Doctor-assisted suicide rules may fall to province, ethics expert says

There are far more questions than answers about doctor-assisted suicide and how it will work in Canada, says a University of Manitoba ethics expert who's part of a panel advising provinces and territories on the issue.

• Canadian Medical Association still polarized by doctor-assisted deaths

The questions that need to be answered before the Feb. 6 deadline — at which point the federal government has to either write new legislation, or the matter will fall to the provinces — include how it will be administered, who will be eligible and what happens when doctors say no, said bioethicist Arthur Schafer, a member of the provincial-territorial expert advisory group on physician-assisted dying.

If the federal government comes up with new legislation to deal with those questions, it will have to conform to the Supreme Court ruling, Schafer said.

If it doesn't, the onus will fall on another level of government. 

"If there isn't new legislation, then it will be up to the provinces under whose jurisdiction health care falls," he said. 

It's particularly unclear what the changes will mean for patients in remote areas where there is a pronounced shortage of physicians, Schafer said.

When doctors say no to patients in remote areas 

"We have heard people from the Yukon and the Northwest Territories say that in many of their communities, there aren't doctors. And it's a doctor who has to assist with a lethal prescription or give a lethal injection," he said. "If there is no doctor in the community, could it be a nurse practitioner? Would it be up to a board to decide? All of these questions, including how you interpret the Supreme Court statement that the adult has to be competent. Competent when? Competent when you make the request? Competent when the assistance comes?" 

One of the most controversial issues will arise if a doctor won't perform the procedure or write a prescription due to conscientious objection, or even refuses to refer a patient to another doctor, he said.

"There will have to be a reconciliation with the patient's right of access and the doctor's right to object because of conscience. You have two values in conflict that will have to be reconciled."

The physician's fundamental ethical obligation is to promote the best interest of the patient, Schafer said. Physicians have a right to object, but not if it means denying a patient a treatment or procedure to which the patient is legally entitled, he said.

CBC interviewed two doctors earlier this week who pointed to the Hippocratic oath not to harm a patient, and that human life is sacred.

• Two more Winnipeg doctors speak out against assisted suicide

"That may be their view, that death is never a preferable outcome, but it's not the view of many Canadians who have watched a loved one die an agonizing death with deep suffering. If a physician feels they can't be part of ending a life, then they can refer, or maybe there will be a special board the patient can go to," Schafer said..

The College of Physicians and Surgeons of Manitoba is asking Manitobans for their input as it writes a draft statement on physician-assisted suicide.

• Manitoba College of Physicians and Surgeons seeks input on doctor-assisted suicide

That statement will be made public next Thursday.