We're sorry but your browser is not supported by Marsh.com

For the best experience, please upgrade to a supported browser:


Risk in Context

Medical Assistance in Dying: Finding the Balance

Posted by Nora Constas January 04, 2017

In February of 2015, the Supreme Court of Canada (SCC) struck down sections of the Criminal Code, effectively leaving the door open for lawmakers to regulate physician assisted death for “a competent adult person who (1) clearly consents to the termination to life and (2) has a grievous or irremediable medical condition (including disease, illness and disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

In the coming months and years, the SCC decision will have far reaching implications relative to the protection of the rights of the patient but also of health care professionals and organizations. Across Canada, hospitals, long term care facilities, and regional health authorities will be key players in the development of a collaborative effort that meets the needs of patients at the end of life together with effective policies and procedures that safeguard and respect the values of the individuals involved, including:

  • Open communication between organizations that will ensure seamless transition in care for the patient – the right care in the right place.
  • Appropriate policies in place to protect health care professionals from potential liability.
  • Policies to ensure:
    • Patients have appropriate and timely access to medically assisted death.
    • Clear criteria for determining eligibility.
    • Review process to assess and validate eligibility.
    • That, in the event that consensus regarding eligibility is not ascertained, organizations have appropriate processes to seeking assistance elsewhere.
  • Quality and oversight offered though a review committee to ensure compliance with regulatory and legislative requirements, and professional standards of practice.
  • As conscientious objectors, faith-based organizations can choose to not participate/offer these services; however, they will still need to ensure that their current policies and procedures uphold duty of care and standards of practice. This can be done by:
    • Ensuring that there are processes in place that will allow for the transfer of care to a “non-objecting facility” where the patient may be assessed for eligibility.
    • Ensuring that palliative and end of life care is delivered with compassion and dignity and based on current evidence-based practices.
    • In consideration of the ethical and moral values held by some health care professionals, organizations must have a process in place that allows individual providers to conscientiously object to certain components of end of life care that does not impede on the rights of the eligible patient. In these cases, providers will require a process to enable the timely transfer of care through referral or direct transfer of care.

While the concept of death and dying are not new to health care professionals, more research and education in the delivery of end of life and palliative care are critical. In addition to a shift in the curriculum to encompass the clinical components of medically-assisted death, education around ethical objections, the legal and regulatory environment, cultural sensitivity and diversity, best practices and safeguards must be embraced. Enhancing research and education in this area will enable a standardized approach, reduce variances in practice, and ensure equitable access as appropriate.

Implementation of medical assistance in dying will be a significant challenge for health care organizations across Canada as it intersects the modalities of medicine, law, ethics, and society with human experience. Organizations need to be prepared with effective and appropriate policies and practices to maximize the patient experience while achieving a balance based on shared values, principles, and interests of all stakeholders.

Nora Constas

Nora is a Senior Consultant within Marsh Toronto’s risk management division, Marsh Risk Consulting (MRC) and is MRC’s National Leader in Health Care and Clinical Risk. She offers clients almost two decades of academic and healthcare experience, including recent process improvement and quality improvement strategy projects using various Six Sigma and Lean methodologies.