ASSISTED DEATH HITS SPEED BUMP
B.C. nurses worry they’re not protected by court ruling.
A B.C. doctor leading the efforts to provide physicianassisted dying says she’s being thwarted in her efforts to recruit nurses to help administer intravenous drugs.
On Monday, Dr. Ellen Wiebe, the medical director of the Willow Women’s Centre in Vancouver, assisted in the death of a Calgary woman with Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis, after an Alberta court issued an exemption allowing the assistance.
Wiebe said Thursday she has a case going to B.C. Supreme Court next week in which a patient has chosen to die at home using intravenous medications. But she said the College of Registered Nurses of British Columbia “does not support this.”
Wiebe won a small victory this week when the College of Pharmacists of British Columbia changed its views about pharmacists providing access to medications used in assisting death. That college said it modified its stance after the Alberta court ruling specifically covered pharmacists. The Alberta judge, however, did not deal with nurses because the patient only sought the help of doctors, and did not specify nurses. The administration of the drugs was carried out by Wiebe and another doctor.
Wiebe said the nursing college is unwilling to change its views.
“We have some more work to do,” she wrote in an email to The Vancouver Sun. “Our next patient is going to the B.C. court very soon, probably next week. The ravages of her disease means that I am worried about getting IV access. She has chosen a death in her home with IV meds. I want to have a nurse with me to make sure the IV goes in smoothly. Unfortunately, the college of nursing does not
“We are in a period of transition where medical assistance in dying remains prohibited… the role of nurses in this process has not yet been considered by a court.
ZAK MATIESCHYN PRESIDENT OF THE ASSOCIATION OF REGISTERED NURSES OF BRITISH COLUMBIA
support this.”
Wiebe said she has a nurse ready to come if she gets support from the nursing regulator.
“The college of nursing needs to be pressured to change their policy, just like we pressured the College of Pharmacists,” she wrote.
In a Feb. 12 post to its website, the college said nurses should seek independent legal counsel if asked to participate in a physician-assisted death. It said the Supreme Court of Canada’s ruling last year allowing people to apply for court exemptions from Criminal Code charges in assisting in death “did not say that this exemption applies to nurses.”
The Supreme Court of Canada, in a February 2015 ruling, struck down laws that prohibited physician-assisted death. However, it suspended its decision for 12 months to let the federal government draft new laws. In the interim, patients must apply to a court for an exemption to the Criminal Code provisions.
The Supreme Court later gave the new Trudeau Liberal government a six-month extension to June 6.
The College of Registered Nurses says it is working to clarify the role of the nurse in physician-assisted death cases.
“Given the current circumstances and the lack of clarity about whether there is a Criminal Code exemption for nurses … participating in physicianassisted dying at this time could put nurses at risk, legally and professionally,” the college said in a statement.
However, the Association of Registered Nurses of British Columbia, which represents nearly 40,000 registered nurses and nurse practitioners, believes nurses would be protected under a court-ordered exemption.
“We believe that the court will recognize the need to protect any health professional who works with a physician on an assisted-death case,” Zak Matieschyn, the president of the association, wrote in an emailed statement. “However, to ensure that any legal obligation is fulfilled and that all necessary information is brought to the attention of the court, we want any B.C. nurse who is considering taking a role in physician-assisted death to obtain legal advice.”
The association has approached the Canadian Nurse Protective Society to provide independent legal advice to nurses at no charge. The society provides nurses with liability insurance.
Matieschyn said his association recognizes “we are in a period of transition where medical assistance in dying remains prohibited by the Criminal Code except when undertaken pursuant to a court order, and that the role of nurses in this process has not yet been considered by a court.”
But he said the nursing association also fully supports a patient’s right to choose what is best for them and their family regarding end-of-life.
However, he said that until the federal government sets its direction around physician-assisted death, he doesn’t believe the college will make changes to nursing standards of practice in B.C.
“In the interim, however, we do not want patients to feel they cannot access every option available,” he wrote. “We believe there may be acceptable legal options that protect nurses who are asked to be involved in physician-assisted death, but each court order must be reviewed by legal counsel on an individual basis.”