Deacon Larry Worthen, executive director of the Christian Medical and Dental Society, believes B.C., Alberta and Saskatchewan are committed to patient navigators, while Ontario committed to the model on June 6. Photo by Michael Swan

Third-party option needed to navigate assisted suicide

By 
  • June 10, 2016

Whether it’s to protect consciences or vulnerable patients, the best hope for limiting the scope of assisted suicide in Canada now is a “robust third party option for all end-of-life care issues,” said Sr. Nuala Kenny as Bill C-14 wended its way from the House of Commons and through the Senate.

Kenny is the one time head of medical education at Toronto’s Hospital for Sick Children, founding chair of the bioethics program at Dalhousie University in Halifax and a former deputy minister of health in Nova Scotia. She advises Canada’s Catholic bishops and the Catholic Health Association of Canada on assisted suicide. She was the one Catholic member of the provincial and territorial advisory panel on the issue, which also recommended a centralized patient navigator system to legislators in Ottawa.

Kenny believes Catholic health-care institutions and Catholics generally should be lobbying hard for a serious patient pathfinder system.

By referring patients to a centralized agency — whose purpose is not necessarily to deliver patients into the hands of a willing doctor but rather to lead them in a thorough look at all their options, including palliative care — doctors can be sure they are not directly or indirectly involved in effecting or approving a suicide. They can also continue to care for their patients even if doctor and patient disagree on assisted suicide, Kenny said.

“Non-abandonment” of patients is essential in the ethics of medicine, said Kenny.

As of June 6, assisted suicide is a reality in Canada, though as of The Register’s press time it remained in a legal limbo as Parliament puts the final touches on Bill C-14. The legislation is the government’s response to the Supreme Court of Canada’s Carter ruling from February 2015 that gave the federal government a year to  have an assisted suicide law in place. That deadline was extended by four months at the request of the newly elected Liberal government.

Patient navigators for people considering assisted dying is not some lonely, Catholic crusade. Kenny’s demand is backed up by the Canadian Medical Association.

“It serves our two objectives — to respect conscience and as well to facilitate patient access,” said Cécile Bensimon, the CMA’s director of ethics.

The CMA believes it has a commitment from Ottawa to set up and fund patient navigators.

“When the government introduced the draft legislation, Bill C-14, as part of their response to the Supreme Court decision, they also committed to some non-legislative measures,” Bensimon said. “One of which was to work with provinces and territories to establish such a central co-ordinating mechanism… We do believe that they will make it happen.”

For now, Health Canada only has plans for a web site.

“When the legislation is passed, a federal web site will provide information on a range of end-of-life care options, including palliative care,” a Health Canada spokesperson wrote in an e-mail to The Catholic Register. 

The web site will include links to palliative care resources and contact information for assisted suicide.

The federal government is still talking to provinces about a nationally co-ordinated system.

“In its final form, a pan-Canadian co-ordination system could serve a variety of functions, including: linking patients to providers for MAID (Medical Assistance in Dying) and providing information on the full range of end-of-life care options available,” said the communications department at Health Canada. “The federal government will continue to work with provinces and territories to support patients’ access to end-of-life care options and to respect the conscience rights of health-care providers.”

Deacon Larry Worthen, executive director of the Christian Medical and Dental Society, has held talks with health officials in four provinces so far. He believes British Columbia, Alberta and Saskatchewan are committed to hiring patient navigators, while the Ontario government, in a press release issued June 6, committed itself to the patient navigator model.

“Ontario will establish a referral service to support physicians in making an effective referral for consultation and assessment for possible medical-assistance-in-dying cases,” said the joint Ministry of Health and Attorney General press release. “The service will help connect physicians who are unwilling or unable to provide medical assistance in dying with physicians who are willing to complete a patient consultation and assessment.”

Across Canada various provincial officials have detailed plans, Worthen said.

“Like an 811 number,” said Worthen. “That 811 number would then direct them (patients) to that navigator position who would help them — hopefully first of all — to identify alternatives and also to help them get an assessment for medical aid in dying.”

The system has to be more than just a dispatch service to link up willing doctors with patients demanding a medical suicide, said Kenny. A system of private self-referral might sidestep objecting doctors, but it would also be “a capitulation to a market model of medicine,” she said.

Medicine isn’t a deli counter, and Kenny insists the doctor-patient relationship must consist of something more than patients ordering up procedures and prescriptions they’ve read about on the Internet. 

Many in Catholic health care are convinced provinces won’t court the disaster of Catholic hospitals and nursing homes shutting down in the face of regulations that force Catholic institutions to refer for assisted suicide, said Kenny. But Kenny herself is not so sure.

“I am not enthusiastic that historical protections will continue to apply,” she wrote in an e-mail. “Ob-Gyn has all but disappeared from Catholic facilities and they can be separated, but physician-assisted death will be occurring everywhere — mostly in the home and community.”

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