When Is Palliative Care Murder?

The Baby Boomer demographic accounts for one-third of the Canadian population and is fast approaching retirement. The Canadian Health Care System has seen its share of legal challenges but the issue of end of life care is deserving of greater attention in the coming decade.

In the medical profession, Palliative Care is commonly used as a method to reduce the suffering an ill patient may experience. When implemented, the patient’s quality of life and level of comfort is intended to improve. This is common in situations where a patient is living with or dying from a terminal disease. Some examples of Palliative interventions include pain medication, sedation, anti-nausea medication, and oxygen treatments amongst a host of others.

Palliative Care interventions can be fatal in some situations because the drugs used specifically to block pain or relax muscles may also restrict respiration leading to death. Even when dosage increases are administered cautiously, the impact on respiration is not always certain.

Palliative Care is a relatively recent medical practice and lacks proper rules and regulations to govern it. Because some Palliative interventions are considered potentially life shortening, healthcare providers deserve clear and consistent rules to maintain consistency across the board.

The law in Canada is clear that assisted suicide is illegal as upheld by the Supreme Court of Canada in Rodriguez v. British Columbia (Attorney General). However, in the very same case, it was stated that potentially life-shortening palliative interventions are legal. The Supreme Court states:

The administration of drugs designed for pain control in dosages which the physician knows will hasten death constitutes active contribution to death by any standard. However, the distinction drawn here is one based upon intention…in any case of palliative care the intention is to ease pain, which has the effect of hastening death… . In my view, distinctions based upon intent are important, and in fact, form the bases of our criminal law. While factually the distinction may, at times, be difficult to draw, legally it is clear.

From this decision, it would seem that the intention of the physician is what is important in determining whether the intention was to end life or alleviate pain. What remains unclear is at which point are the risks of death so great that continuing with Palliative Care would constitute assisted suicide.

Over time, this will hopefully be clarified by the courts or Parliament.

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