The expert panel goes beyond the Supreme Court’s ruling by recommending “nurse practitioners, registered nurses and pharmacists will need to be involved in the process of physician-assisted dying.” It also recommends the new regime include “both physician-administered and self-administered physician-assisted dying.”

In a self-administered scenario, patients could ask for a prescription months or even years before they decide their medical condition has become unbearable and then take the life-ending dose. There would be no assessment for competence or other qualifying conditions. The Supreme Court’s Carter decision spoke only of termination of life for those who already have a “grievous and irremediable medical condition that causes intolerable and enduring suffering.” The court also requires an assessment of the patient’s competence and some way to ensure the patient hasn’t been pressured into the decision to end their life.

The provincial-territorial panel’s report gives three options for doctors and nurses who hold that ending a life violates their conscience.

“Conscientiously objecting health care providers should be required to either provide a referral or a direct transfer of care to another health care provider or to contact a third party and transfer the patient’s records.”

The “third party” option presumes that provinces have set up a central referral agency that would assign cases for assessment to non-objecting doctors and institutions. This option is preferred by the Canadian Medical Association, the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians’ Societies and Canadian Physicians for Life. All of the Catholic organizations object to providing a direct referral.

For nurses who have suddenly been thrust into the debate on assisted suicide, there are still plenty of questions about their role and their ability to opt out.

“Policies surrounding physician-assisted dying will impact all direct care providers, including registered nurses,” said St. Elizabeth Health Care spokeswoman Madonna Gallo.

St. Elizabeth provides home health care, including home-based palliative care. There are no specific recommendations from the provincial-territorial expert panel that cover home care provided by a Catholic organization.

“St. Elizabeth is committed to ensure the availability of high quality hospice and palliative care services in the community, including our investment of $1 million to strengthen end-of-life care this year,” said Gallo in an e-mail.

For Catholic hospitals the challenges will also be considerable, Mike Shea, president of the Catholic Health Alliance of Canada, told The Catholic Register.

“Faith-based institutions must either allow physician-assisted dying within the institution or make arrangements for the safe and timely transfer of the patient to a non-objecting institution,” the panel recommends.

The panel also wants provinces to prohibit Catholic hospitals from requiring their doctors not offer physician-assisted suicide when outside the hospital. Catholic hospitals and nursing homes also should not be able to refuse patients who before admission express a desire to be euthanized. The panel also wants all institutions to be required to inform their patients and residents of “any institutional position on physician-assisted dying, including any and all limits on its provision.”

“Physician-assisted death, by virtue of the Supreme Court decision, is going to be available in Canada. We need to figure out a way to work within that,” said Shea.

Shea was glad the report at least acknowledges that Catholic hospitals, nursing homes and hospices simply can’t facilitate voluntary euthanasia.

“The issue is, how is the system going to work around that?” he said. “That’s what we’re working with right now.”

With the final report of a federal panel soon expected on assisted suicide and the federal government’s application for a six-month extension on the deadline for legislation still pending, the CHAC has a lot of lobbying and persuading to do, said Shea.

“Catholic health organizations and individual providers will need to be active in dialogue with government on those provisions,” he said.

The federal expert panel will not make specific legislative or policy recommendations. The federal report will summarize feedback the panel has collected over the last six months. That leaves the provincial-territorial recommendations as the only input on regulation.

Those recommendations include
- no arbitrary waiting or reflection period after a euthanasia request;
- no lower age limit;
- death certificates to indicate “physician-assisted death” and list an underlying medical condition as cause of death;
- no euthanasia to be administered on the authority of a substitute decision maker;
- no requirement that a physician be present at a self-administered assisted death;
- unlimited ability for patients to ask other doctors after one doctor judges the patient has failed the competency test;
- euthanasia only offered to patients enrolled in publicly funded health insurance plans;
- two doctors must sign off on physician-assisted suicide;
- assessments by video conference to be allowed in areas where there are few doctors;
- a pan-Canadian commission on end-of-life care to provide oversight.