OTTAWA — Health Minister Jane Philpott says provincial guidelines do not provide enough clarity and protection to physicians who may be asked to help their patients die, suggesting people will have trouble finding a doctor to assist them.
"Doctors may have inadequate protection and I expect in these early days, many physicians will be extremely reluctant to provide assistance to patients wanting medical assistance in dying," Philpott told a roomful of health-care professionals in a speech to the National Health Leadership Conference on Monday.
The minister reminded the audience that doctor-assisted dying is about to become legal — effective at midnight tonight, her office said — after the federal government missed a Monday deadline set by the Supreme Court for enacting a law in response to its ruling on physician-assisted death.
Health Minister Jane Philpott speaks at the HealthCareCAN and the Canadian College of Health Leaders' National Health Leadership Conference in Ottawa on Monday, June 6, 2016. (Photo: Sean Kilpatrick/CP)
"Unfortunately, despite tremendous effort, this bill is not yet in place," Philpott.
"That means that, effective tomorrow, you may be asked to do something that has never been expected of you before — to help people end their lives. It's a daunting prospect."
Medical regulators in every province have already issued guidelines for physicians on providing assistance in dying, based on the eligibility criteria outlined by the court.
Those rules impose safeguards similar to — and in some cases, even stronger than — those proposed in the government bill, C-14.
But Philpott said those guidelines are not enough.
"Effective tomorrow, you may be asked to do something that has never been expected of you before — to help people end their lives."
"While I have faith in Canada's health-care providers to carry out these responsibilities responsibly and ethically, I believe that regulatory guidance alone is insufficient, given the nature of what you will be asked to do," Philpott said.
And those guidelines do not apply to everyone, Philpott said.
"Nurses, pharmacists and others who assist doctors will not have the guidance or protection they need," she said.
She also noted the guidelines vary from province to province.
"We will have a patchwork approach to protection of the vulnerable, as safeguards vary across the country," she said.
"We will lack standard criteria for who is eligible," she said.
Draws from her experience as a doctor
Philpott reminded the room that she, too, is a doctor and has experience helping patients deal with end-of-life issues.
"Like many of you, I have spent many hours with people who are suffering. Like many of you, I have watched people die. Some of those deaths, I will never forget," said Philpott, who also devoted a significant portion of her speech to the need for better palliative care.
She later declined to tell reporters what her advice would be to fellow doctors on whether to proceed with physician-assisted dying without legislation in place. She said they should contact their professional associations for advice. She urged the doctors to continue voicing their support for C-14, which is now in the Senate.
Senators are expected to hear today from renowned constitutional expert Peter Hogg, who will say C-14 does not comply with the Supreme Court ruling because it restricts access to people who are already near death.
Philpott told reporters the bill is constitutional.
"We firmly support the fact that this piece of legislation is compliant to the Charter of Rights and Freedoms of Canada, that it responds in an appropriate and responsible way to the Carter decision and there has been no shortage of consultation with experts," she said.
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A look at some jurisdictions where right-to-die laws are in place. (Information courtesy of The Canadian Press)
A right-to-die bill was adopted last year, the first legislation of its kind in Canada. The law, scheduled to go into effect in December, stipulates that patients would have to repeatedly ask a doctor to end their lives on the basis of unbearable physical or psychological suffering. They would have to be deemed mentally sound at the time of the requests. The law, however, is being challenged in court by two Quebec-based groups on the grounds that it undercuts sections of the Criminal Code that outlaw assisted suicide and euthanasia. The federal government has expressed its opposition to the legislation but is named as a defendant in the court challenge because it is responsible for the Criminal Code.
The results of a referendum made Oregon the first U.S. state to make it legal for a doctor to prescribe a life-ending drug to a terminally ill patient of sound mind who makes the request. However, doctors cannot administer the life-ending drugs and the patient must swallow them without help. Patients must state three times -- once in writing -- that they wish to die, and those statements must be made at least 15 days apart. They must also obtain a concurring opinion from a second doctor that they have less than six months to live and are of sound mind. The law took effect in late 1997, and through June, 2014, just over 800 people had used the law.
The state became the first in the U.S. to allow a person's right to die through legislation rather than through a court decision or a referendum result. Vermont's law, which took effect in May 2013, is closely modelled on the system in Oregon and uses the same safeguards. Patients must state three times, including once in writing -- that they wish to die. They must also obtain a concurring opinion from a second doctor that they have less than six months to live and are of sound mind.
In January 2014, a judge ruled that competent, terminally ill patients have the right to seek their doctors' help in getting prescription medication if they want to end their lives on their own terms. The state's attorney general is appealing the ruling, and a decision on whether it will be upheld is expected later this year.
A referendum saw the state enact right to die legislation in 2008. As in Oregon, patients with less than six months to live must administer the doctor-prescribed lethal medication on their own. According to a government report, 549 people applied for the right to die between 2009 and 2013. Of those, 525 actually took their own lives.
In 2009, the state's Supreme Court ruled that Montana's public policy supports mentally competent, terminally ill patients being able to choose aid in dying. Physicians are allowed to prescribe medication that patients must administer themselves. More detailed legislative bills have been introduced in the state but have not passed. The court ruling still stands today, but data about its usage is not available.
A law passed in 1942 forbade anyone from helping someone kill themselves for selfish reasons. As a result, people arguing that they are assisting with a suicide for unselfish motives are not considered to be committing a crime. Suicides can be assisted by people other than doctors and no medical condition needs to be established. Switzerland is the only country that allows foreigners to travel there for the purpose of ending their own lives.
In the Netherlands, euthanasia is legal under specific circumstances and for children over the age of 12 with parental consent. In Europe, patients don't have to prove that they have a terminal illness -- establishing unbearable suffering is usually sufficient. Dutch doctors are allowed to perform euthanasia if a patient whose unbearable suffering has no hope of improvement asks to die with a full understanding of the situation. A second doctor must agree with the decision to help the patient die.