The Final Parting

"Jesus, what is it with these doctors? On the one hand they say the patient has the right to identify 'intolerable suffering' and on the other hand they say it is within the doctor's gift to decide what is 'grievous'."
"So are we to infer, then, that there could be intolerable but not grievous suffering, where the doctor is entitled not to act?"
"These colleges think that they're not simply God, but that they're an assembly of gods. They simply do not understand that in the eyes of the law, they're not gods, they're service providers."
Amir Attaran, professor of law, University of Ottawa, Canada Research Chair in Law, Population Health and Global Development Policy

"[It is incorrect and] ethically unsustainable [for the colleges to state doctors are to decide what is in a mentally competent patient's best interests]. That is the role and the right of the patient."
"But I think we have to be very careful not to see slippage of some kind of judgement going into the assessment of grievous."
"If you say there is a higher standard with respect to consent -- meaning you have to be more rational, more reasonable than you do when making a decision about something that's not 'divisive' -- then fewer people are going to have access."
Jocelyn Downie, professor, faculties of law and medicine, Dalhousie University, Halifax

"This is our first stab at this [draft advice to doctors]. In the consideration of whether you assist a patient to end his or her life, there has to be a balancing of these competing interests, and an understanding that, just because the patient wants it, in not every circumstance is that the right decision."
Dr. Trevor Theman, registrar, College of Physicians & Surgeons of Alberta 

"In some cases, the physician and patient will have a different understanding of whether PAD [physician assisted death] is in the patient's best interests. [Such situations may require] reconciliation through the courts."
"To be explicit: in some situations a physician may offer the opinion the patient does not suffer from a grievous and irremediable condition in which case physician-assisted death should not be offered."
Draft advice, The College of Physicians & Surgeons of Alberta

Fotolia   As the provinces wrestle with who decides when a patient is ready to depart this world, ethicists say the regulators are playing God

The issue is end-of-life decision-making. The Supreme Court of Canada gave notice of the right of severely ill people facing end of life situations to hasten their deaths through their identification of "intolerable" suffering from which they wish to escape life, prematurely to what might be considered the natural process of reaching death. On the premise that who is better positioned to identify "intolerable suffering"; the very people hastening death by their decision to request the assistance to die, yet there is an onus to demonstrate such a decision is "reasoned".

While various provincial medical associations have made an effort to guide their medical membership, some experts in the field of ethics believe that in so doing, they are co-opting authorization from the patients themselves.  Saskatchewan feels that competent adults should be free to make their decisions about their body; "to the extent possible, all those who meet the criteria for physician-assisted dying and request it", should have unquestioned access.

Dr. Theman, college registrar for Alberta, agrees but equivocates; claiming the fundamental value of the Supreme Court ruling; patient autonomy -- still comes up and competes against a physician's professional duty to be aware and act in the patient's best interests; the two are sometimes at odds; patient autonomy and a doctor's duty, and a balancing act then results to adequately and fairly reflect both sides of the same issue.

The Province of Quebec comes up hard against the Alberta interpretation respecting who is to determine whether assisted death is in an individual's "best interests". Quebec's position is that suffering is the fundamental relating to the patient's perception. While Manitoba would like to institute a regimen whereby a psychiatric assessment would be mandatory of anyone seeking assisted death whose condition is not terminal.

Looming close on the horizon in Canada is the legalized assisted suicide and euthanasia law, and with doctors concerned at the impact this will have on their profession and their new and in many instances,  unwanted [some go so far as to claim unwarranted] obligations, the medical colleges have stepped in to provide guidelines. The result of which may be a mixed bag, depending on where anyone lives, with one province providing access at the patient's determination, others requiring specific affirming tests.

The Criminal Code ban on doctor-assisted death is set to expire in Canada on February 6, 2016. The provinces of Alberta, Saskatchewan and Manitoba have proposed policies relating to the issue, and are looking for useful responses. Ontario is in the preparation mode on interim advice to Ontario doctors. Quebec, on the other hand, has produced a precise euthanasia guide, a step-by-step instruction manual on administering life-ending injections reflecting the gravity of the end result.


Bringing this new ruling into law will not result in legislation favoured by most Canadian doctors who have no wish to be complicit in ending life when their profession gears them toward prolonging life. Even when they are guided toward a gently compassionate ethos reminding them of the links between life and death, the vitality and hope in the former, the inevitability of the latter. It is the suffering and pain and fear that people undergo and wish to terminate that leads society to this kind of intervention.

Where, according to the Quebec-sourced instructions, doctors are urged to perform euthanasia within a "peaceful and appropriate" setting, having turned off intrusively disturbing pagers and cellphones, informing colleagues they will be temporarily unavailable, their intention being to remain with the patient as a comfort and partner in the solemnity of life's end, until death do them part.

Brittany Maynard with her dog Charley in San Francisco. Maynard, a 29-year-old with terminal brain cancer, has died, advocacy group Compassion and Choices said in a Facebook post on Sunday -- CNN November 2014