College Disciplinary Decisions
Natural death has become reasonably foreseeable
On February 13, 2018, the College of Physicians and Surgeons of British Columbia (CPSBC) Inquiry Committee issued a Final Disposition Report on a complaint submitted by the Chief Medical Officer and Coroner, BC Coroners Service, about medical assistance in dying for a Ms. S “to ensure that the eligibility criteria for medical assistance in dying were met.”
The Inquiry Committee concluded that “a patient cannot be forced to take treatment they do not consider acceptable, i.e., patients seeking medical assistance in dying retain, as do all competent patients, right of refusal. It was determined that Ms. S met the requisite criteria and was indeed eligible for medical assistance in dying, despite the fact that her refusal of medical treatment, food, and water, undoubtedly hastened her death and contributed to its ‘reasonable foreseeability’. Given the above, the Committee agreed that Dr. Wiebe acted in compliance with the College’s standard in all respects.”
Reflections on the significance of this decision are available here.
Providing MAiD in an institution that prohibits MAiD
On October 16, 2017, a physician administrator (Dr. Keselman) from the Louis Brier Home and Hospital, an Orthodox Jewish long-term care facility submitted a complaint to the College of Physicians and Surgeons of British Columbia (CPSBC) against Dr. Ellen Wiebe, a medical assistance in dying (MAiD) provider. He alleged, that: “despite knowing that the organization did not ‘allow’ MAiD, Dr. Wiebe completed the MAiD procedure on a resident (the “Patient”) of Louis Brier. You [Dr. Keselman] further advised that Dr. Wiebe failed to communicate with nursing staff resulting in inaccurate documentation in the Patient’s chart.”
On July 5, 2019, the CPSBC sent its decision about the complaint to Drs. Wiebe and Keselman. The Inquiry Committee concluded that Dr. Wiebe had not breached College standards. It found that:
- “Louis Brier’s policy on MAiD was published to its website after Dr. Wiebe provided MAiD to the Patient at Louis Brier”
- “Individual patient rooms at Louis Brier, where the Patient was residing, are multidenominational”
- “there is no handover of care between health care providers required for a patient after death… Dr. Wiebe was aware that her treatment of the Patient was complete following the provision of MAiD and that there were no further requirements, including communicating with nursing staff.”
This case is not binding precedent. Other Colleges of Physicians and Surgeons across Canada could make different decisions when confronted with a similar case. In addition, such decisions are very fact-dependent. It isn’t clear what the decision would have been had the Louis Brier policy been posted on the website prior to Dr. Wiebe providing MAiD (although she did know of the institution’s “rules” at the time), had the individual rooms not been multidenominational, had Dr. Wiebe required privileges to see the patient in the institution, or had Dr. Wiebe been under contract with the institution.
But this decision does stand for the position that in BC, where there is no publicly available institutional policy, where the physician does not need privileges to see patients in the institution, where the physician is not under contract with the institution, and where the individual rooms are multidenominational (or the institution itself is not denominational), a physician can provide MAiD in the institution even if told the institution does not “allow” MAiD on its site and that physician need not advise the nursing staff or any other part of the institution in which MAiD occurred.
MAiD and dementia
In January 2017, the Chief Medical Officer for the British Coroners Service wrote to the British Columbia College of Physicians and Surgeons raising questions about the provision of MAiD to
an individual with dementia as her sole underlying medical condition, specifically whether she had a grievous and irremediable medical condition. The College concluded that “Ms. Wilson’s
diagnosis was appropriately considered, and met the criteria for MAiD as specified in the legislation.”
Reflections on the significance of this decision are available here.
