TORONTO — The practice of physician-assisted dying should be publicly funded by Canadian provinces, available to adults of any age, and not put doctors at risk of criminal prosecution, an expert advisory panel said Monday.
The recommendations were among 43 in the final report from the Provincial-Territorial Expert Advisory Group, which was formed with input from 10 of the country's 13 provinces and territories.
The proposed guidelines found instant favour among advocates for doctor-assisted death, who praised the panel for navigating a quagmire of competing policy concerns without losing sight of patients' needs.
"There's been a number of conflicting views from various parties,'' said Wanda Morris, chief executive of Dying with Dignity Canada. "I think they've done a great job of reconciling those differences and ultimately putting patients at the centre of the health care system."
While the group's recommendations are not binding, they are expected to be influential as Canada prepares to act on a Supreme Court ruling that legalized physician-assisted dying across the country.
"Access to physician-assisted dying should not be impeded by the imposition of arbitrary age limits."
Last February, the nation's highest court overturned its previous ruling on the issue and recognized the right of clearly consenting adults who are enduring intolerable physical or mental suffering to end their lives with a physician's help. It also gave Parliament a year to craft a set of laws to govern assisted suicide.
Monday's report focused on the role to be played by provincial governments, which are largely responsible for health-care delivery in Canada.
The group recommended that physician-assisted dying be publicly funded by those governments and not subject to exclusions for inter-provincial reciprocal billing, though only patients who qualify for public coverage would be eligible.
The group also offered a definition for the term "grievous and irremediable" condition, the phrase cited by the Supreme Court to describe those who should have recourse to doctor-assisted death.
The report defined the term as "a very severe or serious illness, disease or disability that cannot be alleviated by any means acceptable to the patient'' and further specified that those conditions could describe adults of any age.
"Access to physician-assisted dying should not be impeded by the imposition of arbitrary age limits," the report said. "Provinces and territories should recommend that the federal government make it clear in its changes to the Criminal Code that eligibility for physician-assisted dying is to be based on competence rather than age."
The report then tackled the question of determining that competence level by advising that existing health-care guidelines should be used to assess a patient. No final decision should be handed down, however, without approval from two separate doctors who have evaluated the patient's competency.
Telemedicine services such as videoconferencing should be used in cases where access to doctors is scarce, it said.
For opponents of the practice, the report didn't go far enough.
"It's very hard to actually control a law when doctors are self-reporting."
Alex Schadenberg of the Euthanasia Prevention Coalition decried the lack of third-party oversight, noting that the panel recommends doctors file reports on assisted deaths only after they have been completed.
This, plus the practice of allowing doctors to document their own actions, raises comparisons with countries such as the Netherlands, where Schadenberg says assisted-death laws are open to abuse.
"It's very hard to actually control a law when doctors are self-reporting,'' he said. "There's no third-party oversight in that sense at all."
The panel's report Monday suggested allowing registered nurses, nurse practitioners or other registered medical professionals working under doctor supervision to help patients end their life.
Doris Grinspun, chief executive of the Registered Nurses Association of Ontario, said such a move makes sense given Canada's vast geography and relatively scarce numbers of doctors.
She argued allowing other professionals a role is also logical from another perspective.
"If you look at who is with people at the end of their lives, whether for palliative care or should they choose assisted dying, it is registered nurses by and large, and also nurse practitioners," she said.
Widespread discomfort among doctors
Schadenberg, however, criticized the suggestion as a means of circumventing widespread discomfort among the country's doctors.
"Most physicians are saying that they really don't like the idea of being involved in this, and by extending it to nurses they're trying to create a greater number of people who would participate in it," he said. "That obviously concerns me."
Other suggested changes to the Criminal Code include protections for doctors or other medical professionals who choose to offer their services to those wishing to end their lives.
Physicians who choose not to provide the service would be obliged to inform their patients of all their options and transfer their care to a doctor who is willing to participate, according to the recommendations.
The report also advised listing physician-assisted dying as the manner of death on all relevant Canadian death certificates, with the cause of death listed as the disease that qualified the patient for the service in the first place.
The provincial group's findings come a day before a similar report is expected to be issued by a panel advising the federal government on how to craft laws around the Supreme Court ruling.
The new Liberal government is seeking a six-month extension on the court's February deadline.
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