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In just six months, it will be legal in Canada for a doctor, under certain circumstances, to help a patient commit suicide and even to perform euthanasia, but it's an open question whether the medical profession -- and the general public -- is ready for this momentous change.

Medical authorities and government officials across the country are scrambling to have proper protocols in place to meet a Supreme Court of Canada deadline of Feb. 6.

Last winter, in a unanimous ruling in a case originating in British Columbia, the high court ended the long debate over whether doctor-assisted suicide should be permitted in Canada.

It gave the federal government a year to draft new legislation. So far, Ottawa has made little progress, except to name a three-person advisory panel just two weeks ago. It is to report back in mid-November.

'It's a huge endeavour'

If no new law is enacted on time, the provinces and medical regulatory bodies such as the College of Physicians and Surgeons of Manitoba will be left in a quasi-legal vacuum, with only the court ruling as their guide.

"It's a huge endeavour," said Dr. Anna Ziomek, registrar of the college, the body that licenses and enforces professional standards for doctors in this province.

The issue of assisted suicide became a hot topic of discussion in Canada more than 20 years ago when ALS (amyotrophic lateral sclerosis) sufferer Sue Rodriguez fought all the way to the Supreme Court for the right to die. She lost her case.

More recently, Winnipegger Susan Griffiths again focused the nation's attention on the issue. She told the story about her attempts to cope with a rare incurable brain disorder and, ultimately, her decision to travel to Switzerland in 2013 for help in ending her life.

This February, the Supreme Court ruled it will be legal next year to help a "competent adult person" terminate his or her life if the person clearly consents and has a "grievous and irremediable medical condition" that causes enduring suffering intolerable to the individual.

'Is the system ready to implement this now? The answer is no' ‐ Dr. Michael Harlos, medical director of palliative care for the WRHA

Ziomek said if patients have the right to receive assistance in dying, there needs to be a clear process set out on how that is going to happen.

"We can't be struggling with trying to decide what we're going to do with this patient now," she said.

There is a multitude of questions that need to be addressed as Feb. 6 draws near.

For example, should physician-assisted suicide be restricted to an institution such as a hospital, or should patients have the choice of dying in their own homes? Which medical professionals -- and how many -- should sign off on a decision to permit physician-assisted suicide or euthanasia?

If a patient's doctor conscientiously objects to assisting in a patient's death -- as many are expected to do -- how will that situation be handled? (The court ruling also protects physicians who are conscientious objectors.)

What is a reasonable time frame for complying with a patient's wishes?

The college has struck a panel, consisting of 10 physicians and laypersons, to develop protocols for Manitoba doctors. The 'working group' is being guided by a broad set of principles and recommendations developed in June by the Federation of Medical Regulatory Authorities of Canada. The federation's document is only four pages long. In point form, it sets out recommendations on the qualification of attending physicians, assessing patient consent, documentation of patient wishes and other criteria.

Dr. Michael Harlos, medical director of palliative care for the Winnipeg Regional Health Authority, said many physicians will find it difficult to participate in assisted suicide.

"Is the system ready to implement this now? The answer is no," he said.

Harlos said it would be wrong to assume physicians can easily step into the role of helping someone to die.

"I've been working 20-something years, and I've never ended someone's life," he said. "And I've talked to intensive care colleagues about how they think they're going to approach this. And they say the same thing: 'We don't know how to do this.' "

Harlos, a founding member of the Canadian Society of Palliative Care Physicians, said a recent membership poll found more than 70 per cent did not believe physician-assisted death fell within the scope of palliative care.

Palliative care physicians also believe with better access to their services -- particularly in rural areas -- there would be reduced demand for assisted dying.

"As of February, your right to access assisted dying for suffering will be kind of legislated or constitutional; your right to access palliative care, good pain management (will be) still inconsistent across the country," Harlos said.

Doctors aren't the only health professionals who are potentially affected by the new legality surrounding physician-assisted death. Pharmacists -- and possibly nurses, who most often dispense drugs in institutional settings -- will also be affected.

Ron Guse, registrar of the College of Pharmacists of Manitoba, said the implications of the court decision are being discussed provincially and nationally within his profession.

"(The type of) drugs, dosages, standards of care, consent -- all that stuff is going to be part of the discussion, absolutely," Guse said. He said his organization is still awaiting word on the specific role pharmacists may play within the new legal reality.

At least one Winnipeg health facility, St. Boniface Hospital, has let it be known it will not contemplate assistant suicide nor euthanasia on its premises.

"Given who we are, it's kind of a foregone conclusion that this is something we would not entertain," said the hospital's president and CEO, Dr. Michel Tétreault, referring to the institution's Roman Catholic faith-based control structure.

Legal vacuum created

Mary Shariff, an associate professor of law at the University of Manitoba, said she is concerned about the legal vacuum that's been created as a result of the Supreme Court decision.

"What the Canadian court has done is pushed, in a very short time frame, the government to try to create legislation without having proper democratic consultations with its constituents," she said.

Shariff has studied how assisted suicide is carried out in both Europe and the United States. She's also advised the Manitoba college of physicians on the issue.

What Canada needs is a thorough national discussion on the issue of doctor-assisted suicide and euthanasia as well as guidance from lawmakers, she said. Instead, the responsibility in the short term for paving the way forward has fallen into the lap of medical regulatory bodies.

"One might want to criticize the federal government for not acting in a short amount of time, but how do you actually act in a 12-month period when you're talking about something that affects all Canadians and when it's actually the ending of life?" she said.

Some U.S. states, such as Washington and Oregon, allow for assisted suicide, but a patient must have a terminal illness, with six months or less to live. The law allows for patients to receive a prescription with which to take their own life.

In Switzerland, where Griffiths received help to end her life, assisted suicide is legal under certain circumstances, while euthanasia is not. A physician cannot inject a lethal drug to end a sufferer's life.

Without further legal guidance from Ottawa, Canadian law, as of Feb. 6, will mirror more closely the situation in Holland, Belgium and Luxembourg, Shariff said. These countries allow for both assisted suicide and euthanasia, although the preferred practice in these countries is euthanasia or legal injection. A person does not need to be suffering from a terminal illness to qualify for medical assistance in dying. That will also be true, as things stand, in Canada.

Coming up with options

Dr. Harvey Max Chochinov, a distinguished professor of psychiatry and Canada research chair in palliative care at the University of Manitoba, has the daunting task of heading up the three-member advisory panel advising Ottawa on how to respond to the Supreme Court decision.

Formed on July 17, the panel is expected to report back to the government by mid-November, following the Oct. 19 federal election.

"What we will be doing is coming up with legislative options for the government's consideration," Chochinov said in a brief interview this week.

The panel has already met twice -- for several days of briefings in Ottawa and earlier this week in Halifax. It has been asked to consult broadly and meet with health-care professionals, regulators, groups representing vulnerable populations and other interveners in the Supreme Court of Canada case. It will also establish an online consultation process that allows any Canadian to submit their views.

Complicating matters for the panel, however, is the looming federal election. Once the writ is dropped, the panel's terms of reference prohibit any face-to-face meetings. Only online submissions will be permitted until after the election, Chochinov said.

Despite the restrictions it faces, the panel is optimistic it can deliver its report on time to whoever is elected.

"Our panel is certainly prepared to rise to the challenge," Chochinov said.


Larry Kusch

Larry Kusch
Legislature Reporter

Larry Kusch didn’t know what he wanted to do with his life until he attended a high school newspaper editor’s workshop in Regina in the summer of 1969 and listened to a university student speak glowingly about the journalism program at Carleton University in Ottawa.

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