SASKATOON — At a Sept. 18 meeting, the College of Physicians and Surgeons of Saskatchewan (CPSS) Council voted to release a draft guidance document on euthanasia and assisted suicide. A public consultation on the document, Physician-Assisted Dying Draft Guidance Document, will be open on the CPSS website, www.cps.sk.ca, until Oct. 20.
The CPSS Council had a brief discussion at the meeting regarding the guidance document, which is based on recommendations prepared by the Advisory Group on Physician-Assisted Dying of the Federation of Medical Regulatory Authorities of Canada (FMRAC).
The document was drafted by a subcommittee of the CPSS, and is meant to guide physicians regarding assessment of the criteria outline by the Supreme Court of Canada in the landmark Feb. 6, 2015, Carter decision that decriminalized euthanasia and assisted suicide. The document does not provide clinical guidelines for performing these practices.
The document lists four criteria which were set out in the Carter decision: “(1) The patient consents; (2) The patient has a grievous medical condition; (3) The condition is not remediable using treatments that the patient is willing to accept; and, (4) The patient’s suffering is intolerable to the patient.”
The document acknowledges that it is not possible to provide doctors with detailed instructions to confirm that patients meet the Carter criteria. However, the document does present eight issues that physicians should consider addressing with their patients when determining whether or not the Carter criteria are met: “(1) Current symptoms; (2) Loss of function; (3) Expectation of progress of symptoms; (4) Expectation of progress of Loss of function; (5) Future suffering and available treatment; (6) Suffering and personality; (7) Suffering and personality-over-time (personal history); and (8) Environment.”
If a doctor determines that a patient meets the Carter criteria, the guidance document requires that the patient’s request for euthanasia or assisted suicide is consistent “over a reasonable period of time.” This time period “will be dependent on the patient’s medical condition and other circumstances.” This approach was adopted to ensure patients receive timely access to “physician-assisted dying.”
The document also specifies that the attending physician must “consult a second physician” who “must interact with the patient” to ensure he or she meets the requirements set out by the Supreme Court of Canada in the Carter decision.
Regarding conscientious objection by physicians, the document states that it “does not address the extent to which individual physicians may be expected to ensure that patients seeking information about physician-assisted dying receive that information or the extent to which physicians may be required to refer patients to another provider if the physician is unwilling to provide physician-assisted dying.” It goes on to say that within the CMA Code of Ethics, “physicians can follow their conscience when deciding whether or not to provide physician-assisted dying.”
In a letter to the Prairie Messenger, CMDS executive director Larry Worthen expressed his concerns regarding the policy, particularly as it relates to conscientious objection. “[The document] acknowledges that there may be a policy in future that requires physicians to refer for assisted dying,” wrote Worthen. “This will make it impossible for many Roman Catholic and other physicians to practice medicine.”
Worthen also expressed concern for vulnerable members of society: “The other disturbing component of this document is that people with disabilities and/or people with psychiatric illness will be able to access assisted death simply because of their disability and their unwillingness to live with it. It will lead to the normalization of suicide.”
Bishop Donald Bolen reiterated the church’s profound worry about the path we are walking as a society, noting that “a truly human response to the suffering or dying should be to care for them, seek to ease their pain, to accompany them in whatever way needed; not to kill them or help them take their own lives.” Regarding the CPSS consultative process, he added, “I would strongly encourage the people of the diocese to reply once again to the request for feedback, stating their opposition to euthanasia and assisted suicide, and their concern to protect the conscience rights of doctors.” He indicated that the church will strive to deepen its commitment to journey with the most vulnerable in our midst.
The guidance document acknowledges that future legislation regarding euthanasia and physician assisted suicide will take priority over the CPSS Document. The consultation will close on Oct. 20, one day after the federal election.