Alberta’s nursing regulators developing guidance on physician-assisted death

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UPDATE (April 7/17): The following topic has been updated.
CLICK HERE for current guidance on this issue.

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The following is a joint message for all Alberta nurses from the College of Licensed Practical Nurses of Alberta (CLPNA), the College and Association of Registered Nurses of Alberta (CARNA), and the College of Registered Psychiatric Nurses of Alberta (CRPNA):

Recent decisions by the Supreme Court and the federal government regarding physician-assisted death has raised questions among nurses about the impact on their practice. In a proactive step, the three nursing regulators in Alberta are working to establish collaborative guidelines for their members.

On June 6, a new right to physician-assisted death in Canada will become law. Currently, individuals who wish to seek physician-assisted death during the four-month extension period between February 6 and June 6 may apply to a judge for authorization.

In preparation for this change, the College of Licensed Practical Nurses of Alberta (CLPNA) is working with the College and Association of Registered Nurses of Alberta and the College of Registered Psychiatric Nurses of Alberta to seek input from members, develop unified guidance and provide resources to professional nurses in Alberta related to best ethical and competent care to patients at or near the end of life. Nurses are intimately involved in end-of-life care processes and the role of the professional nurse in Alberta in the dying process needs to be recognized, articulated and protected in law.

RELATED – FAQs for Nurses about Medical Assistance in Dying (Physician-Assisted Death)

Guidelines for Licensed Practical Nurses

In the meantime, please use the following guidelines:

  • The role of the professional nurse is to continue providing safe, competent, ethical nursing care to Albertans.
  • As part of the therapeutic relationship, nurses have a duty to provide persons in their care with the information they need to make informed decisions, related to their health and well-being.
  • In the absence of Criminal Code amendments providing protection to other members of the health-care team, nurse practitioners, registered nurses, licensed practical nurses and registered psychiatric nurses cannot be involved in any activities that could be seen as assisting or counselling in physician-assisted death. Until legislation is established that protects nurses, any questions by patients seeking physician-assisted death must be directed to a physician.

It is possible that during the four-month extension (February 6 – June 6, 2016) some patients in Alberta may seek a court order to access physician-assisted death. Whether any health care professionals other than physicians can assist with physician-assisted death during this period may depend on the content of the court order obtained by the patient. Any Licensed Practical Nurses who are asked to assist with physician-assisted death during the four month period, and in the absence of Criminal Code amendments providing protection to the health care team, should contact the CLPNA’s Practice Department at practice@clpna.com, 780-484-8886 or 1-800-661-5877 (toll free in Alberta) for advice.

We will continue to work collaboratively and update you on the developments of physician-assisted death in Canada.

More about the Carter Decision

On Feb. 6, 2015 in the Carter decision, the Supreme Court of Canada struck down the federal law prohibiting physician-assisted death creating a new legal right to physician-assisted death in Canada. The Carter case provides legal protection to physicians involved in physician-assisted death, so they can practice without risk of criminal prosecution. Nurses require this protection, too.

This decision was to come into effect Feb. 6, 2016. However on Jan. 15, 2016, the Supreme Court granted a four-month extension to the federal government to consider its approach to physician-assisted death. This means that the Carter decision does not come into effect until Jun. 6, 2016. The Supreme Court did indicate that individuals who wish to seek physician-assisted death during the four-month extension may apply to a Judge for authorization.

A special joint committee on physician-assisted death, comprised of 11 members of Parliament and five senators, has been appointed to review recent relevant consultation activities and studies, consult with Canadians, experts and stakeholders and make recommendations to the federal government on the legislative framework for physician-assisted death.

18 Responses to “Alberta’s nursing regulators developing guidance on physician-assisted death”

  1. I believe that everyone has the right to die with dignity. I believe there does need to be clear consciss guidelines. The extension allows for clarity

    • People do have a right to die with dignity, we have palliative care teams who do a wonderful job of doing this.For most other cases, other than taking off of life support, the physicians treat the symptoms or people can refuse treatment and die naturally. This is an open door to alot of abuse.

    • “Dying with dignity is important as well as Nursing with dignity”

      I do suggest that this competency be put under specialty so that LPN’s can choose if they want to further their knowledge and skills in the processes. It may be psychologically involving.

      • Yet “dying with dignity” should not imply PAD. Quality palliative care gives great dignity to dying patients. Caroline, interesting proposal to make this a specialty competency. I know many nurses are not comfortable being involved in PAD so this might be something to consider.

  2. Nurses should and have to be covered under the new guide lines if they are assisting the physician then everyone needs to be covered and not liable in this legalization of dying with dignity

  3. I agree with Bonnie. There need to be clear guidelines and this issue definitely needs to continue to be examined. I respect choices but at the same time, actively assisting in a death will be a moral and ethical challenge for me as I am sure it will be for all nurses. At this point I am torn as personally I have had to make a choice for a parent to be placed on comfort measures only. I would have a hard time participating in an actively assisted death.

  4. I am completely opposed to assisted suicide and would never participate in such a thing. It is against my religion and all of my personal values. As far as I know God is still God, not the doctors.

  5. I would like the have exact guidelines and rules. My biggest question is; Do I have to be involved in this if I am uncomfortable with it for whatever reason? ( fear, religious, morals, values, ) obviously treating the patient with the upmost respect dignity and care, but I am not sure how I feel 100%. I don’t want to be forced to be in the room, give the Meds, witness etc

  6. While one is given the choice to end their own life.As a nurse I would like the same opportunity to decide not to participate in ending that individual’s life.

  7. Physician assisted death should be exactly that. By their own hands. I would not feel comfortable administering a lethal dose.

  8. I agree with Caroline 100%, this is a great idea to make it a specialty, as a nurse we all choose to work in an area/field that appeals to our “special” qualities and values, whether it be LDRP, Pediatrics, Surgical etc. Each of these areas has it’s own scope of practice and requires individual specialties of it’s own.

  9. I have worked with the paliative care team and it’s hard but everyone helps each other. It’s defiantly better than without them.

  10. Nurses assist Physicians when performing the procedures that are aimed at promoting the wellbeing of any individual or to a dignified death. When one is taking away their own life, it is despair not dignity. What would be the nurses’ mission to partcipate in PAD?

  11. I agree, this should be listed as a specialty that gives us nurses the choice to learn and broaden our skills should we choose to assist just like we have the choice to specialize in other areas like OR or ortho tech etc. I do not feel 100% comfortable in helping end a life even if it is the individuals choice and i would never do a skill if im not 100% confident so this is not something i would ever want to be a part of. Im completely fine and competent caring for a palliative patient but emotionally i choose not to work on these units as i nurse with my heart and my brain, so every patient i care for impacts me for life. I have alot of respect for palliative nurses as its something infind very difficult to see and handle but there are alot of nurses that choose to be on palliative teams and god bless them because the world needs them, however they had the choice to use their individual skills and strength to be there for those patients so please give us a choice!

  12. As a nurse I have spent many year working with palliative patients and their families. These are the situations that became emotionally strenuous and leave a lasting mark. I fully support PAD, although I ask that as nurses we are given a choice as to wether of not we par-take. This can be in the form of a speciality designation (where the nurse is consciously making the decision to prepare for such tasks and therefore can also be offered tools on the possible psychological repercussions also). This will clearly protect thoes who do not wish to participate in such and reduce incident of being forced into it. As a college, it is your job to protect thoes that you regulate, and preserve the emotional stability, morals, and beliefs as such. Failure to make partisipation a choice, could lead to lower moral, increased sick days, and emotional burdens. I have full confidence that we will generate enough nurses to successfully do a PAD. But please, may a choice be offered.

    Sincerely,
    Martina

  13. As a continuation of my previous post I would also like to add that most of us chose nursing with the mind-set of saving lives, preserving quality of life, and treating patients holistically. When the matter of PAD is brought up, it borders all judgment of ethical decision. To try and regulate this procedure with due care and undermining “ethical”, problems will arise. There is something that is easier to accept when natural death takes a life regardless of intervention. We are taught this and generally it is accepted. So going against the grain and forcing nurses to end a life before it’s natural course, can take it’s toll of everyone involved. As nurses of any religion we understand that death is a natural cycle and is synergistic with the beliefs of all. So to be compassionate to not only the medical team and the patient, a choice to participate free of dissapline should be granted. This will allow a saftey net for the college to monitor the effects and revisit guidelines in the years to come. I can foresee a PAD flowing smoothly, with a supportive medical team that’s ready to embrace the patient and family when everyone involved is dedicated and and shares the same ethical purpose and mind set. Let us have a choice. Like the patient does.

  14. I totally support PAD nut I am not sure if I will assist in the process.I agree that it should e added as a specialty so LPN’s have a choice. I believe anyone who will be involved in PAD should be morally and emotionally ready.
    I have known family friends and patients who suffered years of painful debilitating disease , stuck in a wheelchair and they are not themselves any more because they take so much drugs for pain. Can we call that “living with dignity?”

  15. Physician assisted death is a huge moral and ethical dilemma for sure. The issue needs to be carefully considered from all angles to hopefully come up with the best solution.

    I have nursed for many years including palliative care. It is very difficult and heart wrenching at times to try to help those who are suffering terribly.
    Having said that, I would not, in any circumstances be involved in the deliberate choice of a client or a client’s family to end a loved one’s life.

    Respectfully, I ask that the College, in this process, include regulations for nurses (who do not wish to participate regardless of rationale e.g. moral, religious, etc) to refuse if they choose to.

    Thank you also for providing guidelines in the interim on how to best proceed should the situation present itself.

    Sincerely,
    Angela