The Supreme Court-Carter v. Canada and End of Life Care

I had dinner with a very good friend last night. He said, “You must be happy with the Supreme Court decision”. He was referring to Carter v. Canada published on February 6 2015

He is not a health professional and has his own busy life, but he does know vaguely that I am interested in improving the care that we and our families receive once an illness is identified that might result in death. This is not restricted to the period immediately preceding death and continues after death. It was loud and there were a lot of people around so I smiled and indicated I was pleased and the conversation moved on. If it was quieter and we had more time I would have given a very different answer.

I am pleased with the decision itself. It is clear and well written. It is reasonable and based on polling of the public and doctors, it is likely to be widely supported.

People know that if they are “competent adults who clearly consent to the termination of life, and have a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable” they will have the option to get medical assistant in ending their life.

The decision is also clear that doctors will not be compelled to participate in assisted death. This provision is critical for medical professionals and is consistent with Canadian Medical Association policy approved in August of last year.

Parliament, Provincial Legislatures and regulatory bodies have a year to write laws and regulations to allow assisted death and set out the safeguards for vulnerable patients. I’m sure that there are dozens of other practical implementation issues to consider. Work must start immediately, as a year will be a very short time to make the Supreme Court decision work.

But I do have some very real concerns.

Very few of us will ever choose medical assistance in dying. All of us will die.

A minority of us participates in Advance Care Planning. Most of us want to die at home or in another community setting. Most of us will die in hospital. And there are still huge gaps in accessing good quality palliative care.

So I am concerned that the focus of our efforts around End of Life Issues will be spent focusing on a very narrow, rarely used intervention. We can’t let that happen.

This decision is historic. It will change our country. But it will do little to improve care for the vast majority of Canadians.

We must continue to push to improve rates of advance care planning. We must work hard to normalize death and discussions about death. We must improve access to high quality, team based palliative care.

Scott Douglas Wooder, MD

 

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