Council Update

January 26, 2016

Interim Guidance on PAD

Feb 02, 2016

Interim Guidance on Physician-Assisted Death

Now Available

Council of the College of Physicians and Surgeons of Ontario has approved its Interim Guidance on Physician-Assisted Death. This Interim Guidance document was developed to ensure that Ontario physicians are aware of their obligations and the College's expectations when physician-assisted death becomes legal.

This guidance will bridge the four-month extension period that the Supreme Court of Canada has given the government to pass legislation. The deadline for the establishment of a government framework was extended from February 6, 2016 to June 6, 2016.

The Court has ruled, however, that during this extension period, an individual who is suffering intolerably from a grievous and irremediable medical condition, and wishes to seek assistance in dying, must obtain an exemption from a superior court judge before a doctor can assist a patient in ending their life.

"While the Supreme Court has given the federal government a four-month extension on the deadline to pass legislation on physician-assisted death, we believe this guidance needs to be in place as patients will have the option over this period to apply to a judge for an exception to the current law," said College President Dr. Joel Kirsh. "The public and the profession can be confident that we have given careful consideration to this important issue, listened to their feedback and provided guidance that is well-informed and balanced."

Key elements of the Interim Guidance document include:

  • Professional and legal obligations articulated in College policies and legislation that apply in the physician-assisted death context;
  • The criteria for physician-assisted death as set out by the Supreme Court of Canada;
  • Guidance for physicians on practice-related elements specific to the provision of physician-assisted death, as set out in a Sample Process Map; and
  • A statement that physicians do not have to provide services that conflict with their conscience or religious beliefs. Where a physician declines to provide physician-assisted death for reasons of conscience or religion, he or she must make an effective referral in a timely manner to a non-objecting physician or agency. This expectation is consistent with the Professional Obligations and Human Rights policy.

The draft document underwent an abbreviated consultation to meet the Supreme Court's February 6th deadline.  The Interim Guidance on Physician-Assisted Death was informed, in part, by feedback received during a consultation on the draft document, the recommendations of the Provincial-Territorial Expert Advisory Group, the work of Canadian regulators, the Canadian Medical Association, as well as existing frameworks in jurisdictions where physician-assisted death is legalized.

The Sample Process Map included in the Interim Guidance document clarifies that conscientious objectors are not required to assess whether the patient meets the criteria for physician-assisted death prior to making an effective referral.  Key changes were also made to the recommended waiting period between a first and second request for physician-assisted death.  The recommended 15-day period was removed, to allow physicians and patients to adhere to a reflection period that is suitable in the circumstances of each case.

As mentioned above, with respect to conscientious objections, the guidance does not compel physicians to provide services that conflict with their conscience or religious beliefs.  However, where a physician declines to provide physician-assisted death for reasons of conscience or religion, he or she must make an effective referral in a timely manner to a non-objecting physician or agency.  The College acknowledges that the number of physicians and/or agencies to which a referral would be directed may be limited, particularly at the outset of the provision of physician-assisted death in Ontario.  In light of these circumstances, the College expects physicians to make reasonable efforts to remain apprised of resources that become available in this new landscape.  We will be making these resources available on our website as they become available.

During the consultation, a number of stakeholders asked for additional guidance regarding the appropriate drugs to administer or provide to the patient.  As a result, we sought and received permission to provide specific drug protocols from Quebec and Oregon in the Members' section of the College website.  Due to public safety considerations and in keeping with the protocols from the originating organizations, this information is only available to members by signing in with the CPSO login information.

Login instructions to access information about specific drug protocols:

  • Go to www.cpso.on.ca and click on "Member/Applicant login"
  • Please follow the instructions for logging in:
    • Your password is the same as the password you have for your annual renewal.

If you have forgotten your password, click on "Forgot your password" and follow the instructions for resetting your password.