Come Monday Canadians can request medical aid in dying without a court order.
June 6 is the Supreme Court imposed deadline to make the practice legal. While the federal government won’t meet that goal, Alberta is ready.
This week the provincial government released its framework for medical assistance in dying. The document – still being debated by the Alberta Legislature – outlines the how, where, when and, to some extent, the who of this new practice.
As of Monday, AHS’s new medical assistance in dying care coordination service will be available to provide information and facilitate access to the service.
The coordination service, which will consist of one member in the Edmonton area and another in the Calgary area, was set up as a way to respect health care providers’ conscience rights, said Dr. James Silvius, the medical director of community, seniors, addiction and mental health for Alberta Health Services.
The province has confirmed that physicians and other health care providers who object to offering medical aid in dying for moral or religious reasons will not be required to offer the service. Covenant Health as an organization has also been offered this right.
In a policy document of its own, the Catholic health care provider, outlines a detailed procedure for responding to requests, beginning with understanding the reasoning for the request and stopping short of a medical and psychological assessment being undertaken within their facilities.
President Patrick Dumelie said it’s important to understand where the desire for hastened death comes from so that all care options can be explored and discussed.
“What we want to have are really informed patients that understand all of the options. Their decision, often times, is influenced by a whole host of factors including isolation or the feeling or burden or the feeling that their pain can’t be remediated. We want to make sure they understand we’re here to support them,” said Dumelie, who confirmed that medical aid in dying would be among the options discussed with patients.
While Dumelie acknowledges that Covenant Heath’s position might inconvenience some patients and their families, he says Covenant Health won’t be the only ones to undertake transfers of care.
Silvius agrees: “We know there are AHS facilities where this will not occur, particularly in smaller rural centres. That’s the other part of putting the navigators in place.”
But he would like to quell the speculation that there will be a shortage of doctors willing to assist those who are suffering, likely sparked by the case of Calgary resident Ms. S., who travelled to B.C. to carry out her court ordered death in March.
Silvius said her out of province travels had more to do with eligibility than the unwillingness or inability of Albertan physicians to fulfill her request.
About 150 physicians throughout the province and across all five medical zones have indicated they would be willing to offer medical aid in dying, though about half have indicated they would only consider it with their own patients.
Silvius expects to receive around 100 requests per year. This estimate is based on data coming out of Oregon, which approved its Dying with Dignity Act in 1997 and has a similar population size to Alberta.
Though, there could be an influx of requests in the month of June, when the Carter decision takes effect, said Silvius, especially given the uncertainty surrounding eligibility criteria.
Bill C-14, as it currently stands, limits medical aid in dying to terminally ill patients. Though that criterion is likely to be amended by the Senate, it is creating much consternation.
Alberta will respect the Carter decision in the absence of any federal legislative framework, meaning that until Bill C-14 receives royal ascent any resident over 18 with a “grievous and irremediable medical condition that causes enduring suffering that is intolerable to the patient” will be eligible.
The provincial framework also limits the administration of medical aid in dying to physicians, since Carter does not make mention of nurse practitioners or caregivers.
Once the federal legislation is in place it would take precedence, said Associate Minister Brandy Payne.
To protect pharmacists, doctors will have to inform them of the intended use of the prescribed drugs.
Physicians are protected despite the absence of federal legislation, said Silvius, but are encouraged to contact Canadian Medical Protective Association before offering medical aid in dying.
AHS will submit reports to the province and all medical aid in dying deaths will be recorded.
