Medical Aid in Dying in Canada: Undertaking Clinical Ethics Consultations in a Rapidly Evolving Regulatory Landscape

Abstract

Canada’s relatively new medical assistance in dying regime embodies a rapidly shifting regulatory and legal landscape. Healthcare professionals, including clinical ethics consultants, should work to stay apprised of new developments not only in hospital policy but also in federal law. The patient eligibility criteria for medical assistance in dying are, at the time of this writing, undergoing Parliamentary review, and it is very likely that expansion of the criteria will follow shortly. This chapter, therefore, familiarizes clinical ethicists with some of the most important recent developments in the law and the events that precipitated them. It describes two case studies that challenge Canada’s patient eligibility policies for medical assistance in dying, demonstrate the role of Canada’s courts in the development of those policies, and illustrate the nature of the decisions that clinical ethicists must make in a Canadian context. It also discusses the challenge posed by the unwillingness of some institutions and individual physicians to participate in the provision of medical assistance in dying. Canada’s effort to balance physicians’ and institutions’ right to act according to their conscience has come into conflict with patients’ interests in receiving legally authorized care. The legal response to that conflict has left a substantial role for the discretion of clinical ethicists, who should be mindful of the need to prioritize patient care.