Policy and Political Action

Policy & Political Action

Federal Consultation on Legislative Options for Assisted Dying

The Registered Nurses’ Association of Ontario (RNAO) is the voluntary professional association representing registered nurses (RN), nurse practitioners (NP) and nursing students in Ontario. Our mandate involves speaking out for healthy public policy and we extend our gratitude to the Federal Expert Panel for a Legislative Response to Carter v. Canada for the opportunity to participate in the consultation underway.

Today, there are approximately 108,000 RNs and 2,700 NPs eligible to practise in Ontario. Nurses work in a diverse array of settings from public health units to hospitals and palliative care. We are among the public’s most accessible health professionals and are regarded as the most trusted health profession. We have a strong interest in participating, as expert leaders, in a dialogue regarding assisted death.

RNAO has been a leading voice in advancing a national dialogue on end-of-life issues, including assisted death. In 2014, our membership voted, with a large majority in favour, for a resolution that called for a national public dialogue on end of life care inclusive of assisted death and procedural safeguards to mitigate risk (Appendix A). This has been followed by four webinars attended by more than 1,000 RNs, NPs, other health providers and the public. In addition, we organized a live panel facilitated by renowned reporter Carol Goar from the Toronto Star and attended by 580 people at our 2015 Annual General Meeting to discuss perspectives related to this issue.

RNAO also has expertise in end-of-life care, which is evident through our clinical practice guideline End-of-Life Care During the Last Days and Hours. This guideline, which is used extensively by service and academic settings in Canada and abroad, was steered by an expert panel and produced through a systematic review of the literature and extensive stakeholder consultation. The clinical questions addressed by the guideline include:

  1. What knowledge and skills do nurses require to identify and assess individuals and families during the last days and hours of life?
  2. What knowledge, skills and tools do nurses require to support individuals and their families in making informed choices during the last hours and days of life?
  3. What palliative interventions are needed to address the experiences faced by individuals and their families during the last days and hours of life?
  4. What supports are needed to assist nurses in providing high-quality care in the last hours and days of life?/li>

Nurses want to ensure that all Canadians have access to quality publicly funded and not-for-profit palliative and end-of- life care in all reaches of the nation. In response to the 2015 Canadian federal election, RNAO released a policy platform: Why Health Matters.

There are two key recommendations from the platform that are relevant to this submission:

  1. create a national palliative care strategy that provides universally accessible services across the country
  2. develop a principled regulatory framework to implement the Supreme Court of Canada’s decision on assisted death

While beyond the scope of the panel’s review, the present context provides an opportune time to consider how the delivery of palliative and end-of-life care can be enhanced in Canada. RNs and NPs are leaders in the delivery of palliative and end of life care and their full utilization can transform access to quality services for Canadians. In addition, overcoming structural barriers, enhancing provider competency and evidence-based practice will advance person-centred care across the lifespan.

Summary of Recommendations:

Recommendation #1: The Government of Canada create a national palliative and end-of-life care strategy that provides universally accessible, equitable, publicly funded and not-for-profit services across the country.

Recommendation #2: The Government of Canada co-lead, with the provincial/territorial governments, the development of a principled regulatory framework to implement the Carter decision, inclusive of broad public and health professional consultations.

Recommendation #3: The principled regulatory framework clearly articulates and respects the particular parameters that fall within each jurisdiction.

Recommendation #4: The principled regulatory framework includes a registry with clearly defined criteria, and a national tracking system that receives consistent data from the provinces/territories on assisted death.

Recommendation #5: A report on assisted death be issued publicly, by the Government of Canada, on an annual basis.

Recommendation #6: The Government of Canada and provincial/territorial governments enact policy that is reflective of health professional-assisted death, involving registered nurses (RN) and nurse practitioners (NP).

Recommendation #7: No health professional or institution should be forced into providing assisted death, however, in cases of conscientious objection, there is an obligation to refer people to an appropriate alternate setting to receive service.

Recommendation #8: Health system planners must ensure access to assisted death services locally across the country.

Recommendation #9: The Government of Canada enact legislation that protects physicians, RNs, NPs and other health professionals from criminal prosecution when acting within their scope of practice and providing assisted death services.

Recommendation #10: The Government of Canada and provincial/territorial governments support efforts to develop health professionals’ competency related to assisted death through the creation of interprofessional education and clinical practice guidelines.

Recommendation #11: Provincial/territorial health professional regulators develop practice standards related to assisted death to promote quality, safety and accountability.

See the full submission with references below.

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