Doctor-assisted suicide rules may fall to province, ethics expert says

There are far more questions than answers about doctor-assisted suicide and how it will work in Canada,says a University of Manitobaethics expert who'spart of apanel advising provinces and territories on the issue.

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The questions that need to be answered before the Feb. 6deadline at which point the federal government has to either write new legislation, or the matter will fall to the provincesinclude how it will beadministered, who will be eligible and what happens when doctors say no, said bioethicistArthurSchafer, amember ofthe provincial-territorial expert advisory groupon physician-assisteddying.

If the federal government comes up with new legislation to deal with those questions, it will have to conform to the Supreme Court ruling, Schafer said.

If it doesn't, the onus will fall on another level of government.

"If there isn't new legislation,then itwill be up tothe provinces under whose jurisdiction health care falls," he said.

It's particularlyunclear what the changes will mean for patientsin remote areaswhere there is a pronounced shortageof physicians, Schafer said.

Whendoctorssay no to patients in remote areas

"We have heard people from the Yukon and the Northwest Territories say that in many of their communities, there aren't doctors. And it's a doctor whohas to assist with a lethal prescriptionor give a lethal injection," he said. "If there is no doctor in the community, couldit be a nurse practitioner?Would it be up to a board to decide? All of these questions, including how you interpret the Supreme Court statement that the adult has to be competent. Competent when? Competent when you make the request? Competent when the assistance comes?"

One of the most controversial issues will ariseif a doctorwon't perform the procedure or write a prescriptiondue toconscientious objection, or even refuses to refer a patient to another doctor, he said.

"There will have to be a reconciliation with the patient's right of access and the doctor's right to object because of conscience. You have twovalues in conflictthat will have to be reconciled."

The physician's fundamental ethical obligation is to promote the best interest of the patient, Schafer said. Physicians have a right to object, but not if it means denyinga patient a treatment or procedure towhich the patient is legally entitled, he said.

CBC interviewed two doctors earlier this week whopointed tothe Hippocratic oath not to harma patient, and that human life is sacred.

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"That may be their view, that death is never a preferableoutcome, but it's not the viewof many Canadians who have watched a loved one die an agonizing death with deep suffering. If a physician feels theycan't be part of ending a life, then they can refer,or maybe there will be a special board the patient can go to," Schafer said..

The College of Physicians and Surgeons of Manitoba is asking Manitobans for their input as it writes a draft statement on physician-assisted suicide.

• Manitoba College of Physicians and Surgeons seeks input on doctor-assisted suicide

That statement will be made public next Thursday.