Submission to the College of Physicians and Surgeons of Ontario Re: Medical Assistance in Dying (2022)
22 November, 2022
Summary of Recommendations
The Project recommends that relevant statements in CPSO MAID 2021 and CPSO Human Rights 2022 be combined and incorporated explicitly into CPSO MAID 2022 as follows:
The College does not consider a request for MAID to be an emergency or a treatment option in an emergency. Physicians are not required to assess patients for or provide MAID under any circumstances.
Self-administration, continuity of responsibility
The Project recommends the following addition to CPSO MAID 2022:
In all cases, a practitioner who agrees to provide euthanasia or assisted suicide (the most responsible EAS practitioner) should personally administer the lethal drug or be personally present when it is self-administered, and remain with the patient until death ensues.
The most responsible EAS practitioner must be continuously available to promptly provide the service from the time the EAS agreement is made to the time that the procedure is performed, unless the patient withdraws the request for the service.
The most responsible EAS practitioner must arrange for a second EAS practitioner to promptly provide the service if the most responsible EAS practitioner cannot be continuously available or is unable to act promptly in response to an urgent request.
The second EAS practitioner must be continuously available to act promptly in the place of the most responsible EAS practitioner.
Falsification of death certificates
The Project recommends that CPSO MAID 2022 should be revised to the following effect:
§11. When completing the medical certificate of death, the government has requested that physicians:
a. must list the illness, disease, or disability leading to the request for MAID as the cause of death; and
b. must not make any reference to MAID or the medications administered on the certificate.
Practitioners who object to this for reasons of conscience or professional judgement should note their refusal/objection in the reports they are required to submit to the OCC about each MAID death. The OCC can then arrange for a willing coroner to complete the death certificate as requested by the government.
Criminal law and limits on College policy
The Project recommends that
CPSO MAID 2022 and CPSO Advice: MAID 2022 should explicitly caution practitioners that they may be criminally liable if they
(a) support, encourage or facilitate euthanasia/assisted suicide of a patient whom they believe to be ineligible;
(b) suggest assisted suicide to patients who have not expressed an interest in it, in euthanasia or MAID.
The Project recommends that CPSO MAID 2022 and the related document, Advice to the Profession: Medical Assistance in Dying should explicitly caution persons in authority that they may be criminally liable for counselling an offence if they attempt to persuade or compel a practitioner
(a) to provide or facilitate euthanasia or assisted suicide when the practitioner has concluded that a patient is ineligible;
(b) to suggest assisted suicide to a patient who has not expressed an interest in it, or in euthanasia or in MAID.
Criminal law and ethical norms
When a patient has signed a waiver of express consent and later becomes incapacitated, the Criminal Code prohibits euthanasia only if the patient expresses refusal at the point of administering a lethal injection. An expression of ambivalence does not reach that threshold.
CPSO MAID 2022 should provide direction or guidance in relation to the response expected from EAS practitioners should they become aware that an incapacitated patient who signed a waiver has expressed ambivalence about proceeding with euthanasia up to and including the time appointed for the procedure.