A look at progress on assisted-dying guidelines across Canada

The federal law governing medical aid in dying came into effect in June 2016. Photo from Reuters.

Shine A Light, a project of Dying With Dignity Canada, aims to highlight the barriers facing Canadians who want to access their right to assisted dying. It comes at a time when provinces are still working on refining their guidelines for physician-assisted death.

A crowdfunded map of Canada, published on the Dying With Dignity website, shows there are several facilities across the country that will provide the procedure, while others explicitly will not. The map also illustrates the information gaps and potential access issues that exist across the country, particularly in rural areas like Atlantic Canada and the north.

The Shine A Light map is one way to see how access to physician-assisted death varies from province to province. Here is a round-up of how things are playing out across the country after physician-assisted death became fully legal in Canada last June.

British Columbia

According to a CBC News report, Vancouver Island has B.C.’s highest assisted death rate. The numbers show that 77 of the province’s physician-assisted deaths occurred on Vancouver Island between June 17, 2016 and January 10, 2017. The island has a population of approximately 760,000. By comparison, there were 24 physician-assisted deaths in the Fraser Health region during that same time period, where the population is approximately 1.6 million.

The higher rate on Vancouver Island could be related to both the higher average age of island residents and a higher level of awareness of the issue, thanks to Victoria’s Sue Rodriguez and her legal fight to die in the 1990s.

B.C. is also the site of a fight over the payment doctors receive for physician-assisted death — one that could become national. In February, three physicians in B.C. went public about pay for physician-assisted death. They detailed their struggles to be remunerated by the province for performing a procedure at a rate that would reflect their expenses.

Alberta and Saskatchewan

In early fall, officials in Alberta expressed their surprise at the number of requests for physician-assisted suicide. In March, it was reported that the number of people who had received the treatment in the province was nearing double digits.

The Calgary Sun reported that by early January, five more people died with the assistance of a physician. According to a CBC News report, a total of 97 medically assisted deaths had been granted in the province since February 2016.

In provinces like Saskatchewan, where there is a large population of people living in rural and remote communities, access to physician-assisted death can be a challenge.

Manitoba

Some of Manitoba’s policies around physician-assisted death have been criticized by ethicists and advocacy groups. An ethicist with the University of Manitoba told CBC News last year that doctors who can’t provide patients with adequate information about all of the relevant options for assisted-dying are letting their patients down.

In November 2016, two faith-based hospitals in Winnipeg said they wouldn’t provide doctor-assisted deaths to their patients. However, Winnipeg did make moves to expand access in 2017, doubling the size of its medically assisted dying team. Requests for the procedure were higher than expected, and in early January the Winnipeg Regional Health Authority added four doctors to the team, which covers the entire province.

Ontario

On Sunday, Health Minister Eric Hoskins announced Ontario would set up a “care co-ordination service” to help people seeking physician-assisted death reach out directly to appropriate care providers. Hoskins said the service, which could allow patients to bypass physicians who may be opposed to the procedure, could be available as early as May.

In June 2016, the province arranged a line for doctors to call to refer patients to physicians willing to work on assisted death cases. But some physicians with ethical or religious objections to the treatment didn’t want to make the calls themselves. The Globe and Mail reported on April 2 that doctors who are both in support of and opposed to physician-assisted death think the system isn’t working well.

Quebec

Quebec was at the forefront of the right to assisted death in Canada, with the province having its own laws in place before there was a national framework. Now Quebec is seeking court clarification on the national law on physician-assisted death, with the goal of broadening access.

“The professional orders told us that phrase, that part of the law creates problems because you can’t define what is a reasonably foreseeable death,” Health Minister Gaétan Barrette told reporters in late March. “In their opinion, it is unworkable, inapplicable, too fuzzy.”

The provincial government is also working to assemble a panel of experts to further examine the issue of broadening access to physician-assisted death to include patients with dementia or Alzheimers.

Atlantic Canada

Not much information on how physician-assisted death is functioning since becoming legal has been forthcoming from the Atlantic provinces. The four provinces have released incomplete numbers, but few details on how the procedure is working in New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador.

As of January 22, no physician-assisted deaths had been provided in Prince Edward Island, the Times Colonist reported.

The Nova Scotia Health Authority said there were 16 physician-assisted deaths in the province as of October 31, but details about the cases were not revealed. In that same time period, New Brunswick’s English health authority approved nine physician-assisted death requests, CBC News reported.

Meanwhile in Newfoundland and Labrador, the province’s health authority revealed in October 2016 that two people in the region received medical assistance to help them die.

The Territories

Like Atlantic Canada, details on physician-assisted death in the Yukon, the Northwest Territories, and Nunavut are limited one year into the procedure’s availability in Canada. By the end of 2016, no physician-assisted deaths had been performed in the Northwest Territories and one had been reported in the Yukon, according to CTV News.

In September 2016, the Catholic Bishops of Alberta and the Northwest Territories issued guidelines, stating funerals could be refused by priests for people who died via physician-assisted death. They called the procedure “a grave sin.”