Sharon Kirkey

on the big changes — and questions — ahead.

Canada’s highest court has left many questions for some of the central players in any future assisted death scheme — the doctors who will be asked to help put to death adults who have decided to end their lives.

What we know

Physicians’ colleges, Parliament and the provincial legislatures have been given the job of crafting a comprehensive assisted death regimen for people experiencing physical or psychological suffering.

Assisted dying would be permitted for competent adults only who could explicitly provide consent, not people who have been delegated their substitute decision makers should they ever lose the capacity to speak for themselves.

The patient would have to have a “grievous and irremediable medical condition” causing “enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

The person’s condition doesn’t need to be terminal. Doctors should be capable of assessing whether someone is competent, and proper safeguards would protect the vulnerable from “abuse or error.”

Doctors would not be compelled to provide aid in dying. A doctor’s decision to participate “is a matter of conscience and, in some cases, of religious belief,” the court wrote.

But it was more circumspect on whether doctors would be compelled to refer patients to other providers, noting the charter rights of patients and doctors “will need to be reconciled.”

What we do not know

What is “grievous” suffering? Who defines it? What form of “physician-assisted death” would be permitted?

What medications would be used, how many doctors would be required, and who would have to witness and document assisted deaths?

In the case of death by a lethal prescription, would the patient take the drug herself?

What about death by lethal injection?

Would physicians opposed to medical aid in dying have the right to refuse to even refer a patient seeking assisted death to another doctor willing to perform it?

Does the right to assisted death apply to people with mental illness, such as depression?