The document discusses physician-assisted death (PAD) in Canada, defining it as ending the life of a competent adult patient with a grievous and irremediable medical condition causing intolerable suffering, at their request and with a physician's assistance or administration. It outlines the legal and regulatory framework for PAD, including criteria that must be met, safeguards like assessments by two physicians, and the process that must be followed. Ethical issues, perspectives of proponents and opponents, and the rights of physicians and hospitals to conscientiously object are also addressed.

1. Physician Assisted
Death

2. What is physician Assisted death
(PAD)?

3. Defining pad and what it means
 The SCC decision establishes physician-assisted death (PAD) as a Charter right for “a
competent adult person who (1) clearly consents to the termination of life; and (2) has a
grievous and irremediable medical condition (including an illness, disease or disability)
that causes suffering that is intolerable to the individual.” The decision focuses on
“physician-assisted” death.
 This implies that only a patient who is capable of making a decision may have this right.
 Who is excluded: (1) Minors (2) Mentally incapacitated or ill patients

4. Examples of case in which pad may
apply
 A patient with carcinoma with mets to the bones and many other organs, in excruciating pain
which is out of control even with extremely high doses of opioids.
 euthanasia, where a physician directly administers a lethal dose of medication (or equivalent)
in accordance with the wishes of the patient.
KEY: The patient is competent and is not coerced into making the decision to end suffering
 a patient with ALS who is provided with a lethal dose of medication for self-administration)

5. Legality of PAD and regulatory safe
guards
 The SCC decision establishes physician-assisted death (PAD) as a Charter right for “a competent adult
person who
 (1) clearly consents to the termination of life; and
(2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes
suffering that is
intolerable to the individual.” The decision focuses on “physician-assisted” death.
 Patient requesting and consenting to PAD should be assessed by two different physicians and on two
different occasions with at least two weeks time interval in between the two occasions.
 Confidentiality is to be maintained throughout such a treatment.

6. Ethical issues that may arise
How about an individual who wants to commit suicide at home?
As far as the law is concerned, PAD does not affect such an individual. There is no indication that the management of
patients who are suicidal will change. There are many times during which suicidal attempts are a result of momentary
perceived threats to the patients. Once those are dealt with the patient may get back to normalcy.
In the case of PAD,
This is a case where a patient wants to end suffering not with cruel means, but rather end suffering with dignity. Such a
case has to have been verified with 2 physicians, one of the two with no connections with the patient and on two
separate occasions. This is to ensure that the request is not arising out of a momentary decision but rather a carefully
and persistent request to end suffering.

7. Proponents continued…
I do not believe in PAD. It is against both my moral and religious values.
Physicians whose moral and religious values make them uncomfortable to
render this service or treatment to their patients, are free to opt out, but they
are required to find a physician who will be able to provide such a services.
Similarly other health care providers including nurses with similar positions
can opt out of this service.

8. Can the hospital/clinic say no to Pad?

9. Opponents continued…

10. CRITERIA FOR PAD – PATIENT’S SIDE
There are 6 criteria which must be fully met (ALL of them);
(1) The patient must be an adult
(2) Must be capable of giving consent to PAD
(3) There should be no coercion or undue influence
(4) Patient’s decision must be informed
(5) Patient must have a grievous and irremediable medical condition
(6) The grievous and irremediable condition must cause enduring suffering that is
intolerable.

11. PAD SEQUENCE – Physician (primary)
 First step is a written request from a patient to his or her physician for PAD
 The Physician then follows this up with a dialogue with the patient on the diagnosis,
prognosis and treatment options.
 The physician has to give or provide the patient with a copy and the contact
information to the College of Physician in the jurisdictions about PAD.
 Assessment of the patient in person to ensure that the patient meets the 6 criteria

12. PAD SEQUENCE (Secondary Physician)
 Patient meets all the 6 criteria , then the primary MD arranges for a 2nd
MD to assess the patient.
 Inform the patient whether or not he or she is able to provide the service.
 If unable, refer the patient to a 2nd MD known to be willing to assist
patient with PAD
 The 1st MD review all documentation provided by the 2nd MD and advises
the patient of her right to reverse his or her decision at any time in the
time line.
 Then arrangements to provide PAD whether with oral medications or
injectables is discussed with the patient.

13. References
 Standards of Practice: PAD (2016), College of Physicians & Surgeons of Nova Scotia.
Halifax, NS: Retrieved from www.cpsns.ca
 Johnston, W. (2015). Euthanasia in Canada? The coming World of Assisted dying.
Retrieved from https://www.youtube.com/watch?v=SCKVqbO4n2U
 Tyson, R. (2016). Physician Assisted Dying in Canada: The Legion of Reason. Retrieved
from https://www.youtube.com/watch?v=GmAMqnKLKMM