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Physician-assisted dying: the role of a nurse

Nurses should seek independent legal counsel if asked to participate

Please visit the CRNBC medical assistance in dying (MAiD) page for the most current information on this topic   

posted Feb. 9, 2016
updated Feb. 12, 2016
updated Mar. 7, 2016

This announcement has been updated in response to feedback from nurses and the public.

CRNBC recognizes the important role nurses play in providing palliative and end-of-life care. We are committed to supporting nurses as we work to clarify their role in physician-assisted dying.

The recent Supreme Court of Canada (SCC) decision in Carter v. Canada did not address the role of nurses in physician-assisted death, leaving it unclear what involvement they can or should undertake.

We look forward to the anticipated legislation that will clarify the role nurses may have in PAD. Until this legislation is in place, or the courts in British Columbia rule on the matter, the legal position of nurses is regrettably uncertain.

Current role and accountabilities

It's important to note that the Carter decision does not change nurses' accountabilities as they relate to their current roles with clients seeking information or requiring palliative or end of life care. Nurses continue to have an integral role in providing quality care for those clients. This includes:

  • advocating for clients
  • providing comfort care to those who are dying and their families.
  • creating and implementing nursing plans of care
  • collaborating and consulting with other members of the health care team
  • referring to other members of the health care team to ensure clients get their care and information needs met
  • conducting assessments
  • administering medications and treatments

Supreme Court of Canada decision

As of February 6, 2016, following the Supreme Court of Canada (SCC) Carter decision, some British Columbians can apply to courts in this province for approval to die by physician-assisted dying (PAD). The SCC decision in Carter provides an exemption for physicians from charges under the Criminal Code in cases of PAD, as long as certain requirements are met. It is important for registrants to be aware that the SCC did not say this exemption applies to nurses.

Participating in physician-assisted dying

At this point, work is underway  to clarify the role of the nurse in the PAD process. Given the current circumstances and the lack of clarity about whether there is a Criminal Code exemption for nurses under the Carter decision, participating in physician-assisted dying at this time could put nurses at risk, legally and professionally. 

CRNBC advises nurses to avoid initiating a discussion about PAD with patients or their families. If approached for information about PAD by patients or families, nurses should recommend they discuss the matter with a physician.

If you are approached to participate in PAD, we recommend you seek an independent legal opinion regarding your specific situation. Nurses may also want to consider speaking with their supervisor, or workplace contacts in risk management or professional practice.

Resources
  • Our regulatory practice consultants are available to answer questions or concerns about physician-assisted dying and how it relates to professional nursing practice in B.C. They can be reached at practice@crnbc.ca or by phone at 604.736.7331 ext. 332.
  • The Association of Registered Nurses of British Columbia  (ARNBC) has approached the Canadian Nurse Protective Society (CNPS) to ask if they would be prepared to advise nurses regarding PAD. CNPS confirmed that it is available to provide independent legal advice to CRNBC registrants with respect to their specific circumstances, even if the situation arises before March 1, 2016. There is no additional fee to obtain this advice.

    Please note that CNPS is offering extended hours for B.C.  nurses: additional staff are available until 8 pm PST to answer calls and emails until April 29th.
  • Other resources to consider speaking to about PAD include your employer, your union and ARNBC.
Background
  • On February 6, 2015, the SCC in the Carter decision struck down the provisions in the Criminal Code prohibiting physician-assisted dying (PAD).
  • The decision establishes PAD as a charter right for “a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition (including an illness, disease or disability) that causes suffering that is intolerable to the individual.”
  • The decision allows both assisted (patient administered) dying, and voluntary euthanasia, where a physician directly administers a lethal dose of medication at the wishes of the patient.
  • The SCC suspended the decision for 12 months to enable the health and legal system to prepare, and on January 15, 2016, the SCC extended the suspension for an additional four months (to June, 2016).
  • As part of their decision to extend the suspension to June 6, the SCC decided to allow individuals seeking PAD to apply to the Supreme Court of British Columbia for approval relief during the four month extension. Such applications must be in accordance with the criteria established in the Carter decision.

 Questions?

​Contact a regulatory practice consultant

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