SASKATOON — At their Nov. 20 meeting, the Council of the College of Physicians and Surgeons of Saskatchewan (CPSS) voted to approve a policy on euthanasia and assisted suicide. The council’s decision follows a public consultation on a guidance document, which was conducted in October.
The policy’s initial draft was based on recommendations prepared by the Advisory Group on Physician-Assisted Dying of the Federation of Medical Regulatory Authorities of Canada (FMRAC). The policy was drafted by a subcommittee of the CPSS, and is meant to guide physicians regarding assessment of the criteria outlined by the Supreme Court of Canada in the landmark Feb. 6, 2015, Carter decision that decriminalized euthanasia and assisted suicide.
The CPSS policy does not provide clinical guidelines for performing these practices, but is rather intended to ensure that euthanasia and assisted suicide are only performed by physicians who have received appropriate training, once this training is made available.
The council’s discussion focused on three main areas: conscientious objection, the definition of the word “adult” in the Carter case, and the use of advanced health care directives.
Regarding conscientious objection, the policy states that objecting physicians are “expected to provide sufficient information and resources to enable the patient to make his/her own informed choice and access all options for care.”
The policy further states that this means “arranging timely access to another physician or resources, or offering the patient information and advice about all the medical options available.” The physician’s obligations can also be met “by delegating this communication to another competent individual for whom the physician is responsible.”
In its deliberations, the council drew heavily on its recently passed policy on conscientious objection. Some council members expressed concerns that physicians who are opposed to euthanasia and assisted suicide would not be able to meet the obligation to provide their patients with information, as doing so would make them complicit in their patient’s death. This section of the policy passed with nine council members voting for the amended section and five voting against.
The council’s discussion also focused on the word “adult,” which is not defined in the Carter decision. It is possible that persons under 18 could qualify as “mature minors,” a category of persons under the age of 18 who can consent to medical treatments if their doctor determines that they understand the procedure being proposed and the risks and consequences of that procedure. The final policy recommends that physicians only provide euthanasia and assisted suicide to persons 18 years and older unless the courts or legislatures further define “adult” in the future.
Patients will not be able to consent to euthanasia and assisted suicide through advanced care directives, but rather must remain “competent at all stages of the process, until the time of physician-assisted dying.” This requirement could also be changed by a court or legislature in the future.
The policy 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 policy acknowledges that it is not possible to provide doctors with detailed instructions to confirm that patients meet the Carter criteria. The policy states that, “physicians are expected to use appropriate medical judgment and follow a reasonable plan of assessment to ascertain whether the Carter criteria have been met for a specific patient.”
If a doctor determines that a patient meets the Carter criteria, the policy 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” and is not specified in the policy. This approach was adopted to ensure patients receive timely access to “physician-assisted dying.”
The policy 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.
The CPSS’s Policy on Physician-Assisted Dying will guide physicians when the current Criminal Code prohibitions on euthanasia and physician-assisted suicide cease to be in effect. This is expected to occur Feb. 7, 2016, assuming the federal government does not ask for an extension to the Carter case ruling. The CPSS policy will be subject to provincial or federal laws and regulations in the event either level of government chooses to act.
Christian Medical and Dental Society of Canada executive director Larry Worthen responded to the CPSS policy, saying, “We are comfortable with the provisions on conscientious objection. Our members are generally willing to provide information to patients so they can make an informed choice on their options.”
Worthen further stated, “Once our patient makes a choice for assisted suicide or euthanasia, then we must step aside and not participate in the process. We will still care for the patient, but we cannot assist in their death. Many patients will be comforted knowing that their doctor has these moral convictions. People who want to support doctors conscience rights should go to the website MoralConvictions.ca and pass their concerns on to the decision-makers.”
Myron Rogal of the diocesan Office for Justice and Peace noted that information materials about the Moral Convictions campaign and website are presently being distributed to parishes throughout the Roman Catholic Diocese of Saskatoon, with financial assistance from the Saskatchewan Pro-Life Association.
“It is vital that we continue to let leaders know of our grave concern about how the Supreme Court ruling will be implemented. No one should be forced to participate in causing the death of another human being. The conscience rights of doctors and all health care professionals must be protected,” Rogal said.
“The public has a significant role to play in putting pressure on the provincial government to ensure the patient-physician relationship remains one of trust and integrity,” he added.
Saskatoon Bishop Donald Bolen is encouraging ongoing public participation.
“Euthanasia remains a grave threat to many vulnerable persons as well as to our whole society, which once stood firm on a fundamental respect for all human life,” Bolen said. “I encourage all Canadians to contact their MLAs and MPs to influence the drafting of legislation that ensures the protection of conscience rights and keeps the needs of vulnerable persons at the centre of this discussion.”