On June 6, 2016, the legal ban on physician-assisted dying expired allowing Canadians to legally access assisted dying under the guidelines outlined in the Supreme Court of Canada's ruling in the Carter case. Carter v. Canada was a landmark case that successfully challenged the prohibition of assisted suicide as being contrary to the Canadian Charter of Rights and Freedoms. The outcome: Canadian adults who are mentally competent, suffering intolerably and enduringly have the right to a doctor's help to end their life.
What does this mean for Canadians and what are the implications for drug costs? There are still a number of grey areas in this emotionally charged and controversial topic as well as questions regarding what drugs might be used to facilitate medically-assisted dying.
Since June 6, our country's doctors, nurses and pharmacists may be called upon to help people end their lives. Many of these healthcare practitioners may be reluctant or unwilling to provide this type of medical assistance and they aren't required to do so if they so choose. It is apparent there remains a lot of uncertainty and a lack of clarity regarding who is eligible for medically assisted dying. In some provinces, two people must witness the signature of the patient and in other provinces, no such witnessing is necessary. Other examples allow people with mental illness as their only cause of suffering to be eligible whereas this is not a sufficient reason for medically assisted dying in other provinces.
There is also much debate at the Senate level of our government as some say that Bill C-14 does not comply with the Supreme Court ruling in that it contravenes the Canadian Charter of Rights and Freedoms. Opponents say that the bill restricts access to people who are already near death. At present, Bill C-14 prohibits people with a severe chronic illness such as Alzheimer's, Huntington's disease and Multiple Sclerosis their right to die because their death is not considered imminent.
What are the drugs? Physicians, provincial health ministries, pharmacists and private insurers are trying to sort out the answers related to what specific drugs will be needed to painlessly and humanely end a patient's life and honour their request to die with dignity. At present, oral drugs that could be taken by eligible people are not available in Canada. A barbiturate, pentobarbital, is a drug approved in Canada for this purpose, but the cost of a single dose, if it can be obtained by the company who sells it, is $23,000. Its is not known if pharmacies dispense drugs prescribed for medically assisted dying and therefore it isn't possible for private insurers to confirm payment of these drugs.
Who administers the drug? Currently, doctors who agree to help with medically-assisted dying must administer the lethal medications.
Who pays? It is believed that the provinces will cover the cost for the lethal prescriptions but this has yet to be confirmed by all provinces. In Quebec, the price tag for euthanasia drug kits is covered by the province. Ontario has said it will support covering the cost as well.
Bill C-14 and the topic of medically-assisted dying is fraught with controversy for our nation, our elected officials, and the medical community. We continue to monitor this topic to ensure we're able to offer our clients the most informed support and guidance. Please contact us for additional information and resources. We're here to help so you can focus on what you do best.
Dave Dickinson, B.Comm, CFP, CLU, CHFC
Experienced Benefits Specialist ready to optimize your group benefits and pension plans.