Appendix “B”

Full Text

B.1    “Ideally,” according to the Canadian Association of MAID Assessors and Providers (CAMAP), “MAID should never be done as an emergency” (emphasis added),108 obviously implying that it might be.  CAMAP’s concern was that many patients were so late in requesting the procedure that euthanasia/assisted suicide had to be expedited because natural death or loss of capacity was imminent. In such circumstances, euthanasia/assisted suicide was apparently considered an emergency.

B.2    CAMAP advises Canadian EAS practitioners attempting euthanasia in patients' homes to call 911 for ambulance personnel to help if they are unable to obtain IV access when it is immediately required, or if they are unable to provide "intraosseous infusion emergently." They are advised, or to transport the patient to hospital if need be so that an intravenous line can be inserted by emergency room (ER) staff.109 According to CAMAP, 3 of over 300 Canadian ER practitioners had encountered such cases,110,111 and in 1 of 13 known cases of self-administration of EAS drugs, a patient was taken to hospital by emergency medical services “as a result of adverse effects or a delayed death.”112 The problems that arise in such circumstances have been documented elsewhere.113

B.3    Paramedic regulators in British Columbia,114 Saskatchewan,115 Nova Scotia116 and Alberta117 acknowledge that paramedics may be called by EAS practitioners to insert an intravenous line. Alberta Health Services has a detailed Emergency Medical Services protocol that anticipates 911 calls by practitioners seeking paramedic assistance in providing EAS.118 EAS practitioners on Vancouver Island have made arrangements with hospitals to admit patients “as an emergency for continuation of the procedure” should difficulties arise with EAS provision outside hospital settings.119 The protocol is available on British Columbia’s General Practice Services Committee website, a committee representing physicians, Ministry of Health, Doctors of BC, BC Family Doctors and regional health authorities.120 And calling 911 for help with EAS and taking EAS candidates to hospital emergency departments was suggested in Ontario even before publication of the CAMAP paper recommending it.121 In sum, it appears that requests for active assistance in providing EAS are treated as emergencies by mainstream actors in Canada’s public healthcare system.

B.4    Beyond requests for “emergency continuation” of EAS, the Project’s 2015 submission to the External Panel on Options for a Legislative Response to Carter v. Canada warned that the condition of a patient approved and scheduled for EAS may suddenly and unexpectedly deteriorate, triggering an “emergency” request for EAS before the appointed time.122 The warning was based on 2013 testimony by representatives of the College of Pharmacists of Quebec about Quebec’s euthanasia legislation.123 The specific scenario envisaged by the Project was proposed in a 2018 article within the context of Canadian hospital emergency room practice.124

B.5    It is almost inconceivable that an ER physician in such circumstances would be in a position to fulfil the legal obligations associated with the provision of EAS for a pre-approved and capable patient.125 When EAS remains a legal option, one of the authors of CAMAP: Complications suggested in 2016 that it would likely be more appropriate to ask the initial EAS practitioner to come and "administer a lethal medication in the ED.”126 In any case, CAMAP warns, “No clinician should administer life-ending medications who was not involved in the MAID assessment and consent process.”127

Notes

108.    CAMAP Brief, supra note 80 at 3.

109.    F Bakewell, VN Naik, "Complications with Medical Assistance in Dying (MAID) in the Community in Canada: Review and Recommendations" (28 March, 2019), Canadian Association of MAiD Assessors and Providers (website) [CAMAP: Complications], at Executive Summary para 7-10; p 7; Summary Flowchart.

110.    Ibid at 5, “Canadian experience”.

111.    CAMAP: Complications, supra note 100 refers to 3 of 335 surveyed physicians, but the published report (by one of the authors of the CAMAP paper) states that there were 303 responses to the survey. cf F Bakewell, “Medical assistance in dying – a survey of Canadian emergency physicians” (2019) 21:S1 CJEM, 21(S1) S66 at S66.

112.    CAMAP: Complications, supra note 109 at 8, “Canadian experience”.

113.    David H Wang, "No Easy Way Out: A Case of Physician-Assisted Dying in the Emergency Department" (2018) 72(2) Annals of Emergency Medicine:206-210 at 206.

114.    “BC Emergency Health Services Clinical Practice Guidelines 2021" (February, 2021), BC Emergency Health Services (website) at P08: Medical Assistance in Dying (MAID).

115.   Saskatchewan College of Paramedics, “Medical Assistance in Dying (MAID): Guidelines for Paramedic Practitioners” (2 May 2017), Saskatchewan College of Paramedics (website).

116.    College of Paramedics of Nova Scotia, “CPNS Guidance on Medical Assistance in Dying (MAiD)”, College of Paramedics of Nova Scotia (website).

117.    Alberta College of Paramedics, “Position Statement: Medical Assistance in Dying” (October, 2017), Alberta College of Paramedics (website).

118.    Alberta Health Services, “EMS requests related to medical assistance in dying events” (12 June, 2019), Alberta Health Services (website).

119.    Jonathan Reggler, Tanja Daws, “Medical Assistance in Dying (MAID) Protocols and Procedures Handbook 2017 2nd edition”, General Practice Services Committee (website) at 16.

120.    General Practice Services Committee, “Who We Are” (2020), General Practice Services Committee (website).

121.    Julie Campbell, “Taking the Mystery Out of MAID” (Powerpoint presentation delivered at the meeting of the Elgin South West Primary Care Alliance, 7 June, 2018), South West Primary Care Alliance (website) at slide 25.

122.    “Protection of Conscience Project Submission to the (Federal) External Panel on Options for a Legislative Response to Carter v. Canada: Direct Consultation (Project Administrator)" (26 October, 2015), Protection of Conscience Project (website) at “Urgent situations.”

123.    Quebec, Assemblée Nationale, Journal des débats de la Commission permanente de la santé et des services sociaux, 40th Législature , 1st Sess, Vol. 43 No. 34 (17 septembre, 2013) at 51–52 (Mme. Véronique Hivon & Dianne Lamarre). The Project has provided what appears to be the only English translation available: see “Consultations & hearings on Quebec Bill 52, College of Pharmacists of Quebec: Dianne Lamarre, Manon Lambert. Tuesday 17 September 2013 - Vol. 43 no. 34", Protection of Conscience Project (website) at T#85–98.

124.    Thara Kumar, Richard Hoang, "Dying to Know More: Death and Dying in the ED in the Era of MAiD" (20 September, 2018) EM Ottawa (blog) at Case 3.

125.   Criminal Code, supra note 7 at s 241.2(3).

126.   F Bakewell, “Medical Assistance in Dying (MAID) in the ED: Implications for EM Practice” (22 June, 2016) CanadiEM (blog).

127.    CAMAP: Complications, supra note 109 at 7.