Medical Assistance in Dying
The provision of medical assistance in dying in Canada has far-reaching implications for healthcare institutions and the pharmacy team working in them. In accordance with the laws and ethics that govern and guide pharmacists in every Canadian jurisdiction, CSHP advocates for respect of the rights and autonomy of the patient. CSHP also supports each healthcare professional’s right to conscientious objection, provided that continuity of care is not compromised.
The Supreme Court of Canada struck down the prohibition against assisted suicide and voluntary euthanasia, concluding that the laws were unconstitutional. In its decision on February 6, 2015, the Supreme Court ruled that the current prohibition would remain in effect for one year, until February 6, 2016.
An External Panel on Options for a Legislative Response to Carter v. Canada (“External Panel”) was established by the Government of Canada in July 2015. The Panel gathered submissions on issues to consider in response to the Carter v. Canada ruling: CSHP conveyed key messages in its formal submission to the External Panel. The External Panel issued its final report, Consultations on Physician-Assisted Dying: Summary of Results and Key Findings.
Eleven provinces and territories formed a Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying (“Advisory Group”) in August 2015. CSHP responded to a questionnaire issued by the Advisory Group. The Advisory Group issued its Final Report in November 2015.
The Parliament of Canada formed a Special Joint Committee on Physician-Assisted Dying in December 2015. The committee issued its report Medical Assistance in Dying: A Patient-Centred Approach in February 2016.
The Supreme Court, on January 15, 2016) extended the suspension of the declaration of invalidity by 4 months (to accommodate the 4 months in which Parliament was dissolved because of the federal election which caused a delay in developing a legislative response to the Supreme Court’s decision). The province of Québec was exempted from the 4-month extension. The Supreme Court also ruled that Canadians outside Québec seeking physician-assisted dying could apply to their provincial superior court for relief.
On June 17, 2016, the Government of Canada passed legislation that allows eligible adults to request medical assistance in dying.
Key messages from CSHP
- Medical Assistance in Dying: Position Statement (2017)
- Aide médicale à mourir : Énoncé de position (2017)
- Physician-assisted Dying: Position Statement (Approved in January 2016, retired in April 2017)
- Aide médicale à mourir : Déclaration de principes (Approuvée en janvier 2016, retirée en avril 2017)
Feedback to the External Panel via a survey and a formal submission
- the legislative framework should be set at the federal level of government, safeguarding the process and providing confidence to the public and healthcare professionals that their decisions are protected in the same manner across Canada
- a pharmacist should be included in a national interprofessional advisory/oversight panel, which would also involve a patient advocate, and in the interprofessional team managing the patient’s journey to death
- the application of the legislation should not be restricted to a list of diseases
- the patient should be offered all appropriate, available end-of-life options, including palliative care, which are based on best and leading practices
- a patient’s clear consent must be informed, given voluntarily and free of external influence (coercion)
- a physician should be present during voluntary euthanasia or physician-assisted suicide to manage the patient’s journey to death, e.g., to handle side effects, ensure efficacy for intended outcome, and provide supportive care
- the pharmacist has the right to voluntarily withdraw his/her support for physician-assisted dying at any time due to matters of personal conscience, without penalty and should refer the patient to another pharmacist who agrees to provide that care.
To learn more about the Supreme Court’s decision, the meaning of assisted dying, eligibility criteria, and other information on the topic of assisted dying, visit the Government of Canada’s web page, Medical assistance in Dying.
Information about guidance offered by pharmacy regulatory authorities in Canada on the topic of medical assistance in dying: