Canada’s assisted suicide guidance for docs: ‘virtual’ assessments, and don’t tell patient’s family

Denver, Colo., Apr 14, 2023 / 11:12 am (CNA).

The Canadian government has released new recommended standards and advice for medical doctors concerning physician-assisted suicide that critics say do nothing to protect vulnerable patients from premature death.

The new guidelines allow for “virtual” physician-assisted suicide, advise doctors not to notify family members when a patient requests suicide, and require medical professionals who object to physician-assisted suicide to refer patients to others who are willing to participate in their suicides.

Health Canada released on March 27 the “Model Practice Standard for Medical Assistance in Dying,” as guidance for the practice of assisted suicide, made legal in 2016 and known as medical aid in dying (MAiD). More than 31,000 people have already died by legal euthanasia in Canada.

In an accompanying statement, Canada’s national health department said the standards are designed to “ensure that MAiD practice in Canada can operate in a consistent and safe manner across the country.” This guidance “will help clinicians align their practice with clear guidance and will assist regulators to ensure the protection of the public in the context of complex cases, including where the person’s sole underlying medical condition is a mental illness.”

The guidelines follow prominent news reports that some poor or isolated Canadians are securing medical approval for euthanasia for treatable pain, minor conditions, or fear of homelessness.

Critics of MAiD and advocates for the disabled say that far from protecting people, the new standards normalize euthanasia and protect doctors and nurses from liability.

Alex Schadenberg, executive director of the Ontario-based Euthanasia Prevention Coalition, warned that the fundamental problems of legal assisted suicide will continue regardless of the new guidance.

“The government is reacting to the euthanasia (MAiD) approvals and deaths of people with disabilities and others, who requested death based on poverty, homelessness, an inability to receive necessary treatment, and other reasons that Canadians have found appalling,” Schadenberg said.

“The ‘medical practice standards for medical aid in dying’ will not solve the problem since these shocking and horrific deaths are based on the lack of definition in the legislation and the complete legal protection in the law for doctors and nurses who participate in euthanasia,” he said.

Amanda Achtman, who works with Canadian Physicians for Life on ethics education and cultural engagement, told CNA that medical aid in dying is “the intentional killing of a patient by a physician or nurse practitioner.”

“The goal of MAiD is to end a person’s suffering by causing death and so, contrary to the language in the documents, there is no ‘safe’ way to do it when it comes to the outcome for the patient,” she said.

What’s in the new assisted suicide guidance for doctors?

‘Virtual’ assisted suicide recommended

Though requests for assisted suicide require two consultations with medical professionals to proceed, the Health Canada standards say assessment of suicide eligibility may take place virtually if the relevant regulatory authority allows it.

Doctors advised not to notify family of assisted suicide request

The recommendations include provisions that say medical providers should not notify friends or relatives of assisted suicide requests without the explicit consent of their patients.

An accompanying document from Health Canada, “Advice to the Profession: Medical Assistance in Dying,” states that eligibility assessors and assisted suicide providers must not disclose to family and friends whether assisted suicide has been requested or received without the patient’s express consent. The document says providers should explain to the patient “the potential harms of nondisclosure.”

Achtman objected “that a loved one can be euthanized without the family having even the slightest idea about it until it’s too late.”

“Health Canada is directing medical professionals not to involve relatives if the patient wants to be euthanized secretly,” she said.

No allowance for conscientious objectors

Though no physician or nurse practitioner may be compelled to prescribe or administer assisted suicide drugs, the standards say, they must refer patients to others who are willing to do so. However, Schadenberg voiced concern about the compulsion of medical professionals who do not wish to take part in assisted suicide.

“When reading the ‘medical practice standards’ it is clear that these ‘guidelines’ undermine rights that exist in certain provinces,” Schadenberg said. “For instance, these standards require physicians who are unwilling to participate in euthanasia to provide an effective referral or transfer of care. Manitoba recognizes conscience rights for physicians and nurses. These guidelines undermine those conscience rights.”

“The ‘guidelines’ also require physicians and nurses to inform patients, who may qualify for MAiD, that MAiD is a legal option,” he added. “Medical professionals who oppose killing will not be willing to inform their patients that they can be killed.”

Guidelines offer no protections, critics say

Health Canada said Canada’s government is “committed to ensuring that the practice of MAiD balances laws that give autonomy and freedom of choice for Canadians, a system that provides strong safeguards that protect those who may be vulnerable, and a process that guarantees compassionate and diligent consideration of every request for MAiD.”

The medical practice standards say physicians or nurse practitioners must ensure patients are informed of “the full range of treatment options available to relieve suffering.”

If the medical professional finds “reasonable grounds” to believe a patient is eligible for assisted suicide, he or she must determine if this is consistent with the patient’s values and goals. If this is so, the patient should be advised about the potential for MAiD.

Yet critics say the guidance offers little protection for vulnerable patients.

“All of these ‘guidelines’ are designed to make MAiD/euthanasia appear to be carefully carried out and yet, the medical practitioner only needs to be of the opinion that the person fits the criteria of the law,” Schadenberg told CNA. “In other words, these guidelines are ink on paper.”

Assisted suicide to expand to mental health issues

Quebec first legalized assisted suicide in 2015 and the practice was legalized nationwide in 2016. Since MAiD was legalized, more than 31,000 people had died by assisted suicide as of Dec. 31, 2021.

To qualify for legal assisted suicide in Canada, at least two medical practitioners must assess whether a patient is eligible. Patients seeking assisted suicide must be age 18 years or older and capable of making their own decisions. They must have “a grievous and irremediable medical condition.”

The average age of recipients is 76 and most have terminal cancer or heart disease, “although the number of recipients with nonterminal conditions is rising,” according to an April 3 article in the Canadian Medical Journal by Diana Duong and Lauren Vogel. In Quebec, medically assisted suicide made up more than 5% of all deaths from 2020-2021.

Beginning March 17, 2024, Canada will allow legalized assisted suicide for people who only have a mental disorder as an underlying health condition.

Achtman said the expansion of MAiD and the issuance of the new guidelines are concerning. She characterized the document as “a further attempt by the Canadian government to normalize euthanasia as medical care.”

“Through the use of acronyms, euphemisms, and professional jargon, the Canadian government is expanding euthanasia to an ever-widening demographic of Canadians as a means to end their suffering,” she said, warning that the elimination of people who suffer will affect everyone.