The Supreme Court of Canada’s June 6 deadline has passed and the ban against physician assisted suicide has been lifted without federal legislation in place to set regulations for how it will be done.
Without federal law, the result may be a patchwork of services for medical assistance in dying across the country. But what does that mean for more remote communities like Prince Rupert?
Dr. Gillaum Coetzee, the chief of staff at the Prince Rupert Regional Hospital said they are still waiting for lawmakers to determine what the law will say and it’s too early to comment.
“I don’t think anyone is opposed to it,” he said. “People need to understand that these things don’t happen at the flick of a switch. We have to make sure the correct processes are in place to make sure it’s done decent and a way that is helpful to medical care.”
The provincial government cleared some of the mud on June 6 when Health Minister Terry Lake and Justice Minister Suzanne Anton stated that the standards set by the B.C. College of Physicians and Surgeons on assisting a patient to die will be enforced until federal law is presented.
Provincial direction for medical assistance in dying
Anton released another statement on June 8 stating that if the conditions of the Supreme Court’s conditions in the Carter case is met then “there is no substantial likelihood of a conviction under S. 241 (b) for physicians or other health care professionals involved in carrying out a physician-assisted death in B.C.”
Northern Health is working with the province and other health organizations on the issue, said Jonathon Dyck the spokesperson for Northern Health.
“A provincial working group is working hard to facilitate a provincial approach to policy development and to better understand and work through any issues and barriers that must be addressed throughout the implementation process,” Dyck said in an email including that there is work with the province and health authorities to consider the logistical aspects.
The federal government’s law on medical assistance in dying (Bill C-14) has been delayed after the senate voted to amend a key part of the bill on June 8 that defines how a patient is eligible for the service. While the bill returns back to the House of Commons, and legislation remains at an impasse, provincial law will rule on medically assisted dying in British Columbia based on the College of Physicians and Surgeons regulations.
How the college recommends the process should work
It will only be available for patients older than 19. The patient must also be competent and they must have a grievous and irremediable medical condition that causes suffering. The request to die must be witnessed by two independent people and they are eligible for publicly funded health care.
The process involves getting the opinion from two physicians, an attending and consulting physician. Access to a physician can be challenging in Prince Rupert, but the college has allowed for one of the physicians to assess the patient through telemedicine.
Ten days must pass between when the request is signed by the patient and when medical assistance in dying is provided.
Then, the physician can prescribe the substance used in the medically assisted dying process (what the substance is remains unclear). The college states the physician can provide the substance for the patient to self-administer or the physician can administer the substance themselves.
In the college’s regulations, which the province has declared will dictate the process of medical assistance in dying until federal law passes, physicians have the right to decide whether they will provide this service to their patient.
Limitations in remote communities
With limited physicians in Prince Rupert, if none of the doctors provide the service, patients who decide to go through the medical assistance in dying process may have to travel to regions of the province that do provide the service.
Dr. Gillaume Coetzee doesn’t think that will be an issue. “I think there’s a good chance there will be access I just can’t guarantee it will be in Prince Rupert that will depend on every physician whether they feel comfortable doing it at this early stage,” he said.
“It’s a new concept for physicians as well. Nowhere in our training were we ever taught how to end peoples’ lives, that’s not something we do. I think it will take a bit of time for us to get comfortable with complying with such choices patients make, not that we don’t respect those choices, but it’s not the way we’re trained traditionally.”
The Prince Rupert Hospice Society has offered to provide patient with palliative care at the end of their life since 2009. The society has taken a stance, within the local chapter, regarding medical assistance in dying.
“If their choice is doctor assisted dying we’ll support them in whatever way we can. We’re the basket holding everybody up together,” said the president of the hospice society, Judy Riddell.