Health Minister Eric Hoskins is asking the federal government to quickly pass assisted suicide legislation because some Ontarians are in a concerning position where they qualify for assisted death today, but may not in a matter of weeks or months.

Physician-assisted dying is now legal in Canada, but federal legislation on the issue has been delayed — and may remain delayed for months. The Senate is debating amendments to Bill C-14, which, if passed, will send the bill back to the House, which may, or may not, accept changes.

In the interim, the College of Physicians and Surgeons of Ontario (CPSO) has approved guidelines for physicians in Ontario based on the Supreme Court ruling Carter v. Canada.

However, Hoskins acknowledged the guidelines are closely based on the Supreme Court ruling and more permissive than the federal legislation passed by the House of Commons. That puts certain patients in the position of being able to legally receive physician-assisted dying today, who would not when the legislation comes into force, if it eventually passes unchanged.

“That why I’ve encouraged that the Senate, and if necessary the House again, to pass legislation as quickly as possible. It’s important to have a national framework in place. In the meantime, in this interim period, the law of the land is the Supreme Court decision made a year and a half ago, roughly,” said Hoskins.

Physician-assisted suicide is available in Ontario now, he said. Patients can approach their doctors and their doctors can reach out to the CPSO for guidance.

The province has set up a phone number for doctors to call for a consultation on assisted death, or, if they object to helping patients die, to refer patients to doctors who don’t share that objection.

While Hoskins is recommending patients and physicians seek a hearing from the courts on each request for physician-assisted death, that is no longer legally required.

“I feel confident, here in Ontario, because of the work we’ve done as well of the hard work by the CPSO, where they have in place now guidelines for physicians,” he said.

The CPSO guidelines are closer to Carter v. Canada than the House of Commons' Bill C-14, said Kerry Bowman, an ethicist with the University of Toronto Joint Centre for Bioethics.

For example, the CPSO guidelines allow someone with “a grievous and irremediable” condition – but not necessarily a fatal one – to receive assisted suicide. The House of Commons bill would not.

The CPSO guidelines also allow physician-assisted death for patients whose suffering is psychological, due to mental illness, and assisted death for mature minors. The pending legislation does not allow this — but does commit to study.

Bowman said there’s considerable concern among physicians about their obligations toward those patients before the federal legislation is passed.

Many health-care professionals are also concerned about the nurses, pharmacists and other members of hospital teams who are part of a team involved in assisted death in the interim because the Supreme Court decision left their legal status unclear, he said.

However, Bowman said health-care providers must also remember patients' right to access assisted death.

“In ethics, access is justice,” said Bowman.

That's why referral system set up by the province, which will allow doctors who aren’t comfortable with assisted death to refer patients to another doctor, is especially important at this time, he said.

Bowman said he’s worried that the medical community has become too consumed with their own obligations related to their professional practice concerning assisted death at this uncertain time — instead of their patients’ needs.

“Nobody is talking about patients and what their fundamental constitutional rights are right now, and how we’re going to respect that,” he said. “We’re just completely absorbed with all the parameters of professional practice and no one is talking about patients at the moment. We can hide there.”

For some patients, assisted death legal today but not necessarily for long

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