Doctor-assisted dying must be available to rural communities says prof

Those drafting Canada's new assisted dying laws must consider those in the rural parts of this country, where there are often shortages of doctors and services.

Catherine Schiller says people should not have to travel to urban centres in order to die comfortably.

The nurse, former lawyer and assistant professor at the University of Northern B.C., says remote communities could struggle to implement the proposed legislation to legalize physician-assisted dying, which was tabled in a federal bill on April 14.

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"If you're entitled to a service, then it shouldn't be just a service that you can access if you happen to live — if you're in B.C [for example] — in Vancouver," Schiller told Daybreak North host Robert Doane.

Challenges for rural communities

"We really needed right from the top to have a government that was recognizing that not all of Canada is in the big centres.

We have a lot of people who live in rural or remote settings who need to have a framework … that's feasible to put into place, and it doesn't [require] somebody, who is in final stages of an illness and in tolerable pain, to travel all over the province or all over the country to find practitioners who will provide them with a service that they're legally entitled to have."

The first draft of Bill C-14 only includes some of the 21 recommendations from a parliamentary committee that was struck to study how physician-assisted dying could be implemented, but Justice Minister Jody Wilson-Raybould said there will be further study on the other proposals, and amendments could come down the road.

Limited number of doctors

One of the recommendations was that a request for this service could only be carried out if two independent physicians approved the patient.

Schiller said that while she believes this is a "reasonable safeguard", she wonders how it will work in all areas of the country.

"How do we do that in a rural and remote setting where many of these communities are lucky to have one practitioner who leads the framework most or all of the time?" she said.

"Or what about those communities where the framework is led by an RN, and not a physician? So now you may have to travel to two different independent practitioners to get approval for medical assistance in dying. It has the potential to put an added burden on people in the north."

An additional complication, Schiller said, is that the patient isn't supposed to have a personal relationship with the medical practitioner who they are asking to approve their wish for doctor-assisted dying — yet with few doctors around, that might not be possible.

"For some of these rural and remote communities, the line between personal and professional for the patient and the healthcare provider isn't necessarily as clear cut. It's not as firm of a line as you might get in a big centre where you have anonymity very easily."

With files from CBC's Daybreak North and Matthew Lazin-Ryder

To hear the full story listen to the audio labelled: Doctor-assisted dying must be made accessible in rural communities, nurse says