Suicide had been a crime in Canada since its colonization. It was also considered immoral and sinful in many religions. In 2016 the Supreme Court of Canada (SCC) decided it could no longer be a crime. Legislation soon followed making it legal under certain conditions, now known as Medical Assistance in Dying (MAID). Our blog has written extensively in the past on this subject. What follows is an update on some of the ongoing legal developments occurring across Canada.
We know that there are doctors opposed to having any involvement with MAID. Their numbers are not known. However, McGill University recently published a national survey of 1,200 graduating physicians on their willingness to perform MAID. The result was that overall, 71% of the respondents would be open to providing MAID. The graduates from the province of Quebec were the most supportive at 85%, and those from Alberta were the least supportive at 63%. Religious belief was the main reason cited for non-support amongst the respondents.
Jean Truchon and Nicole Gladu are asking the Quebec Superior Court to rule that the federal and provincial MAID requirements are too restrictive and constitutionally invalid. Nicole had polio as a child and has since developed post-polio syndrome. She suffers from a lack of mobility and function due to her deteriorating muscles and relies on an electric wheelchair. Jean has cerebral palsy and has lost the use of all of his limbs. Although these conditions will progressively worsen, it is not a certainty that their lives will end soon naturally. They both wish to end their lives through MAID, with Gladu stating that for her, living is mere existence, and not a life with real quality or meaning. Both Gladu and Truchon have undergone evaluations which concluded that they are competent and do not suffer from any condition that would affect or impair their judgement.
To be considered eligible for access to MAID at the federal level, the applicant's natural death is imminent and foreseeable. The provincial legislation in Quebec goes a step further, requiring that the applicant is at the end of their life. The thrust of their argument is that the SCC, in their Carter decision, gave the right to MAID for all patients with a grievous and irremediable medical condition. There was no additional requirement imposed that the person must also be close to death or that their death was foreseeable. These requirements in the legislation are subjective and dependent on the assessment of doctors and not the patients. The counterargument is that these provisions protect the vulnerable patient who although seriously ill, is not close to death. The results of Gladu and Truchon's federal challenge would apply nationally, subject to appeal.
There is also an ongoing debate and study on the following issues:
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The Chief Medical Officer of Health for Ontario has issued an updated Directive #2 (dated May 26, 2020) for Regulated Health Professionals in the province.
Pursuant to the updated Directive #2, all deferred non-essential and elective services by health care providers may be gradually restarted – subject to the rest of the requirements set out in the Directive.
The updated Directive #2 does not provide particularly detailed guidance to health professionals on how to proceed, likely because it applies to such a broad spectrum of health care and health professionals. It does, however, provide some principles to assist health care providers in making decisions as we enter this transitional period.
In addition to the mask and hand sanitizer shortages, Ontario’s response to COVID-19 highlights the need for more frontline health care workers. Each regulated health profession’s college responded differently, and we have discussed some of those changes in other posts to keep you apprised.
Today, we focus on the College of Physicians and Surgeons of Ontario (CPSO), who set out to increase the number of available and licenced physicians out on the frontlines through certificates of registration that authorize supervised practice of short duration. The temporary licences authorize practice for 30 days.
Undoubtedly, COVID-19 has affected how health professionals practice. Pharmacists across the country are not only experiencing changes in how they practice (for example, accepting emailed prescriptions, where appropriate) but the scope of their practice as well. The latter change is not permanent, although the disruptions in practice may be felt long after the COVID-19 emergency subsides.
On March 19, 2020, Health Canada issued a short-term section 56(1) exemption under the Controlled Drugs and Substances Act (CDSA) that would authorize pharmacists to prescribe, sell, or provide controlled substances in limited circumstances, or transfer prescriptions for controlled substances (the CDSA Exemption).