Providing option for assisted death a personal choice

By Paul Russell, Contributor

If patients request medically assisted death, it is imperative that physicians and nurse practitioners are aware of the legal requirements involved in that process, says Toronto health lawyer Elyse Sunshine.

“If you’re going to implement assisted dying into your practice, it’s not simply a matter of getting the drugs and giving them to patients,” says Sunshine, partner with Rosen Sunshine LLP, “There are a number of important legal requirements and steps that have to be completed first.”

She tells that health professionals must first decide if they are comfortable with providing this type of care.

“Medically assisted death is an important thing to be able to offer patients, but it’s not something everyone wants to do,” Sunshine says. “Every health professional has to think about whether this is within their scope of practice, and if are they capable of providing this type of care.”

The Canadian Press reports that almost 7,000 Canadians have received medical help to end their lives since Canada legalized assisted dying three years ago.

Physicians administered the majority of medical assistance in dying (MAID), the story states, with less than 10 per cent provided by nurse practitioners.

“Health professionals who have a conscientious or religious objection do not have to provide this service,” says Sunshine.

“However, they have to make an effective referral, and direct the patient to another doctor or nurse practitioner who can carry out the service in a timely manner,” she says.

Sunshine says that doctors who decline to assist with a patient’s death have to tell the patient that is due to their own personal beliefs, and not for clinical reasons.

“Doctors can’t make this a moral issue, or try to dissuade the patient from going down this road,” she says.

There are a number of criteria people must meet to be eligible for assisted death, Sunshine says, starting with being over 18 years of age and a Canadian citizen.

“Unlike other jurisdictions, you cannot come here as a medical tourist to obtain a medically assisted death,” she explains.

Before obtaining medically assisted death, patients also have to provide informed consent, Sunshine says, and have the mental capacity to understand what is involved in the process.

“Health professionals must make sure the patient is not getting external pressure from someone else,” she says.

The 2016 legislation that legalized assisted death in Canada states patients must have “a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

“The disease or condition must be in an advanced state, or it has to be that something that causes the person to endure either physical or psychological suffering that’s basically unbearable,” Sunshine says.

If a patient meets these requirements, she says health professionals still must discuss other options with them, such as palliative care.

“Palliative care doesn’t extend life, but it does assist in alleviating suffering in a person’s final days,” Sunshine says.

Before the patient is given the medication that will end their life, they must again give consent, according to the legislation.

“That can be a challenge, depending on the nature of the condition that the person suffering from,” Sunshine notes, adding that a guardian or family member cannot give this consent.

“For people with conditions that impair their cognitive functioning or could otherwise cause a decline in mental capacity, there is a concern that they will not be capable of consenting to MAID when the time comes to provide that second affirmation of consent, and in those circumstances, the person will not be eligible to receive the service. This issue is currently the subject of a constitutional challenge to the MAID legislation,” she says.

While most patients have health professionals administer the life-ending medication, patients can do that themselves, she says, provided they have gone through all the steps required with a medical professional.

According to the news story, “only six people have opted to self-administer drugs to end their lives” in the last three years in Canada.

Health professionals must keep a record of all the discussions and actions taken with assisted death, Sunshine says, and send a detailed report to the province’s chief coroner.

Sunshine says the fact that almost 7,000 Canadians have opted for this service in three years shows that it is a valued option for those facing death.

“The most important factor of people’s health care is the ability to make autonomous decisions about what care they receive. At the end of our days, we should have that ability to make that decision and really choose that path for ourselves, if that’s what we want,” she says.

“It’s not for everyone, but it’s there if you need it, and I am grateful to the health professionals who are willing to provide this service,” says Sunshine.

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