UPDATE (April 7/17): The following topic has been updated.
CLICK HERE for current guidance on this issue.
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):
On June 6, 2016, a new right to medical assistance in dying in Canada will become law. These recent decisions by the Supreme Court of Canada regarding medical assistance in dying have 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.
Currently, nurses are prohibited from aiding or counselling for suicide, and also may not participate with medical assistance in dying.
This includes doing anything that can be construed as counselling for or assisting a person to achieve medical assistance in dying either by suicide (patient is provided with a lethal dose of medication for self-administration), or by voluntary euthanasia (a physician legally administers a lethal dose of medication after patient consent).
Frequently Asked Questions for Nurses
Below are the responses to the most frequently asked questions by nurses regarding medical assistance in dying in Canada:
What’s happening now?
On Feb. 6, 2015 in the Carter v. Canada decision, the Supreme Court of Canada struck down the federal law prohibiting physician-assisted death.
This decision was to come into effect Feb. 6, 2016 however, on Jan. 15, 2016, the Supreme Court of Canada granted a four-month extension to the federal government to consider its approach to medical assistance in dying. This means that the Carter decision does not come into effect until June 6, 2016. The Supreme Court did indicate that individuals who wish to seek medical assistance in dying during the four-month extension may apply to a judge for authorization. Specifically, a court order would indicate the outcome of the medical assistance in dying request.
Who is eligible for medical assistance in dying?
The Supreme Court of Canada determined that a competent individual with a grievous and irremediable medical condition (causing enduring suffering and is intolerable in the circumstances of his or her condition) may seek and consent to medical assistance in dying.
Why are nurses prohibited from participating in medical assistance in dying?
The Carter case and the proposed amendments to the Criminal Code provide legal protection to physicians involved in medical assistance in dying, so they can practice without risk of criminal prosecution. These amendments only protect the physician.
Nurses are not currently listed within these Criminal Code amendments, leaving nurses vulnerable to criminal prosecution if they are found to be involved in any activity that is considered as assisting or participating in medical assistance in dying.
We anticipate that in the future, this federal legislation may change to protect others in the health-care team that provide services in relation to medical assistance in dying. An Act to amend the Criminal Code and to make related amendments to other Acts with regards to medical assistance in dying was introduced to the Federal Government on April 14, 2016 (Bill C-14). Further updates will follow.
What do I say if a patient or client wants more information on or is seeking medical assistance in dying?
Acknowledge the request for information in a competent and compassionate way. Inform your client that currently, you cannot legally provide any information that could be seen as initiating a discussion or counselling in medical assistance in dying however, you will advise the physician of their request to have more information and/or a conversation about medical assistance in dying.
Engage the client in meaningful communication to clearly understand their health needs and the reason for the request. Continue your nursing assessments and provide care as you always would with empathy, respect and compassion. Reinforce your commitment to support and help them with their care needs and any decisions they make. Your nursing role is to continue providing safe, competent, compassionate, ethical nursing care.
Highlight to your client that nurses:
- work to relieve pain and suffering through appropriate and effective symptom and pain management, including fostering comfort and advocating for adequate relief of discomfort
- introduce palliative care as an option of consideration to support symptom management if not already done
- ensure that clients in their care receive all of the information they need to make informed decisions related to their health and wellbeing
- advise the client that you will inform their physician in a timely manner, about their request to have a conversation and receive more information about medical assistance in dying
- if the physician is not available, the nurse will follow the organizational policies that detail who to contact alternately for this specific query
- ensure the client is not seeking medical assistance in dying due to lack of understanding of additional supports available to them
What if there is a court order indicating that the nurse is to support medical assistance in dying?
Currently, without Criminal Code amendments providing protection for other health-care providers aside from physicians, nurses cannot participate or provide information that could be construed as counselling in medical assistance in dying unless specifically named in a court order.
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 medical assistance in dying. Whether any health-care professionals other than physicians can assist with medical assistance in dying during this period will depend on the content of the court order obtained by the patient. Any nurse, who is asked to assist with medical assistance in dying through a court order, should contact their regulatory college for advice.
What if medical assistance in dying is against my beliefs or values?
Nurses will not be required to participate in medical assistance in dying if it is in conflict with their moral beliefs and values (conscientious objection).
Currently, without Criminal Code amendments providing protection for other health-care providers aside from physicians, nurses cannot participate or provide information that could be construed as counselling in medical assistance in dying unless specifically named in a court order. If you are asked to participate in any aspect of medical assistance in dying within a court order and you choose not to participate due to reasons of conscience, ensure you notify your employer so that alternative arrangements can be made.
How do I prepare for questions on medical assistance in dying?
Familiarize yourself with federal and provincial regulations, professional regulatory college standards and guidelines and organizational policies on medical assistance in dying. Participate in and provide feedback to provincial, organization, professional and local work area surveys. Participate in conversations on this topic with your team to promote understanding. Call your professional regulatory college with any questions.
Where Can I Learn More?
Carter v. Canada (Attorney General), 2015 SCC 5
Report of the Special Joint Committee on Physician-Assisted Death.
Canadian Nurses Association (January 2016). Brief to the Special Joint Committee on Physician-Assisted Dying.
Alberta Health Services (2016). Physician Assisted Death.
Covenant Health (2016). Statement: Physician Assisted Death.
College of Physicians and Surgeons of Alberta (2016). Advice to the Profession.
Who can I call if I have further questions?
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