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Memorandum

To

Clinical Leadership Team (CLT)


Medical Advisory Committee (MAC)

From

Dr. David Unger, Director, Ethics Services


Camille Ciarniello, Risk Management, Patient Safety & Patient Relations

Date

February 16, 2016

Re.

Physician Assisted Death (PAD) Update

The following information provides a summary and update on the issue of Physician Assisted Death
(PAD). It provides information for PHC care-program leadership on the processes and required consults
to follow with Ethics Services and Risk Management, should such issues arise in our care settings.
Program and physician leaders are encouraged to discuss and share this consult process with their staff.
Background:
In a monumental decision on Feb. 6, 2015, the Supreme Court of Canada (SCC) ruled that certain
individuals have the right to seek a physicians assistance in hastening their death and that Criminal Code
prohibitions against such were in violation of the Canadian Charter of Rights and Freedoms.
Per the SCC decision, Canadians that meet the following broad criteria shall be permitted to ask for and
receive Physician Assisted Dying (PAD): a competent adult person who clearly consents to the
termination of life and has a grievous and irremediable medical condition (including an illness, disease or
disability) that causes suffering that is intolerable to the individual.
PAD includes both physician assisted suicide (prescribing medications that will cause death and which
the patient can take at a time and place of their choosing), and euthanasia (actively administering
medications to a patient that causes their death).
The decision was suspended for 12 months to enable the new federal government to amend existing
legislation, construct new legislation, and facilitate whatever regulatory instruments and policies it saw fit
to enable the provinces to accommodate this ruling within their health service plans.
Current Situation:
The Carter decision stands, but the prohibition on PAD, which was to expire on Feb. 6, 2016, has now
been extended to June 6, 2016.
In the interim four months, individuals wanting PAD can seek a court-ordered exemption as of Feb. 6,
2016.
PHC provides health care in conformity with the Catholic Health Alliance of Canada (CHAC) Health Ethics
rd
Guide (3 ed., 2012). Accordingly, and at the most fundamental level, PAD contradicts the basic tenets of
Catholic health care wherein life is held to be sacred from conception to natural death and not
permitted in Catholic health care institutions such as Providence.
We remain committed to providing the same excellent care at all stages of life to our patients and
residents, and to providing the best palliative and comfort care for those at the end of life.

Going Forward:
The implications of the Carter decision have near-term and long-term implications.
In the short term (now until June 6):
Health care workers and other employees of PHC may be asked about PAD, and may be asked
by a patient or resident to provide PAD.
In such a case, the patient/ resident can only avail themselves of the procedures upon securing
an exemption from the Supreme Court of BC. So, patients/residents will need to approach a
lawyer to begin an application to the court and they should be informed of this process.
This is uncharted territory so there is no possibility of providing catch-all guidance or policy on this
matter. For that reason, health care providers approached with such a request from patients/
residents, are urged to contact Ethics Services and Risk Management at PHC as soon as
possible so that a collaborative effort may be made to address the request and find a solution on
a case by case basis. This will be done presumably within the interim structures established in
other health care facilities in the region.
PHC will not abandon patients and residents and will, as always, provide them with the best
possible care to relieve their suffering at our facilities at these critical times, and we will do so in
accord with Catholic teaching and the precepts of the CHAC Health Ethics Guide.
In the long term (June 6 and beyond):
We will monitor and conform to the regulatory and legislative demands as they take shape.
We will be constructing robust policies for handling requests for PAD as the facts of the legislation
and regulations become known.
We will continue to work with our partners within and between health care regions, and with our
academic and research affiliates.
We are confident that we will develop policies and procedures that will meet the needs of all
stakeholders, including patients/ residents, healthcare workers, and other organizations.
If there are any questions about this communique or related matters, please contact us at Ethics
Services 6-9092, and Risk Management at 6-8879.