View this email in your browser

Will Canada Become a Permissive Jurisdiction for Assisted Dying Practices?

The recent Canadian Supreme Court Carter v. Canada decision surprised a lot of Canadian healthcare professionals with the wideness of its breadth and scope. In an anticipated federal and provincial/territorial (other than Quebec) legislative and regulatory vacuum, as of early February 2016, it will no longer be a criminal offence for a physician to assist her/his patient to die through use of either physician-assisted suicide or voluntary active euthanasia as long as certain, key conditions are met. The patient must be experiencing enduring and intolerable suffering of a physical or psychological nature as the result of a grievous and irremediable medical condition, and he/she must be capable of providing informed consent for the assisted dying practice to be used. Like in Belgium and the Netherlands, and unlike in other legalized settings in North America, there is no stipulation that the requestor of an assisted death be at the end-of-life. This is a key difference from the euthanasia-related provisions of Quebec’s Bill 52 (that will be going into effect this December) which, as currently worded, require that the requestor “suffer from an advanced state of irreversible decline in capability.”

It is conceivable that some Canadian provinces could become permissive ‘Wild Wests’ with regard to unregulated assisted death practices. It is difficult to predict how members of the Canadian public will respond if Canadian assisted dying practices take their lead from experiences in Belgium where a number of recent, sensational euthanasia cases have caught the attention of the international media. Such cases include 45 year old twins with congenital deafness who were progressively losing their vision because of glaucoma, a transgendered person, a person with an eating disorder, and the planned euthanization of a convicted murderer-rapist (which was called off at the last minute in January by the Minister of Justice). A close look at these cases reveals that there are significant, socio-relational features to take into consideration and that they do not constitute obvious, actual ‘slips’ in the indications for euthanasia in Belgium. However, the reportage on these cases has helped to open-up an international ‘imaginative public space for doubt and fear’ about assisted dying practices. The unease of some public members has also been influenced by the articulate critiques of disability rights activists, such as Catherine Frazee, who express understandable concerns about possible, related devaluation of the lived experiences of persons with disabilities, given the long history of discrimination directed against disabled persons and members of other historically-marginalized and disadvantaged social groups in the healthcare domain. This particular subject area is under-researched but the limited studies that have been performed to date have not demonstrated over-representation of, or disproportionate impacts on, persons with non-terminal, physical disabilities or chronic illnesses (other than persons with HIV Disease).

There are two distinct sets of circumstances in which assisted dying practices are typically used. In paradigm circumstances, the affected person is experiencing unbearable suffering which is primarily physical in nature, e.g., pain, shortness of breath, delirium, at the very end-of-life (death is anticipated within days to a few weeks), and the individual’s distress has not responded adequately to a variety of palliative treatment modalities. In non-paradigm circumstances, the requestor, whose death is not expected to be ‘near’, makes an informed decision to end her/his life because of the presence of a significant health condition that, from her/his perspective, makes the prospect of further life ‘not worth living’. The distress is primarily psychoexistential in nature and is typically associated with one or more negatively-perceived quality-of-life factors: inability to participate in activities that formerly made life meaningful and/or enjoyable; hopelessness; perception of current or anticipated-future, progressive loss of ‘self’, dignity, independence and/or social significance; a preference for control over one’s destiny; and the desire to not become, or continue to be, a burden to loved ones.

There are some morally-relevant differences between the use of assisted dying practices in near-death paradigm and non-paradigm circumstances in the ethics domains of consequences and proportionality. The foreshortening of life is usually considerably shorter in the former, and it is the use of assisted dying practices in the latter circumstances that has opened-up the previously referenced ‘imaginative public space for doubt and fear’. It is therefore more difficult to support a claim that the ‘good effect’ of elimination of profound suffering clearly outweighs the ‘bad effects’ (and thereby constitutes a proportionate therapeutic benefit) in non-paradigm than in near-death paradigm circumstances. In my view, these distinctions help to justify the development and implementation of stricter legislative and regulatory monitoring and safeguarding mechanisms for the use of assisted dying practices in non-paradigm than in paradigm circumstances.

In the event that neither the Canadian parliament nor our provincial government steps-up to the legislation-development plate before early 2016, one hopes that the College of Physicians & Surgeons of Nova Scotia will work closely with stakeholder-deliberators and relevant resource persons (including a healthcare ethicist) to develop a set of policy and practice guidelines for the province’s physicians to follow in navigating their patients’ requests for an assisted death starting next year. Although it is likely that many physicians will conscientiously object to direct participation in assisted dying, in my view, they will have a moral obligation ‘to refer’ to another willing and able practitioner or at least ‘to inform’ requestors of a designated internet site and person who can provide detailed, practical information about how to access assisted dying practices throughout the province.

Respectively submitted by
Dr. Jeff Kirby, NSHEN/Dalhousie University



Featured Articles Coming Soon!

NSHEN is working on a new Featured Article resource, where we will be highlighting interesting and relevant articles from the recent health ethics literature. We recognize that many health care providers and administrators are too busy to wade through bioethics journals. So we will periodically choose an article of interest, develop and distribute a summary for for those too busy to read the entire publication, and make the article available for those who would like to read more. Of course, if you find an article that you think will be of interest to others, please send it our way and we will add it to the list!


Save the Date!

NSHEN's annual conference will be held October 21 & 22, 2015 at the Best Western Burnside (Dartmouth). The conference will explore ethics issues related to living at risk. More details will be provided soon.


National Health Ethics Week

Save the date! Next year's National Health Ethics Week will take place April 4-10, 2016.

Please contribute your ideas and share your feedback on this year's initiative by completing a short evaluation here:

For more info on National Health Ethics Week, please visit


Fireside Chats

NSHEN continues to post Fireside Chats online, with our most recent videos discussing "Difficult" Patients and Advance Care Planning. These short video discussions, accompanied by discussion questions and resource lists, were developed as education tools for ethics committees and health care teams.

You can view these videos at​

Tweet Tweet 

NSHEN is now on Twitter!

Give us a follow at:



Ensure You Are on NSHEN's Contact List

On July 1, 2014, Canada’s anti-spam legislation (CASL) came into effect. This new legislation prevents NSHEN from sending emails that promote a programme or resource with a fee (such as our annual conference) without express consent from the recipient.

To ensure you are on NSHEN’s mailing list to receive periodic notice of our resources and events, please contact Krista at or 902.494.4038 and indicate your request. You can, of course, unsubscribe at any time.

We hope you have found our communication helpful and informative and would like to continue providing these to you.

Table of Contents

Book Library

 NSHEN currently has a library of books that may be of interest to

Recent additions include: The Ethos of Medicine in Postmodern AmericaWhat Patients Teach: The Everday Ethics of Health Care and The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age.

 Please check our website for complete listing and contact the
 Administrator to arrange a book loan.

What Makes NSHEN Unique?

 While there are other  ethics networks and  centres across the  country, there are a  few features that  make NSHEN unique  within Canada.

 * Our collaborative    structure facilitates  dialogue between  partners

 * Our strategic goals  are collectively  established by the        collaborating      partners

 * NSHEN involves  academia,  government, and  health care  organizations in a  single network.This  results in a network  that is  innovative,  efficient, and  responsive to ethics  needs in Nova

You're receiving this newsletter because you have worked with or are a friend of the Nova Scotia Health Ethics Network.

For general NSHEN information contact the NSHEN Administrator directly:
Krista Mleczko-Skerry | (902) 494-4038
Want to change how you receive these emails?

Dept of Bioethics
Dalhousie University
5849 University Ave
Rm C313, CRC Bldg
PO Box 15000
Halifax, NS, B3H 4R2

This email was sent to <<Email Address>>
why did I get this?    unsubscribe from this list    update subscription preferences
Nova Scotia Health Ethics Network · 5849 University Ave · Rm C313, CRC Bldg, Po Box 15000 · Halifax, NS B3H 4R2 · Canada

Email Marketing Powered by Mailchimp