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JCB Working Group Explores the Ethical Dimensions Related to Implementing Physician-​Assisted Death

February 3/2016

On Feb. 3, 2016, the University of Toronto Joint Centre for Bioethics (JCB) released the discussion paper An Ethics-based Analysis and Recommendations for Implementing Physician-Assisted Dying in Canada by Nadia Incardona, Sally Bean, Kevin Reel and Frank Wagner. This paper is the first in a series that the JCB is planning on publishing in regards to ethical issues in healthcare.

Last February, the Supreme Court of Canada issued deadline of February 6, 2016 following its unanimous Carter decision which would give Canadians access to physician-assisted dying (PAD). The deadline has since been extended by four months to June 6, 2016 after an application to the Supreme Court of Canada by the Attorney General in January 2016.

JCB members have produced two previous reports to inform Canadian policy in regards to PAD as part of both the Provincial-Territorial Expert Advisory Group with the Ministry of Health And Long-Term Care, and a JCB Task Force on Physician-Assisted Death.

“While the Carter decision sanctioned PAD in Canada, operationalizing PAD presents challenges that sit at the multiple intersections of law, medicine, society, social relationships, ethics and the human experiences of living and dying. Even though the request originates with an individual patient, that request necessitates a systems-wide response involving multiple health professions (each with their unique role), institutions and organizations,” the authors wrote in their discussion paper.

This most recent publication is the culmination of discussions that began as part of a working group that came together through the JCB Task Force on Physician-Assisted Death. The working group has diverse representation from bioethics, medicine, occupational therapy, law, policy, health administration and patient advocacy.

The aim of the discussion paper is to articulate the broad ethical dimensions of implementing PAD, as well as provide ethics-based recommendations to inform the development of PAD policy and supporting practices. The authors’ ethical analysis of PAD implementation is based on the principles of accountability, collaboration, dignity, equity, respect and transparency. Recommendations for PAD operationalization are presented both by ethical principle and by stakeholder group.

“The Carter decision gives us the opportunity to redress intolerable suffering and examine EOL care in Canada, including enhancing existing palliative care.”

The paper also highlights and begins a discussion of three major issues left unresolved by Carter: the definition of adult, the role of advance wishes for PAD, and PAD ‘tourism.’

Click here to read the full report.