Not all physician assisted death policies are created equal: Assessing some practical and ethical implications of policy options for medical assistance in dying

Daryl Pullman1

1Faculty of Medicine, Memorial University, St. John’s, Canada

Canada introduced legislation to legalize medical assistance in dying (MAiD) in June of 2016. In the same month the state of California passed the “End-of-Life Option Act” that now permits physician assisted suicide in that state.

Although California and Canada have approximately the same size populations (California @ 38 million; Canada @36 million) the two jurisdictions have had vastly different experiences with rolling out their respective end-of-life legislations. In California, between June and December 2016, 258 individuals began the end-of-life option process, 191 individuals were prescribed aid-in-dying drugs, and 111 were subsequently reported by their physicians to have died after ingesting the drugs. For a variety of reasons Canada does not currently keep detailed statistics on how many individuals initiate the MAiD process, although the number of deaths resulting from MAiD is reported by each province. For a comparable period of time (January – June 2017) there were 1,179 deaths due to MAiD in Canada (effectively 10 times as many deaths as in California).

In this presentation I discuss some of the reasons for the dramatic differences between physician assisted suicide as it is offered in California, and MAiD as it is practiced in Canada. A significant part of the explanation hinges on the availability of the ‘oral protocol’ (i.e. the ingestion of a lethal prescription by the patient) as opposed to a lethal injection administered by a physician intravenously. California’s legislation permits only the oral protocol. In Canada, the province of Quebec permits only lethal injection. Other provinces in Canada permit either lethal injection or the oral protocol, although the vast majority of deaths occur via lethal injection.  We will consider some of the practical and ethical implications of either policy as it pertains to the matter of patient choice.

Biography to come.