Medical assistance in dying
Following a Supreme Court of Canada ruling, medical assistance in dying will become legal in Canada on June 6, 2016.
We know that end-of-life care and medical assistance in dying are important, sensitive, and emotional issues for Albertans. We recognize that patients have many decisions to make when faced with end-of-life care or intolerable suffering. The Government of Alberta wants to encourage Albertans to know and understand all the health care options available to them.
As we develop policies and practices around the delivery of medical assistance in dying, Alberta Health’s goal is to serve and protect patients, health care providers and our most vulnerable. We welcome the views and input of all Albertans in this difficult and important task.
What we heard report based on public survey
- Read the What We Heard – Medical Assistance In Dying report based on the results from the public survey.
What is medical assistance in dying?
Medical assistance in dying occurs when a physician provides or administers medication that intentionally brings about the patient's death, at the request of the patient. For example, a physician directly administers a lethal dose of medication (or equivalent) in accordance with the wishes of the patient. In accordance with the Supreme Court ruling, this procedure will only be available in limited circumstances.
Is medical assistance in dying legal?
In February 2015, the Supreme Court of Canada decided that it will no longer be a criminal offence in Canada for physicians to help someone end their life in certain circumstances.
The court has given provinces and territories until June 6, 2016, before its decision takes effect. This was to allow time for Parliament, the provinces, territories and the health care community to develop legislation, policies and procedures to protect patients and health care professionals in delivery of medical assistance in dying.
Medical assistance in dying will be legal in Alberta on June 6, 2016, regardless of whether there is provincial legislation in place. Alberta must be prepared by June 6 to provide access to medical assistance in dying while ensuring protection for health care workers and vulnerable patients.
The role of the Alberta government compared to the federal government
Health care is an area of shared jurisdiction by federal and provincial-territorial governments. The federal Parliament creates laws in relation to health care under its criminal law authority (for example, restricting controlled drugs, prohibiting or regulating certain practices). The federal government is therefore responsible for changes to the Criminal Code so that it aligns with the Supreme Court ruling.
The provinces and territories create health care laws about things like health insurance, the regulation of health professions, medical consent/decision-making, and hospitals. Alberta will therefore be responsible for all of these matters as they apply to medical assistance in dying.
There is a need for both orders of government to coordinate certain aspects of medical assistance in dying so they do not conflict.
There is also a need for the input of health authorities, health care institutions, professional associations, community and faith-based organizations, the public and many others to ensure practices are aligned with what the federal government might regulate and what the Supreme Court of Canada decision stated.
Who qualifies for medical assistance in dying?
The Supreme Court decision in Carter v. Canada (Attorney General) establishes the right to medical assistance in dying for “competent adult patients” who:
- clearly consent to the termination of their life; and
- have a “grievous” and “irremediable” medical condition (including an illness, disease or disability) that causes suffering that is “intolerable” to the individual.
Forthcoming legislation from the federal government may or may not further define these terms.
The Supreme Court ruling means that when medical assistance in dying is legal, a physician who performs it in the circumstances set out by the Court will not be charged with or prosecuted for a criminal offence as it will no longer be a criminal act. This will occur across all Canadian provinces and territories.
Who will be allowed to perform medical assistance in dying?
The Supreme Court ruling specifies that only physicians will be allowed to directly assess for and perform medical assistance in dying. At this time the role of other health care providers is being clarified by both orders of government. The federal government may choose to extend protection from prosecution to other health care providers.
The Alberta government respects the rights of health care providers to decline to participate in medical assistance in dying for moral or religious reasons.
Protecting vulnerable people
There are many contentious issues around the safe delivery of medical assistance in dying, and the protection of vulnerable people. Some concerns that have been raised about medical assistance in dying include patient coercion, the role of patient depression in decision making and complications with drugs.
Evidence shows that these issues and many others can be mitigated with strong policies and safeguards.
What if someone wants medical assistance in dying prior to June 6?
Medical assistance in dying is illegal until June 6, 2016, but under the Supreme Court ruling those who want to access it and meet the criteria, can apply for an exemption to the Superior Court of their home province. In Alberta, this is the Court of Queen’s Bench.
In 2015, 11 provinces and territories convened a Provincial-Territorial Expert Advisory Group to ensure that we would all have the best advice available regarding the implementation of medical assistance in dying in preparation for when the Supreme Court decision comes into effect.
The Expert Advisory Group invited over 250 stakeholder groups to complete written submissions on a wide range of issues related to the implementation of medical assistance in dying in Canada. This included submissions from Alberta stakeholders such as Covenant Health and the Health Quality Council of Alberta.
The Expert Advisory Group also held consultations (in-person or by phone) with experts and national stakeholders to clarify specific implementation issues. The group publicly released its report in December 2015.
Provincial/territorial governments continue to communicate regularly with the federal government on this issue and will continue to work together to share information as we move forward.
The College of Physicians and Surgeons of Alberta (CPSA) solicited public input on its document, Advice to the Profession: physician-assisted death, which sets out processes and requirements for determining eligibility, and for administering and reporting medical assistance in dying. It also provides guidance for those physicians who do not wish to participate on moral or religious grounds. The document was updated and released to the public in December 2015.
Alberta Health Services has been engaging with multiple stakeholders, including regulatory colleges, as it prepares for the safe delivery of medical assistance in dying, ready for June 6, 2016.
Through a medical assistance in dying steering committee, Alberta Health Services receives information from 6 sector-specific expert panels: Primary Health Care; Hospital/Acute Ambulatory Care; Continuing Care; Cancer Control/Care; Palliative and End of Life Care; and Addictions & Mental Health.
What Alberta is doing to prepare for medical assistance in dying
Alberta Health, Alberta Health Services, the College of Physicians and Surgeons of Alberta, and other health professional colleges are working together to develop a regulatory framework that is aligned, legally sound, safe and consistent with the Supreme Court ruling. The framework will be respectful, ethical and compassionate to those requesting medical assistance in dying and those providing the service.
This framework will be informed by feedback received during consultations with Albertans and will be aligned with any legislation passed by the federal government.
Public consultations in Alberta
The Supreme Court’s ruling has created broad and sensitive questions that Alberta needs to consider in how we deliver and regulate medical assistance in dying. In order to ensure patients, families, healthcare providers and our most vulnerable are sufficiently protected, input from Albertans is required on several key areas.
From February 29 to March 31, 2016, Albertans were encouraged to take part in an on-line survey. The Alberta government will use the information gathered to inform many of the decisions that will need to be made prior to June 6, 2016.
- Bill C-14: Medical Assistance in Dying
- Other options for end-of-life care
- The Supreme Court Ruling Carter v. Canada (Attorney General)  1 SCR 331
- Provincial/Territorial Expert Advisory Group Final Report
- Canadian Medical Association, “CMA Policy: Euthanasia and Assisted Death”
- Alberta Health Services information on medical assistance in dying
- Alberta Health Service interim clinical directive
- College of Physician and Surgeons of Alberta “Advice to the Profession”
- Report of the Special Joint Committee on physician-assisted death