Missed deadline on medically assisted dying leaves doctors divided
Does delay in passing a new law empower doctors to act, or lead to further legal confusion?
Today is the last day for Parliament to pass legislation governing medically assisted dying before a deadline imposed by the Supreme Court. It won't happen.
On Friday, the Senate sent the bill to its legal affairs committee for study. The committee meets today but won't be able to report on the bill until the full Senate resumes tomorrow. And it still could be weeks before any federal law is in place.
That means tomorrow, the Supreme Court's original ruling becomes the law, which means doctors can't be prosecuted under the Criminal Code if they help a patient suffering from a "grievous and irremediable" illness to die.
So, what does that mean?
The medical community is divided.
- Philpott warns of 'patchwork approach' without new doctor-assisted death law
- Ontario will provide drugs at no cost for assisted dying
- Here's a list of the strict assisted death guidelines across most of Canada
- Assisted-dying bill won't pass Senate before Monday's deadline
Dr. Gus Grant, with the Federation of Medical Regulatory Authorities of Canada, believes doctors are better off without a new law.
"Many voices have created June 6 to be a deadline. It's not a deadline. It's simply the day (the Supreme Court's Carter decision) becomes the law of the land," Dr. Grant said on CBC News Network's Power & Politics last week.
"And the language that said it's a deadline creates the brinksmanship type mentality, a false sense of urgency, which is what is motivating people to pass legislation that is flawed," he added.
Everyone has told me I will not participate if there are not federal rules in place. This is not a threat- Dr. Jeff Blackmer, Canadian Medical Association
Grant argued the condition in the government's legislation that requires a patient's death to be "reasonably foreseeable" is meaningless to physicians.
But Dr. Jeff Blackmer, Canadian Medical Association's vice-president of medical professionalism, argues the exact opposite, saying the federal government's language needs to be more precise than simply a "grievous and irremediable illness."
"I have spoken to hundreds and hundreds of physicians. We have done the work on this. We have gone out to our membership and said, 'Does this make sense to you? Can you incorporate this at the bedside?' And they have unequivocally told us 'No.'
"So they are looking to the federal law for guidance on this."
Protection for doctors
The regulatory guidelines from each of the provincial colleges of physicians and surgeons do not provide enough protection, he added.
"If you do something after June 6, and there's no federal law in place, (and) as a physician you get it wrong and you're taken to court and that court said 'we don't think you met these grievous and irremediable criteria,' well then, those regulations will be cold comfort to you in that situation of criminal sanctions," he said.
Grant dismissed that argument as fear mongering, but Blackmer said it's simply the feeling among doctors he's spoken with.
"Everyone has told me I will not participate if there are not federal rules in place. This is not a threat. This is not rhetoric," Blackmer said.
Meanwhile, the organization that provides legal advice to doctors is telling them to meet with a lawyer if a patient comes to them Tuesday asking for help to die.
There can be no more vulnerable patient population than people who are suffering and whose wishes will be subjected to a vague determination of eligibility based on flawed legislation.- Dr. Gus Grant, Federation of Medical Regulatory Authorities of Canada
Dr. Douglas Bell of the Canadian Medical Protective Association said the Supreme Court's Carter ruling is unclear on some specifics, such as the exact age a patient must be to ask for help.
"Carter talks about a consenting adult and there's some debate as to whether you have to be 18 or 19 years old, or whether you can be younger and have the maturity of an adult to make that decision," Bell said.
By contrast, the government's legislation states a patient must be 18 or older, and that the issue of "mature minors" will be studied once the legislation is passed into law, Bell said.
What about pharmacists?
Meanwhile, the secretary of the College of Physicians and Surgeons in Alberta said the biggest challenge for someone seeking a medically-assisted death on Tuesday may not be in finding a doctor, but rather the other health care professionals needed to make it happen.
Dr. Trevor Theman points to pharmacists in particular, who would have to issue the drugs.
"If other health professionals, like pharmacists, find that they are not protected, they're not exempted [from] the risk of prosecution, recognizing that's probably a very low risk, and are not willing to participate — that would be the biggest issue," Theman told CBC News.
Theman said Alberta is ready for whatever is in place on Tuesday.
"We kind of have plan A, plan B, and plan C, depending on whether or not there is federal legislation as of June 6," he said.
Senators said last week they hope to have C-14 passed through the Senate by the end of this week, or early next.
But it is highly likely it will be amended, which means it will be sent back to the House of Commons for MPs to vote on it again.
Last week, the prime minister would only say he's hopeful the bill will pass the Senate quickly.
- Analysis: Let the politicians keep talking, Supreme Court already settled death debate
- Liberals may accept Senate amendment to pass assisted dying bill
- Dealing with Death: MPs reflect on the end of life
But even so, Dr. Grant said it's important to keep patients in mind.
"I think the important voice is that of the patients. There can be no more vulnerable patient population than people who are suffering and whose wishes will be subjected to a vague determination of eligibility based on flawed legislation."