Physician-Assisted Dying Part 3: Finding A Balance Between Autonomy And Access

"Health institutions, including regional health authorities and other institutional providers (e.g. hospitals, hospices and long-term care facilities) are critical enablers of effective and equitable access to physician-assisted dying."

Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying,

Final Report, November 30, 2015, at 3.

Part 2 of this series examined the implications of the decriminalization of physician-assisted dying for frontline health care professionals. In the absence of governing legislation, until June 6, 2016, individuals in British Columbia may seek judicial approval for a physician-assisted death.

On February 9, 2016, the College of Registered Nurses of British Columbia ("CRNBC") responded to the current state of limbo created by the Supreme Court of Canada's exception to the extension of the suspension of its decision in Carter v. Canada (Attorney General), 2015 SCC 5, which permits eligible individuals to access a physician-assisted death with the approval of the superior court in their jurisdiction (See Carter v. Canada (Attorney General), 2016 SCC 4).

In the absence of legislative amendments expressly exempting nurses from the Criminal Code, CRNBC's current position statement on the role of nurses in providing physician-assisted dying cautions nurses against taking part in any capacity without first seeking independent legal advice. The College of Pharmacists of British Columbia has taken a similar position, advising its registrants to seek an independent legal opinion should they be interested in assisting with the delivery of a physician-assisted death.

The current positions of the CRNBC and the College of Pharmacists have practical implications for British Columbia's health authorities and health care facilities, which rely on a team-based model for care delivery. The medications used for the process of physician-assisted dying, some of which are not readily available in Canada, may only be available through a hospital's pharmacy, and may need to be administered intravenously. Pharmacy technicians who dispense and the nurses who prepare those medications play a critical role in the health care team. At a minimum, nurses, pharmacists, and any other health care professionals acting in a supporting role during the process of a physician-assisted death will require clear exemptions from the Criminal Code.

While the present lack of a clear exemption may present the greatest barrier to access in...