The February 2015 unanimous decision of Canada`s Supreme Court regarding the legality of assisted suicide being included in the Criminal Code will inevitably impact profoundly on our health, law and societal infrastructures. Briefly, the applicant argued that her terminal condition would inevitably result in a protracted and uncontrollably painful death and that being sound mentally, she should to choose her own endpoint. She argued that the criminal code prohibition against assisted suicide infringed on her Charter Rights to `life. Liberty and security of the person“
Prior to this decision, patients with a similar situation had three options. Attempting the action on their own with a substantial probability of failure considering 99% of our general population have no background in medicine, anatomy and pharmacology. The second option required a willing caregiver to assist, running the risk of prosecution under our existing law while the third required an travelling to a jurisdiction there is more enlightenment around end-of-life matters. Holland, as the example, allows assisted termination of life and or the option of self administered lethal prescriptions with instructions. The Canadian Supreme Court has placed a moratorium on Criminal Code charges regarding assisted suicide for a period of one year allowing the provinces with health care jurisdiction to draft appropriate legislation. Knowing the details of this individual medical scenario, I am absolutely convinced the Court made the only and correct decision available but equally important, this decision from the highest Court in the land sets the standard for the inevitable debate to follow.
Specifically, the Court did NOT state that any individual physician was obligated to provide assistive services. The Court was correct in stating physicians (I would add some subspecialty nursing personnel) have unique professional skills to assess the patient`s medical status and competency to make their own decision. In fact, though the prime facie dictum of medicine from Hippocrates forward has always been `DO NO HARM“ The majority of physicians through its spokesbody the CMA are opposed to a presumptive role. Palliative care practitioners are adamantly and vocally opposed to assistive interventions being included in their specialty.
This one answer has already generated several new questions in a variety of medical scenarios including age restrictions on eligibility for young adults, teens, even children with terminal illness. We need to address the fact in Canada, fully a third of our hospitals and senior and disabled facilities have a religious affiliation which wold be in conflict with the new law and possibly thereby threatening their public funding. There is also the issue of universal accessibility to this service. This could be a problem in a rural community where
there may only be a single overburdened family practitioner. Patients already have the right to refuse life-saving care and physicians acknowledge their ethical and legal responsibility to abide by these wishes. What about a nursing home patient who has become mentally incompetent who has previously signed a DO NOT RESUSCITATE request? Will he or she be eligible for inclusion? That will be another debate. The Ontario Superior Court of Justice has issued a list of guidelines directed to patients seeking end of life assistance. These include both medical and psychiatric stability assessments, a waiting period and notice to affected family. We do not have sufficient numbers of psychiatric personnel for the existing mental health issues. Perhaps the Superior Court will fine tune its recommendations to allow more flexibility in who might administer end of life care perhaps a team consisting of an MD, and the other a nurse practitioner as just one example.
We as a society have a long journey ahead toward resolution of these questions but we have at least taken a first step in the correct direction.
Written by: Dr. David Carll