canadians who qualify and want access to physician-assisted dying are able to do so regardless of their financial means or place of residence. Other recommendations address concerns about safety and consent, suggesting oversight processes and multi-step consultations between patient and physician.

Examples of the Expert Advisory Group’s recommendations include:

• Provinces and territories should work with the federal government to create and implement a pan-Canadian strategy for palliative and end-of-life care, including physician-assisted dying (PAD).
• Access to both physician-administered and self-administered PAD should be available and publicly funded across Canada.
• An extensive case review and system oversight process should be created.
• The Criminal Code should be amended to protect physicians and other health professionals who assist in providing PAD.
• Substitute decision-makers should not be given the authority to authorize PAD on behalf of an incompetent patient.
• Governments should not attempt to create lists of specific medical conditions that qualify as “grievous and irremediable,” and define the term broadly as a very severe illness, disease, or disability that cannot be alleviated by any means acceptable to the patient.
• Access to PAD should be available only to those eligible for publicly funded health services.
• Health professionals who conscientiously object to providing PAD should be required to inform patients of all end-of-life options, including PAD, but should have mechanisms available to transfer their patients to PAD-providers.
• There should be no mandatory “waiting period” between an initial request for PAD and the signing of a patient declaration form.
• Non-faith-based institutions must provide PAD at their facilities, and faith-based institutions must either allow PAD or arrange for safe and timely transfer of patients to PAD providers.
• Provincial review committees and a pan-Canadian commission should be established to ensure PAD providers comply with relevant legislation and regulatory standards.
• Professional organizations, regulatory authorities, and universities should develop appropriate education and training for medical students related to providing PAD.
• Governments should fund public campaigns about PAD to educate citizens and engage them in developing end-of-life care policies and legislation.

An Adult Conversation About End-of-Life

As governments prepare to draft legislation and regulations related to physician-assisted dying, they must be conscientious of a variety of issues, voices, and concerns. To this end, CARP encourages open, mindful discussion and debate on the issue of end-of-life care. Families stand to benefit from having adult conversations about end-of-life care. CARP members have held panel discussions on end-of-life care to encourage open conversation on this complex issue, and CARP recommends that families discuss end-of-life options, needs and decisions with family members and their doctors. To support Canadians’ end-of-life needs, CARP calls for the development of a national palliative care strategy, and an increase in funding for palliative and hospice services.

CARP will continue to monitor consultation on physician-assisted dying legislation across Canada, and update members regularly on new developments.