Irremediable Medical Condition Research Articles

Quality of Bereavement for Caregivers of Patients Who Died by Medical Assistance in Dying at Home and the Factors Impacting Their Experience: A Qualitative Study.

Background: Medical Assistance in Dying (MAiD) was legalized in Canada in June 2016. MAiD is available to those who are at least 18 years of age with an irremediable medical condition and an irreversible state of decline causing unbearable suffering. Between June 2016 and December 2019, 13,946 MAiD cases were reported in Canada.3 Although 35.2% have taken place in the home, very little is known about the experience of caregivers in this setting. Objectives: This study explored caregivers' experience with MAiD in the home-setting and their bereavement process. Setting/Subjects: Caregivers of patients of the Temmy Latner Centre for Palliative Care in Toronto, Canada, who underwent MAiD by a physician at home. This study was approved by the Sinai Health Research Ethics Board. Design: This study used a semistructured interview guide and standardized questionnaires. Thirteen caregivers were contacted at least six months post-MAiD to participate in a one-on-one interview. The interviews were transcribed, coded, and evaluated using a thematic analysis approach. Results: The main themes that emerged from the interviews were the caregivers' experience with MAiD, their interaction with the MAiD team, disclosure about MAiD, their bereavement experience, and comparison of experiencing a MAiD death to a natural death. Conclusion: We hypothesize that caregivers in our study were better prepared for the upcoming death due to more certainty as to how and when their loved one would die. Having closure and being able to say goodbye may also have positively influenced the bereavement experience. Finally, MAiD may have spared the caregivers the trauma of witnessing their loved one deteriorate in their final days of life.

Medical Assistance in Dying in patients with advanced cancer and their caregivers: a mixed methods longitudinal study protocol

BackgroundThe legal criteria for medical assistance in dying (MAiD) for adults with a grievous and irremediable medical condition were established in Canada in 2016. There has been concern that potentially reversible states of depression or demoralization may contribute to the desire for death (DD) and requests for MAiD. However, little is known about the emergence of the DD in patients, its impact on caregivers, and to what extent supportive care interventions affect the DD and requests for MAiD. The present observational study is designed to determine the prevalence, predictors, and experience of the DD, requests for MAiD and MAiD completion in patients with advanced or metastatic cancer and the impact of these outcomes on their primary caregivers.MethodsA cohort of patients with advanced or metastatic solid tumour cancers and their primary caregivers will be recruited from a large tertiary cancer centre in Toronto, Ontario, Canada, to a longitudinal, mixed methods study. Participants will be assessed at baseline for diagnostic information, sociodemographic characteristics, medical history, quality of life, physical and psychological distress, attitudes about the DD and MAiD, communication with physicians, advance care planning, and use of psychosocial and palliative care interventions. Measures will subsequently be completed every six months and at the time of MAiD requests. Quantitative assessments will be supplemented by qualitative interviews in a subset of participants, selected using quota sampling methods.DiscussionThis study has the potential to add importantly to our understanding of the prevalence and determinants of the DD, MAiD requests and completions in patients with advanced or metastatic cancer and of the experience of both patients and caregivers in this circumstance. The findings from this study may also assist healthcare providers in their conversations about MAiD and the DD with patients and caregivers, inform healthcare providers to ensure appropriate access to MAiD, and guide modifications being considered to broaden MAiD legislation and policy.

Advance Requests for Medically-Assisted Dying

When medical assistance in dying (MAiD) was legalized in Canada in June 2016, the question of allowing decisionally capable persons to make advance requests in anticipation of later incapacity was reserved for further consideration during the mandatory parliamentary review originally scheduled to begin in June 2020 (but since delayed by COVID-19). In its current form the legislation does not permit such requests, since it stipulates that at the time at which the procedure is to be administered the patient must give “express consent” to receiving it. Since express consent presupposes decisional capacity, this requirement rules out administering MAiD to a patient who has lost capacity. Amendments to the legislation passed by Parliament in March 2021 open the door slightly by allowing advance requests by patients after they have been approved for MAiD, if they fear losing capacity before the procedure can be administered. But this provision would apply only to patients whose natural death was deemed to be “reasonably foreseeable”, and would continue to exclude (a) requests made after diagnosis of a “grievous and irremediable medical condition” but in advance of approval for MAiD, and (b) requests made before such a diagnosis. My aim in this paper is twofold: to explore the ethical and legal issues concerning advance requests for MAiD, and to argue for expanding provision for such requests to include both of these further scenarios.

Advance Requests for Medically-assisted Dying

When medical assistance in dying (MAiD) was legalized in Canada in June 2016, the question of allowing decisionally capable persons to make advance requests in anticipation of later incapacity was reserved for further consideration during the mandatory parliamentary review originally scheduled to begin in June 2020 (but since delayed by COVID-19). In its current form the legislation does not permit such requests, since it stipulates that at the time at which the procedure is to be administered the patient must give “express consent” to receiving it. Since express consent presupposes decisional capacity, this requirement rules out administering MAiD to a patient who has lost capacity. Amendments to the legislation subsequently tabled by the government in February 2020 would open the door slightly by allowing advance requests by patients after they have been approved for MAiD, if they fear losing capacity before the procedure can be administered. But this provision would apply only to patients whose natural death was deemed to be “reasonably foreseeable”, and would continue to exclude (a) requests made after diagnosis of a “grievous and irremediable medical condition” but in advance of approval for MAiD, and (b) requests made before such a diagnosis. My aim in this paper is twofold: to explore the ethical and legal issues concerning advance requests for MAiD, and to argue for expanding provision for such requests to include both of these further scenarios.

Interpreting Eligibility Under the Medical Assistance in Dying Law: The Experiences of Physicians and Nurse Practitioners

This study examines the experiences of physicians and nurse practitioners interpreting the statutory criteria determining patient eligibility for Medical Assistance in Dying (MAiD). The Criminal Code sets out what qualifies as “a grievous and irremediable medical condition”, which includes the requirement that a patient’s “natural death has become reasonably foreseeable” (NDRF). The Superior Court of Quebec struck down the provision as unconstitutional and the government responded by introducing Bill C-7 which now deploys the NDRF criterion in new ways. Ambiguity and controversy have attached to the phrase since the Government introduced Bill C-14 before Parliament in 2016. From January to March 2019, we conducted semi-structured interviews with twenty-four Canadian MAiD assessors and providers to find out how they interpret the relevant federal and provincial legislative provisions. Respondents included 9 doctors from Quebec where the provincial law differs from the Criminal Code. The article identifies differences in the eligibility regimes, while providing a detailed analysis of how health care practitioners interpret and apply the statutory requirements to determine patient eligibility for MAiD. Our findings shed new light on Truchon and Bill C-7, while offering insight into the on-the-ground experiences of health care professionals in this changing field of law.

An Alternative to Medical Assistance in Dying? The Legal Status of Voluntary Stopping Eating and Drinking (VSED)

Medical assistance in dying (MAiD) has received considerable attention from many in the field of bioethics. Philosophers, theologians, lawyers, and clinicians of all sorts have engaged with many challenging aspects of this issue. Public debate, public policy, and the law have been enhanced by the varied disciplinary analyses. With the legalization of MAiD in Canada, some attention is now being turned to issues that have historically been overshadowed by the debate about whether to permit MAiD. One such issue is voluntary stopping eating and drinking (VSED) as an alternative to MAiD. In this paper, I will apply a legal lens to the issue. An understanding of whether VSED is legal provides a foundation for ethical reflection on whether it ought to be permitted. Is it permitted for those who prefer VSED to MAiD? Is it permitted for those who do not qualify for MAiD under our current legislation – for those who do not have a grievous and irremediable medical condition, for mature minors, for individuals whose sole underlying medical condition is a mental disorder and who do not otherwise meet the eligibility criteria, and for individuals who have lost capacity but had completed an advance directive?

A Time and Manner to Die: A Study of Medical Assistance in Dying in Canada

At the heart of one’s decision to seek medical assistance in dying lie a person’s autonomy and bodily integrity. In Carter v Canada (Attorney General), the Supreme Court of Canada applied this reasoning to hold that every adult person, who has a grievous and irremediable medical condition and is enduring intolerable suffering has the right to a physician-assisted death. I argue in this paper that if a life is no longer worth living due to the very high price to pay to live it, then a person should be permitted to “waive” his/her right to life. In my view, just bearing the grievous and irremediable medical condition that has the effect of causing enduring intolerable suffering to an individual constitutes a very high price to pay. Expecting that individual to have a reasonably foreseeable natural death as well is an affront to that person’s autonomy, bodily integrity and human dignity. I contend that this is the effect of Bill C-14, Parliament’s response to Carter, and Quebec’s Act Respecting End-of-Life Care. Both laws require a patient to prove the elements of a grievous and irremediable medical condition, as the condition is defined in each respective legislation, but in addition, this patient must prove that his/her natural death is reasonably foreseeable and, in Quebec, that he/she is at the end of life. I argue that both laws contravene the essence of Carter and the Canadian constitution on both grounds of federalism and the Canadian Charter of Rights and Freedoms (Charter). As the notion of dialogue or Charter dialogue often surfaces to describe the relationship between the courts and a competent legislative body, this paper invokes this notion as the basis for its theoretical framework. This paper adopts a normative perspective in anticipation that the Supreme Court will take another look at the issue of medical assistance in dying. It argues what Parliament should have done, or, perhaps, more accurately, what it should not have done in response to Carter. I raise similar arguments in the case of the Quebec legislation. In my opinion, the two laws could successfully be challenged in court.

Medical assistance in dying: A paediatric perspective.

The Supreme Court decision in Carter v. Canada (2015) has led to changes to the Canadian Criminal Code, such that physician-assisted death is now a legal option for consenting adult patients who have a 'grievous and irremediable medical condition' that causes 'enduring' and 'intolerable' suffering. In June 2016, Bill C-14 was enacted, allowing medical assistance in dying (MAID) for an eligible adult whose death is 'reasonably foreseeable'. An independent report on the status of 'mature minors' (who are currently excluded under federal legislation), with focus on their potential eligibility for MAID, was required by the 2016 Act and is expected to be presented to Parliament by December 2018. Ensuring that newborns, children and youth receive the highest possible standard of care as they are dying is a privilege and a responsibility for physicians and allied professionals. Bringing a thoughtful, respectful and personal approach to every end-of-life situation is an essential and evolving duty of care, and the process should meet each patient's (and family's) unique social, cultural and spiritual needs. This statement describes the current Canadian legal and medical context of MAID and articulates a paediatric perspective that has emerged from-and been informed by-the broad, structured consultation process unfolding in Canada and elsewhere. Although 'mature minors' are the only youth currently mandated for further legislative consideration in Canada, the need to examine requests for and attitudes around MAID for minors of all ages remains compelling for two main reasons: Canadian health care professionals are increasingly being approached by the parents of 'never-competent' infants and children, including those too young to make a reasoned decision, and by youth themselves, to discuss MAID-related issues. Results from a Canadian Paediatric Surveillance Program (CPSP) survey, discussed below, indicate that parents raise such questions with paediatricians more often than do minors.The discussion of MAID policy in Canada has been framed as much by the issue and context of suffering as by considerations of autonomy. While current legislation clearly prohibits MAID for incapable persons at the request of any other person, it is possible that parents may request MAID on behalf of their dying child.

Exploring attitudes toward physician-assisted death in patients with life-limiting illnesses with varying experiences of palliative care: a pilot study

BackgroundOn February 6th, 2015, the Supreme Court of Canada ruled that competent adults suffering intolerably from a grievous and irremediable medical condition have the right to the assistance of a physician in ending their own lives, an act known as physician-assisted death, and later defined as medical assistance in dying, allowing for provision by a physician or a nurse practitioner. As of June 6th, 2016, this is no longer illegal across Canada. There is strong support amongst the general population for physician-assisted death, however there is no recent data on the attitudes of terminally ill patients. Our main objective was to gain information on terminally ill patients’ general and personal attitudes toward physician-assisted death.MethodsThis is an exploratory pilot study. We surveyed three groups of patients with life-limiting diagnoses: one with new referrals to palliative care; one with no palliative care involvement; and one with prior and ongoing management by a palliative care team. Respondents were surveyed twice, approximately two weeks apart, and rated their general attitudes toward physician-assisted death and the hypothetical consideration of physician-assisted death for oneself on a five-point Likert scale at baseline and follow-up. Respondents with new referrals to palliative care were surveyed before and after palliative care consultation. This study was approved by The Western University Health Sciences Research Ethics Board and Lawson Health Research Institute.ResultsWe surveyed 102 participants, 70 of whom completed both surveys (31% dropout rate). Participants in all groups predominantly responded between somewhat agree (4 on a 5-point Likert scale) and strongly agree (5 on the Likert scale) when asked about their general attitude toward physician-assisted death. Patients with prior palliative care involvement reported the highest average ratings of hypothetical consideration of physician-assisted death for oneself on a 5-point Likert scale (3.4 at baseline; 3.9 at follow-up), followed by patients with a new palliative consultation (3.2 at baseline; 3.3 at follow-up), and patients with no palliative involvement (2.6 at baseline; 2.9 at follow-up).ConclusionsGiven the preliminary results of this pilot study, we can conclude that terminally ill patients generally agree that physician-assisted death should be available to patients with life-limiting illnesses. Furthermore, descriptive data show a trend for higher hypothetical consideration of physician-assisted death in those patients with prior and ongoing palliative care involvement than patients without palliative involvement. Responses in all groups remained fairly consistent over the two-week period.

Foreseeably Unclear: The Meaning of the 'Reasonably Foreseeable' Criterion for Access to Medical Assistance in Dying in Canada

In April 2016, the federal government of Canada introduced draft legislation to regulate medical assistance in dying (MAiD). There was a swift and fierce response to various aspects of the Bill with some of the fiercest criticisms aimed at one of the criteria for eligibility found in the proposed text for s.241.2(2) of the Criminal Code: (2) A person has a grievous and irremediable medical condition only if they meet all of the following criteria:… (d) their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining. Some criticized the provision for being inconsistent with the Canadian Charter of Rights and Freedoms (drawing especially but not exclusively on the decision of the Supreme Court of Canada in Carter v. Canada). This criticism is now being litigated in the courts through Lamb v. Attorney General and Jean Truchon and Nicole Gladu v. Attorney General (Canada) and Attorney General (Quebec) and is not the focus of this paper. Others criticized the provision for containing a phrase that is unfamiliar and unclear: “reasonably foreseeable.” Despite attempts to remove s. 241.2(2) (at the hearings for both the House of Commons Standing Committee on Justice and Human Rights and the Standing Senate Committee of Legal and Constitutional Affairs, and in amendments passed by the Senate but rejected by the House of Commons), the provision remained in the version of the legislation that came into force on June 17, 2016. Not surprisingly, eighteen months on, there is confusion among health care providers, lawyers, and the public as to what the provision means. One court case tackled the issue head on but, for reasons discussed below, did not resolve all of the confusion. As a result of the ongoing confusion, there is reason to be concerned that under- or overinclusive interpretations of this eligibility criterion are adversely affecting access to MAiD. With critical interests at stake (e.g., access to MAiD and potential criminal liability), it is essential that the meaning of the provision be clarified. Furthermore, the meaning of “reasonably foreseeable” will no doubt be contested in the two Charter challenges to the federal MAiD legislation currently before the courts in British Columbia and Quebec. In order to determine whether s.241.2(2) violates the Charter, the courts will have to first determine what it means because whether the limits on access to MAiD violate the Charter depends on the scope of the limits. For these two reasons, and because MAiD providers and assessors and the public need guidance as they wait for an authoritative interpretation from the courts, it is worth bringing the principles of statutory interpretation to bear on the phrase “reasonably foreseeable.”

Public and Professional Insights on End-of-Life Care: Results of the 2016 Health Care in Canada Survey.

A new dimension has been added to Canadian Medicare ߝ exemption from prosecution for physicians, nurse practitioners and assistants providing medical assistance in dying for competent and informed adult patients with a grievous and irremediable medical condition causing intolerable physical or psychological suffering, irreversible decline in capabilities and reasonably foreseeable natural death. To define stakeholders' perceptions on all contemporary end-of-life care options, we analyzed data from the 2016 Health Care in Canada Survey comprising representative samples of the adult public (n = 1,500), physicians (n = 102), nurses (n = 102), pharmacists (n = 100), administrators (n = 100) and allied health professionals (n = 100). Among the public, enhanced pain management, hospice/palliative care and home/family care were all supported at, or above, the 80th percentile; medically assisted death was supported by 70%. Among all professionals, hospice/palliative care, pain management and home care garnered >90% support; support for medically assisted death ranged from 58% (physicians) to 79% (allied professionals). In terms of priority to implement available options, medically assisted death was rated first by 46% of the public, overall, and by 69% of the sub-group who strongly supported it, followed by enhanced pain management (45%) and home care (42%). Among professionals, top implementation priorities (range: 57ߝ61%) were: enhanced pain management, hospice/palliative care and home care support. Priority for medically assisted death ranged between 25% and 41%, although among professionals who strongly supported it, it was their top priority (52%). When asked to balance patients' right to access assisted death, versus some professionals' reluctance to provide it, 42% of the public and the majority of professionals thought providers should be allowed to opt out if they referred patients to another willing provider. And many professionals perceive some risk of either legal or regulatory reprisal if they assist in patients' deaths. In summary, there is substantial contemporary support for all components of end-of-life care among all stakeholders. However, non-lethal care modalities remain generally preferred, perhaps, at least in part, because medical professionals have a pervasive concern of going in harm's way by participating in assisted death, or by refusing. Things can be better.

Analysis of the Medical Assistance in Dying Cases in Ontario: Understanding the Patient Demographics of Case Uptake in Ontario since the Royal Assent and Amendments of Bill C-14 in Canada

On June 17, 2016, the Canadian government legalized medical assistance in dying (MAID) across the country by giving Royal Assent to Bill C-14. This Act made amendments to the Criminal Code and other Acts relating to MAID, allowing physicians and nurse practitioners to offer clinician-administered and self-administered MAID in conjunction with pharmacists being able to dispense the necessary medications. The eligibility criteria for MAID indicates that the individual 1) must be a recipient of publicly funded health services in Canada, 2) be at least 18 years of age, 3) be capable of health-related decision-making, and 4) has a grievous and irremediable medical condition. Because this is a new practice in Canadian health care, there are no published Canadian statistics on MAID cases to date, and this paper constitutes the first analysis of MAID cases in both the province of Ontario and Canada. Internationally, there are only a few jurisdictions with similar legislation already in place (US, the Netherlands, Belgium, Luxembourg, Switzerland, Columbia, Japan, and the United Kingdom). The published statistics on MAID cases from these jurisdictions were reviewed and used to establish the current global practices and demographics of MAID and will provide useful comparisons for Canada. This analysis will 1) outline the Canadian legislative approach to MAID, 2) provide an understanding of which patient populations in Ontario are using MAID and under what circumstances, and 3) determine if patterns exist between the internationally published MAID patient demographics and the Canadian MAID data. Selected patient demographics of the first 100 MAID cases in Ontario were reviewed and analyzed using anonymized data obtained from the Office of the Chief Coroner for Ontario so that an insight into the provision of MAID in Ontario could be obtained. Demographic factors such as age, sex, the primary medical diagnosis that prompted the request for MAID, the patient rationale for making a MAID request, the place where MAID was administered, the nature of MAID drug regimen used, and the status/specialty of medical personnel who administered the MAID drug regimen were analyzed. The analysis revealed that the majority of the first 100 MAID recipients were older adults (only 5.2% of patients were aged 35-54 years, with no younger adults between ages 18-34 years) who were afflicted with cancer (64%) and had opted for clinician-administered MAID (99%) that had been delivered in either a hospital (38.8%) or private residence (44.9%). Although the cohort was small, these Ontario MAID demographics reflect similar observations as those published internationally, but further analysis of both larger and annual case uptake in both Ontario and Canada will be conducted as the number of cases increases.

Medical aid in dying: What matters most?

With the passing of Bill C-14, Canadians who are mentally competent adults suffering from a grievous and irremediable medical condition may now seek medical aid in dying.[1][1] The policy has already resulted in ripples of controversy. For example, some large faith-based hospitals currently do not

Broken to the Hope

The UN Convention on the Rights of Persons with Disabilities is a landmark international agreement recognizing the rights and equal status of disabled people. States Parties commit to protect the right to life of all such people and to promote their equal dignity. Canada ratified the convention in 2010. However, Canada’s Medical Assistance in Dying Act, which received royal assent in 2016, allows for assisted suicide and euthanasia of those dis­abled people who have a grievous and irremediable medical condition. This essay contends that the act violates Canada’s treaty obligations not to enact legislation inconsistent with the convention by jeopardizing the right to life of such people and placing them in a significantly unequal status within Canadian society.

Physician-Assisted Death in Canada.

The Criminal Code of Canada prohibits persons from aiding or abetting suicide and consenting to have death inflicted on them. Together, these provisions have prohibited physicians from assisting patients to die. On February 6, 2015, the Supreme Court of Canada declared void these provisions insofar as they "prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." This declaration of invalidity was scheduled to take effect one year (later extended by six months) after the ruling, to give the government time to put legislation in place. We trace the history of this decision, discuss how it has forever changed the debate on physician-assisted dying, and identify the issues that must be resolved to write the legislation. Of special importance here are the topics of access, safeguards, and conscientious objection.

The Parameters of a Charter Compliant Response to Carter v. Canada (Attorney General), 2015 SCC 5

The Supreme Court of Canada’s remedy in Carter was a declaration of invalidity: “Section 241(b) and s. 14 of the Criminal Code unjustifiably infringe s. 7 of the Charter and are of no force or effect to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition. (paras. 127 and 147)”The Court suspended its declaration of invalidity in Carter, initially for twelve months, and ultimately for sixteen months, because it recognized the complexity of the issues to be resolved. What the SCC found unconstitutional, and needs to be replaced, is an absolute ban on physician-assisted death. This leaves significant room for Parliament to choose what safeguards are necessary to protect the vulnerable. As the Court said: “Complex regulatory regimes are better created by Parliament than by the courts.” (para. 125) As the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying said in its Final Report (November 30, 2015): “Although the Supreme Court did not outline the framework for such a system [of safeguards] in the Carter decision, it expressed confidence that such a system could be implemented in Canada.” (p. 15)The overlap of federal criminal law jurisdiction and provincial health jurisdiction raises the possibility of conflicting legislation. If the Criminal Code is stricter than provincial legislation, reliance on provincial legislation will not avail in a criminal prosecution. If the provincial legislation is stricter than the criminal law, the lack of criminal liability would not preclude professional discipline under provincial legislation, meaning the access contemplated under the criminal law would be thwarted. There is thus a high premium on harmonizing federal and provincial law.The Final Report of the External Panel on Options for a Legislative Response to Carter v. Canada (15 December 2015) set out the vastly divergent positions of a broad range of stakeholders; many choices have to be made. There is significant pressure to amend the Criminal Code by 6 June 2016, when the suspension of the declaration of invalidity will expire, in order that a system of safeguards under the criminal law be in place. However, nothing done as of 6 June 2016 is cast in stone. Adjustments based on reconsideration and/or experience will always be possible. Legislating in stages is also an option.In what follows I will explain why, in my assessment, it is consistent with Carter to (1) limit physician-assisted death to end-of-life conditions; (2) include a mechanism of prior review beyond doctors` assessments; (3) preclude reliance on advance directives; and (4) limit availability to those 18 and over.

Legalization of euthanasia in Quebec, Canada as “medical aid in dying”: A case study in social marketing, changing mores and legal maneuvering

Summary We discuss the logic and implications behind the choice, in the 2014, Quebec province law, Bill 52, which legalized euthanasia, of calling it “medical aid in dying”. The adoption of this euphemism to define the practice of euthanasia as a medical act was so that it would arguably be considered part of health care, which is under provincial jurisdiction, rather covered by the federal criminal code. Also, the general public was more likely to accept a practice labelled “medical aid” than “euthanasia”. Polls indicate that many Quebecers and health care professionals are confused about what is legal and illegal. We suggest that there is an ethical imperative for lawmakers to clearly inform the public about the explicit nature of what is being legalized. After passage of Bill 52, the Supreme Court of Canada, in 2015, decreed in Carter v. Canada, to legalize the practice of assisted suicide and/or euthanasia throughout Canada, and gave the Federal Government one year to establish guidelines. The Supreme differentiated between when there is no health care issue, and when a person is suffering from a “grievous and irremediable medical condition”. The objection raised by two senatorial reports, that we should not offer death as an option to abridge suffering when adequate palliative care is not universally available, has not been directly confronted. Despite concerns about the costs of palliative care, research found that in the United States, each dollar spent on palliative care saves over $1.30 in medical expenses. We contend that with assisted suicide, patients have greater freedom to change their minds free of social pressure and not complete their assisted suicide. In fact, between 1998 and 2012, 36% of people in Oregon who received lethal medications for assisted suicide did not take the medications. The ending of life is one of the most challenging issues before legislators. It is paramount that they should search for a convincing consensus among the public based upon a clear understanding of options and exercise prudence before overly determining outcomes.

From Courtroom to Bedside - A Discussion with Dr. Jeff Blackmer on the Implications of Carter v. Canada and Physician-Assisted Death

Introduction:On February 6th, 2015, the Supreme Court of Canada (SCC) concluded that “the prohibition on physician-assisted dying is void insofar as it deprives a competent adult of such assistance where (1) the person affected clearly consents to the termination of life; and (2) the person has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”[1]. The Court added, “The declaration of invalidity is suspended for 12 months,”[1] to allow the government to respond with appropriate legislation to guide and regulate the practice of Physician-Assisted Death (PAD).Dr. Jeff Blackmer is the Vice President of Medical Professionalism at the Canadian Medical Association (CMA). He holds a Masters in Medical Ethics from the University of Toronto. He served as the Executive Director of the CMA’s Office of Ethics, Professionalism and International Affairs and has been the interim Director of Ethics for the World Medical Association in Geneva. In an interview on February 11th, Dr. Blackmer kindly agreed to help us navigate through an array of ethical and practical ramifications stemming from the decision on Carter v. Canada.