Assisted dying guidelines issued by College of Physicians and Surgeons of P.E.I.

Guidelines for physician-assisted dying have been adopted by the College of Physicians and Surgeons of Prince Edward Island for physicians as the federal government drafts legislation for assisted dying. The guidelines were adopted February 29.

"In the current absence of federal, provincial or territorial legislation related to physician assisted dying, it falls to the medical regulatory authorities in Canada to develop standards or guidance for physicians within their provinces or territories," states the Policy on Physician-Assisted Dying. 

The document also states that when legislation is developed, it will supersede the document, and may lead to the document being revised.

In February 2015, the Supreme Court of Canada struck down the prohibition on doctor-assisted death, giving Parliament one year to enact new laws. Last month, the high court granted the new Liberal government a four-month extension to June. 

• Supreme Court gives federal government 4-month extension to pass assisted dying law

This whole issue of physician-assisted dying is a fairly radical direction in the way medicine has been practiced and thought about for 30 years or more.- Dr. Cyril Moyse

"At present, although the legislation is not there, the Supreme Court has said that patients can be granted access to the service by application to the courts. So if that were to happen we thought physicians at least needed some guidance as to what they should do," said Dr. Cyril Moyse, Registrar of The College of Physicians and Surgeons of P.E.I.  

The guidelines are based on similar ones already developed in Alberta, Saskatchewan and Manitoba.

"We didn't want to see physicians stuck in the middle with no guidance at all, and other provinces had established guidelines which were very good," said Moyse. 

"This whole issue of physician-assisted dying is a fairly radical direction in the way medicine has been practiced and thought about for 30 years or more," said Moyse. 

Guidelines for physician-assisted dying

The full Policy on Physician-Assisted Dying can be read here. Here are some of the guidelines the College gives doctors:

• The College recommends that only patients 18 years old or older are considered for possible physician-assisted dying.
• Doctors must be satisfied the patient is mentally capable of making an informed decision and giving informed consent to physician-assisted dying throughout the process. If a doctor is unsure, the patient must be referred for further assessment.
• The physician must be completely satisfied that the decision to undergo physician-assisted dying has been made freely, independent of coercion or undue influence from any person, including family members, and health care workers. 
• The physician should ensure the patient has consistently expressed a desire for physician-assisted dying over a reasonable period of time. The length of that period of time may vary depending on the patient's medical condition and other circumstances.
• The physician has to obtain consent from the patient immediately prior to the physician-assisted dying. Consent forms will be developed and are to be completed by the the administering physicians and any consulting physician.
• Doctors must let the patient know the details about their health status and the certainty of death from taking lethal medication and the potential complications associated with the medication, and alternatives, including comfort care, palliative and hospice care, pain and symptom control, and other available resources to avoid the loss of personal dignity.
• Doctors have to let patients know about counselling services and help them access resources that may provide an alternative to physician assisted dying, if they want that information. 
• The physician has to consult with a second physician before providing physician-assisted dying. 
• The physician has to inform the patient of his or her right to rescind the request at any time.
• The coroner must be notified of the death and the physicians involved must cooperate with any review.

Moyse says the College felt it was important to put in safeguards to protect people such as mandatory consultations. 

"Patients often suffer from reasons other than the physical and it's sometimes difficult to sort out despite the fact that in the Supreme Court decision they had every confidence that physicians could do that," said Moyse. I and a lot of practitioners don't feel quite as confident as the court did in that." 

Physicians can decline

Under the guidelines, a physician who declines to provide physician-assisted dying must disclose that fact to the patient, continue to treat the patient with dignity and respect, and provide medical care until no longer required of wanted, or until another physician has assumed responsibility for the patient.