June 6 has come without federal legislation on medical assistance in dying. Because of the Supreme Court’s decision on the Carter case, it is no longer a criminal offence for Canadian physicians to participate.
It may take some time before the Senate and the House of Commons reach agreement. In the meantime, it is timely for physicians to consider their response if a patient asks for help to end his/her life. What if you have known the patient for many years?
The Hippocratic Oath instructs that “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.”
The problem lies with interpretation. What of the words injury and wrong-doing? Facilitating suicide by providing the drugs for ingestion sure seems harmful. Injecting drugs that would cause imminent death seems like wrong-doing.
On the other hand, relieving undeniable, intolerable, incurable suffering can be viewed as a blessing. On yet another hand, physicians want to be viewed by the community as bringers of life, not death.
So what will happen once the legislation is finalized? In each province, the College of Physicians and Surgeons will develop rules and regulations as to the “how.” Based on precedent, no physician will be forced to participate. But there will be an expectation that physicians will refer the patient to a colleague willing to participate.
Abortion raises strong emotions, both pro and con. In Prince Edward Island, no physician is willing to perform these procedures. Patients must travel out-of-province. The Supreme Court decriminalized the performance of abortions and asked the federal government to propose legislation. It never did.
Physicians have three options. One, they can decide that it is not permissible or appropriate for physicians to hasten death. Two, they can decide that in special circumstance, such as unbearable suffering, it is acceptable to do so, but, they, personally, do not wish to be involved. Finally, some physicians will participate, within provincial regulations, because they cannot bear witness to unbearable suffering and do nothing.
But this is not all. If physicians are to write prescriptions for home use, then pharmacists will need to fill the prescriptions. If physicians are to inject drugs, then hospitals and nursing staff may become involved.
Finally, we need clear legislation. Right now, the words are fuzzy. The Minister of Justice called them flexible in order to give physicians room for maneuver. I do not believe that health professionals will wish to act in an uncertain legal environment.
Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective. If you have a question for Dr. Zalan, email it to [email protected].
