Canada and Assisted Dying….

Writing about assisted dying, dying with dignity or euthanasia is touchy. Many do not agree with it, many do agree with it. Many will not talk about it or write about it. I ask that you keep an open mind and be willing to educate yourself on the topic and be open to discussions on the topic whether with friends, family, professionals…….

Quebec has already put forth legislation regarding assisted dying and has been utilized by a few already,

The rest of Canada made Assisted Dying legal on June 13th, but with strict criteria. The new law “limits the option to the incurably ill, requires medical approval and mandates a 15-day waiting period. (

A patient must:

  • Be eligible for government-funded health care (a requirement limiting assisted suicides to Canadians and permanent residents, to prevent suicide tourism).
  • Be a mentally competent adult 18 or older.
  • Have a serious and incurable disease, illness or disability.
  • Be in an ‘advanced state of irreversible decline,’ with enduring and intolerable suffering.
  • As a safeguard, the law also requires that two independent witnesses be present when the patient signs a request for a doctor-assisted death.

Religious individuals are not accepting of the legislation and will not make use of it, but for those that do-it is a choice. Whether or not, we as professionals agree with the patients choice, it is our professional obligation to listen and provide support and if we are unable to because of religious reasons, morals or personal values, the patient/client should be referred to another professional who will provide the needed support.

Dr. Paul Saba, along with his patient Lisa D’Amico, a woman who is living with life-threatening disabilities, sought the injunction to contest Bill 52, but they were unsuccessful. Dr. Saba says the new law forces him as a physician to either perform euthanasia or refer patients. “I will neither perform the act nor refer, so my ability to practice medicine is prejudiced,” he said.

I have a hard time understanding why. Judaism is a religion that has so much richness to it, compassion, caring, empathy, and a willingness to help others-is this not helping others by referring the individual to the person who can best help them? He could be “severely sanctioned” by the College of Physicians for refusing to be involved in an act “that goes against the practice of medicine.”

Why does this go against the practice of medicine? Medicine is to diagnose, treat and to help. Perhaps what this is about is that doctors, nurses and other professionals have been taught a certain way and this way of thinking has become ingrained within the profession, but now it is time to change. Like everything in life-change will happen and like anything in life-professionals need to continue to learn and grow while updating their skills and keeping an open mind. The law allows professionals to opt out, but they must refer. I do not see referring a patient/client to another person as a negative thing; I see it is positive as the professional is admitting to themselves and recognizing they cannot help this person, so they will refer them to one who can. Is this not what medicine and helping professionals are supposed to do?

If I cannot help my client I will refer them to one who can. No one can be all knowing-perfection does not exist.

Is medical aid in dying ‘a slippery slope’ as some say? Quebec has decided it is allowed with the proper conditions. Although Canada’s new health minister has acknowledged that there is evidence that only 15 percent of Canadians have access to high quality pain control, parliament has been told that special traveling teams should be available to deliver physician-assisted death to the country’s remote regions to guarantee that patients can have their lives ended. So to me, pain management needs to be improved along with more Palliative Care beds made available to those that really need one.

The “Quebec protocol” calls for a three-step process that starts with sedation, followed by putting the patient into an artificial coma, then administering a powerful muscle relaxant that causes breathing and the heart to stop…
Under the protocol the dispensing pharmacist is required to prepare two identical sealed kits — in case there’s an issue with the first one.

The law, both the one in Quebec and the one that is expected to be passed in Canada, does not mandate that all (Quebec) physicians must participate in assisted suicide or euthanasia, only that facilities such as hospitals must offer the service of medical aid in dying to individuals.

Quebec’s health minister, Gaetan Barret, maintains that the law is one that Quebecers have been awaiting a long time. “People in this province have had the debate,” he said. “People are waiting for that law. I don’t think there are people waiting to have access to medical aid in dying, but the principle of having the choice is something people want to have.” According to a recent poll, at least two-thirds of Quebec doctors have indicated they want no part of euthanasia.

I find it interesting that the general population in principle agrees with the new law while many physicians do not. Why is that?

Let’s go over the rules of Assisted Dying in Quebec:

  • Before giving consent to terminal palliative sedation, a patient who wishes to receive such sedation or, where applicable, the individual authorized to consent to care on behalf of the patient, must among other things be informed of the prognosis, the irreversible and terminal nature of the sedation and the anticipated duration of the sedation. Consent to terminal palliative sedation must be in writing and filed in the patient’s record.
  • Only a patient who meets the following criteria may obtain medical aid in dying:  (1) be of full age, be capable of giving consent to care and be an insured person within the meaning of the Health Insurance Act (chapter A-29); (2) suffer from an incurable serious illness; (3) suffer from an advanced state of irreversible decline in capability; and (4) suffer from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.
  • The patient must request medical aid in dying themselves, in a free and informed manner, by means of the form prescribed by the Minister. The form must be dated and signed by the patient or, if the patient is physically incapable of doing so, by a third person. The third person may not be a minor or an incapable person of full age or a member of the team responsible for caring for the patient. The form must be signed in the presence of a health or social services professional who countersigns it; if the professional countersigning is not the attending physician, the signed form is given to the attending physician.
  • A patient may, at any time and by any means, withdraw their request for medical aid in dying.
  • Before administering medical aid in dying, the physician must (1) be of the opinion that the patient meets the criteria of section 26, after, among other things, (a) making sure that the request is being made freely and without any external pressure; (b) making sure that the request is an informed one, in particular by informing the patient of the prognostic and of other therapeutic possibilities and their consequences; (c) verifying the persistence of suffering and that the wish to obtain medical aid in dying remains unchanged, by talking to the patient at reasonably spaced intervals given progress of the patient’s condition; (d) discussing the patient’s request with any members of the care team who are in regular contact with the patient; and (e) discussing the patient’s request with the patient’s close relations, if the patient so wishes.
  • make sure that the patient has had the opportunity to discuss the request with the persons they wished to contact; (3) obtain the opinion of a second physician confirming that the criteria set out in section 26 have been met. The physician consulted must be independent of both the patient requesting medical aid in dying and the physician seeking the second medical opinion. The physician consulted must consult the patient’s record, examine the patient and provide the opinion in writing.
  • If a physician determines, subsequent to the application of section 28, that medical aid in dying may be administered to a patient requesting it, the physician must administer such aid personally and take care of the patient until their death. If the physician determines that medical aid in dying cannot be administered, the physician must inform the patient of the reasons for that decision.
  • A physician practising in a centre operated by an institution who refuses a request for medical aid in dying for a reason not based on section 28 must as soon as possible notify the director of professional services or any other person designated by the executive director of the institution and forward the request form given to the physician, if such is the case, to the director of professional services or designated person. The director of professional services or designated person must then take the necessary steps to find another physician willing to deal with the request in accordance with section 28. If the physician who receives the request practises in a private health facility and is not associated with a local authority for the administration of medical aid in dying, the physician must as soon as possible notify the director of professional services or any other person designated by the executive director of the local authority, and forward the request form given to the physician, if such is the case, to the director of professional services or designated person. The steps mentioned in the first paragraph must then be taken.
  • All information and documents in connection with a request for medical aid in dying, regardless of whether the physician administers it or not, including the form used to request such aid, the reasons for the physician’s decision and, where applicable, the opinion of the physician consulted, must be recorded or filed in the patient’s record.

This is very thorough. One cannot just request and die the next day with medication. What is the real issue here? What is the underlying emotions that make individuals uncomfortable with the topic? Why would a professional not be willing to refer a patient to one who can best help them?

Victoria Brewster, MSW