Health Care,

Communities and
Public Law in Canada-
Medical Assistance in
Dying
AP/PPAS/POLS 2200 M
Meredith Hatton # 212963278
 Medical Assistance in Dying (MAID)

Medical assistance in dying (MAID) was officially legalized in the Criminal

Code of Canada (Code, hereafter) June 17, 2016 with Bill C 14, which was an

act to amend the Code to legalize medically assisted dying in Canada. 1

Physician-assisted suicide is generally defined as a physician assisting a

terminally ill person (eg, by prescribing a lethal dose of drugs) so that the person

can bring about his or her own death (eg, by swallowing the drugs). 2

Bill C 14 was an amendment to the Code legalizing physician assisted suicide

following the Supreme Court ruling in Carter v. Canada February 6, 2015 in

regards to the right to assisted suicide. This decision declared that sections

241(b) and 14 of the Criminal Code, which prohibit a physician's assistance in

terminating life, infringe upon the right to life, liberty and security of the person for

individuals who want access to physician-assisted death. The Court suspended

its declaration so that it would not come into effect for 12 months, stating that "it

is for Parliament and the provincial legislatures to respond, should they so

choose, by enacting legislation consistent with the constitutional parameters set

out in the reasons for judgment.3

1 House Government Bill - Bill C-14 - Royal Assent (42-1). (n.d.). Retrieved March 13, 2017, from
http://www.parl.gc.ca/HousePublications/Publication.aspx?DocId=8384014

2 Claxton-Oldfield, S., & Miller, K. (2014). A Study of Canadian Hospice Palliative Care Volunteers' Attitudes Toward
Physician-Assisted Suicide. American Journal of Hospice and Palliative Medicine,32(3), 305-312.
doi:10.1177/1049909114523826

3 Carter v. Canada: The Supreme Court of Canada's Decision on Assisted Dying. (n.d.). Retrieved March 13, 2017, from
http://www.lop.parl.gc.ca/content/lop/ResearchPublications/2015-47-e.html#a13

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 The provinces and territories are left with the responsibility of creating

health related laws that comply with the Code. As to date, the only province that

has done so is Quebec with B-52 Respecting End-of-Life Care. 4

With Bill C 14 three major concerns have come forward regarding this

health care service that is supposed to be available to all Canadian patients who

meet the criteria. One is that at the provincial and territory level, whereas health

related laws at this level are not consistent. The second is the right of a Doctor to

refuse to provide this form of health care, due to conscience or religious beliefs.

Doctors further contest the obligation to provide a referral when they cite these

reasons for not providing health care. The third is that faith based facilities in

most provinces with exception of Quebec, will not be allowing MAID within their

facilities. This paper will examine each of these concerns and then provide a

final summary with recommendations on how Canada can address these

concerns that will benefit all its citizens.

Current Provincial and Territory Information On MAID

End-of-Life Law and Policy in Canada developed by the Health and Law

Institute at Dalhousie University keeps a current complied listing of the provincial

and territory responses to Bill C14.5

Alberta Health Services has created policy Medical Assistance in Dying.

4 Canada, H. (2016, July 20). Medical assistance in dying. Retrieved March 13, 2017, from
https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html#a6

5 Euthanasia. (n.d.). Retrieved March 13, 2017, from http://eol.law.dal.ca/?page_id=238

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 British Columbia, Ministry of Health has posted steps and forms when

requesting MAID, but has not created any health policy.

Manitoba, Winnipeg Health Authority has created a MAID team which

team of medical professionals that provide MAID services, patient

inquiries and information for health care professionals. 6

New Brunswick has yet to develop any public information regarding MAID.

Newfoundland has yet to develop any public information regarding MAID.

Northwest Territories Health and Social services has developed Medical

Assistance in Dying Interim Guidelines for the Northwest Territories

effective June 17th, 20167. That includes a central coordination of MAID

services.

Nova Scotia Health Authority has developed forms for requesting MAID

and checklist form. It also gives information on patient frequently asked

questions as well as medical professional frequently asked questions.

6 W. (n.d.). Contact. Retrieved March 13, 2017, from http://www.wrha.mb.ca/maid/contact.html

7 Services, H. A. (n.d.). Medical Assistance in Dying. Retrieved March 13, 2017, from
http://www.hss.gov.nt.ca/en/services/medical-assistance-dying

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 Nunavut has yet to develop any public information regarding MIAD
Ontario, Ministry of Health and Long -Term Care has developed a very

simple webpage that provides options, and has yet to move forward with

creating health care laws. Responsibility has been left at hospital level to

create policy and procedures regarding MAID. In Ontario the provincial

government is moving forward with allowing faith based health care

facilities to opt out of providing medical assistance in dying (MAID). By

amending the Patients First Act with proposed Bill 41, now allows religious

health care facilities to refuse to perform services that go against their

beliefs.8

Prince Edward Island, Health PEI has developed guidelines as of January

25, 2017.

In Quebec, they passed B-52 Respecting End-of-Life Care in 2014 which

has taken the approach that fits the definition of euthanasia, which does

not allow any health care facility to opt out of providing MAID; and the

province has created health related laws to ensure that MAID is available. 9

Saskatchewan, the ministries of justice and health are still developing

processes and resources, but do post information on eligibility.

8 Warren, R. M. (2016, November 25). A right out of reach. Niagara Advance. Retrieved from
http://www.niagaraadvance.ca/2016/11/25/a-right-out-of-reach

9 Landry, J. T., Foreman, T., & Kekewich, M. (2015). Ethical considerations in the regulation of euthanasia and physician-

assisted death in Canada. Health Policy,119(11), 1490-1498. doi:10.1016/j.healthpol.2015.10.002

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 Yukon has yet to develop any public information regarding MAID.

From this review, it demonstrates how MAID is approached in Canada, and

the extreme inconsistencies between the provinces and territories, which have

nothing posted publicly on what MAID is, and if it is available. The next issue is

that inconsistent healthcare support is being provided in Canada, due to lack of

transparency of process.

Doctors Obligations and Rights

With this new amendment to the Criminal Code Bill C 14, medical

professionals can refuse to provide this service, however it is expected they refer

their patient to a provider who will assist them. This is not uncommon practice as

Doctors can limit service provided due to conscience or religious beliefs, however

they must respect patient dignity, while ensuring access to care and patient

safety. A policy has been developed in Ontario by The Council of the College of

Physicians and Surgeons of Ontario (CPSO),The Professional Obligations and

Human Rights policy,10 and the Ontario Provincial Government Patients First

Act.11

In an article published in The Globe and Mail, Christian doctors challenge

Ontarios assisted-death referral requirement. The belief is that having to refer

10 Professional Obligations and Human Rights. (n.d.). Retrieved March 13, 2017, from http://www.cpso.on.ca/policies-
publications/policy/professional-obligations-and-human-rights

11 Bill 41, Patients First Act, 2016. (n.d.). Retrieved March 13, 2017, from
http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&BillID=4215&detailPage=bills_detail_the_bill

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MAID, violates freedom of conscience and religion, which is protected in Section

2 of Canadas Charter of Rights and Freedoms, as it still has them in the

process12.

According to a 2013 survey of more than 2000 Canadian Medical

Association (CMA) members, 20% would be willing to participate in euthanasia if

it were legalized, and 16% would assist a patient in suicide. The number of

physicians refusing to participate in these practices if they were legalized was

42% and 44% for euthanasia and patient assisted suicide (PAS). 13

With the mixed support of MAID by Doctors it is important that the

provinces and territories take these concerns seriously; and look into ways to

ensure that no ones rights are violated, and that access is not impeded due to

policy and process not being consistent across Canada.

Publically funded Faith- Based health care facilities

Do faith based publically funded health care facilities, such as St Michaels

Hospital in Toronto, Ontario have the legal right to refuse MAID on the same

grounds that is given to an individual considering that their primary purpose is

health care not religion? Ontario, British Columbia and Manitoba all have

supported faith-based hospitals with the choice of not providing MAID.

In Canada many communities have only one health care facility available

to them in their community like found in Elliot Lake, Ontario with St. Josephs
12 Fine, S. (2016, June 22). Christian doctors challenge Ontarios assisted-death referral requirement. The Globe and
Mail. Retrieved from http://www.theglobeandmail.com/news/national/christian-doctors-challenge-ontarios-assisted-death-
referral-policy/article30552327/

13 Claxton-Oldfield, S., & Miller, K. (2014). A Study of Canadian Hospice Palliative Care Volunteers' Attitudes Toward
Physician-Assisted Suicide. American Journal of Hospice and Palliative Medicine,32(3), 305-312.
doi:10.1177/1049909114523826

6
Hospital. So if a patient in Elliot Lake requests MAID they will be refused this

request and will have to transfer to a facility that provides it either in Sudbury 168

kilometres away or Sault Ste. Marie 201 kilometres away. For patients in Elliot

Lake both of these options are extreme hardships as they are not within their

community, removes them from family supports and will require ambulance or air

ambulance transfer.

The Globe and Mail article, B.C. doctor takes stand against Catholic hospitals

assisted dying policy. Jonathan Reggler, a general physician resigned from the

ethics committee at a local Catholic hospital because it refuses to offer assisted

dying on site, a stand that he says is unnecessarily causing critically ill patients

more suffering as they are transferred to facilities dozens of kilometres away.14

It very concerning as it demonstrates that faith based facilities are denying patients a

medical service that is right under the Charter of Human Rights further extending their

suffering due to being in the wrong facility.

In Quebec they have made it law that all health care facilities provide

MAID in accordance to their provincial health policies. This has removed religion

aspect thus providing zero obstacles to access to MAID.

Recommendations

When a health care service conflicts with peoples values and religious

beliefs it can cause a wide spread struggle in the development of consistent

public policy regarding it which then impacts the right of the patient to receive this

service. This has been seen with the provinces and territories not having
14 Hager, M. (2016, October 18). B.C. doctor takes stand against Catholic hospitals assisted dying policy. The Globe
and Mail. Retrieved from http://www.theglobeandmail.com/news/british-columbia/doctor-takes-stand-against-catholic-
hospitals-assisted-dying-policy/article32436426/?1489270287722

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consistent policy in place or at times lack of any public information on MAID. The

rights of Doctor and the clash of expectations on if they should be required to

provide information when they do not support MAID. Along with the movement of

Christian Doctors that feel even referring is in violation of their beliefs are

examples of disagreement within the medical community that impacts patient

rights. The final concern is with that most provinces with the exception of Quebec

allowing faith-based hospitals to refuse to provide MAID even when they are the

only care facility in a community.

In order for MAID to be accessible and consistent across Canada the

federal government is going to have to take a heavier hand with the provinces

and not allow them to drag out policy creation. The Quebec B-52 Respecting

End-of-Life Care could be used a model for development across Canada, as it

does not allow facilities to opt out. As well the approach of Northwest Territories

and Manitoba with centralized approach that has healthcare providers who are

willing to provide this care under one umbrella. Having a centralized service that

connects people to information and care by doctors and nurses that are

comfortable with MAID removes the barriers that patients could face if their

doctor is opposed to MAID. It also offers a layer of zero judgement for patients

who want information or would like to pursue the option of MAID, which is of the

upmost importance when faced with the decision of choosing to end your life due

to your dire medical condition.