When the Supreme Court of Canada's deadline for the federal government to pass legislation on medically-assisted dying passes at midnight, the grace period is over, and Canada will be without a law on the matter.
Bill C-14 is before Senate, where it is not expected to be put to a vote before Friday. The Liberals had hoped to have new assisted-death laws in place by Monday, but the legislation earned approval from the House of Commons only last Tuesday and has yet to make it through the Senate for final approval.
Senators voted Friday to send Bill C-14 to a committee on legal and constitutional affairs, which will weigh in on the divisive bill. However, the Senate has adjourned until Tuesday -- the day after the high court's deadline.
In the meantime, medically assisted dying is now legal in Canada, under the criteria issued by the Supreme Court and the medical regulators' guidelines in each of the provinces.
Doctors who specialize in end-of-life care fear being left in a legal grey area as of Monday, however.
Senators reviewing the legislation say it was not written in the spirit of the Carter decision -- the Supreme Court ruling that struck down the ban on assisted death. The court ordered the government to write a new law, and gave the feds until June 6 to do so.
Even in the absence of a new law, palliative care specialist Dr. Kevin Workentin, from Michael Garron Hospital in Toronto, is not expecting a flood of patients to begin asking for an assisted death.
In the 14 years that he's worked in palliative care medicine, he has only been asked five times to offer something to a patient to hasten their death. It was simply never a legal option to him before. While some doctors are very much against the idea, Dr. Workentin says he understands why some people grow tired of an extended death and want to end their suffering.
He supports giving patients another option in their end-of-life decisions but he doesn't think his own day-to-day work of caring for the dying will change much.
"It's a huge step forward for our nation, and the evolution of our appreciation for the rights of the individual鈥� but I think it is a small blip on the radar of what I think constitutes excellent palliative care," he says.
Down the hall, in one of the palliative unit's rooms is 83-year-old Jean Neuert, who is dying of colon cancer. She's been paying attention to the assisted dying debate and knows the choice is coming her way.
"I would make the decision for an assisted death if I had to," she says.
Neuert knows all about life and death decisions in medicine. She is a retired delivery room nurse who also worked in public health. She says she is thankful for having had a happy full life, and is staying cheerful despite her plight.
With her husband by her side feeding her chips of ice, she's happy to have the choice for an assisted death, but has no intention of asking for anything yet.
"At this point in time, I am not prepared in any shape or form to change what is going on, as long as I can handle the pain," she says.
She praises her palliative care team, saying they are a great help to her.
She says what's needed most in Canadian medicine is more good end-of-life care.
"This is part of health care," she says. "It's going to be growing, with the younger age coming up."
Physicians such as Dr. Workentin agree there isn't enough good quality palliative care in many parts of Canada. He says some regions in northern Ontario, where he's from, have only one hospice bed to serve thousands of kilometres and residents.
He hopes the attention on assisted death encourages Canadians to begin talking about what should constitute a good death.
"If it raises the profile of palliative care, that's awesome," he says.
"If this is a seed that provokes more of that to hit the airwaves, and reach the tables and living rooms of families, that's terrific."
As for the future of palliative care in Canada, palliative care specialist Karina Wulf at Toronto East General Hospital says she doesn鈥檛 expect to see assisted dying reduce funding for end-of-life care for patients.
鈥淚f anything, it strengthens the request for more funding for good pain and symptom management and good quality end-of-life care, because that is very often what individuals fear,鈥� Wulf said. 鈥淲ith this change in law, I think that the pressure will be on to support palliative care more.鈥�
She added that nurses could face difficult ethical challenges once the law is in place, particularly when it comes to navigating how patients come to the decision to end their own life.
鈥淭here are certainly risks 鈥� and it is important for us as teams to make sure that this is not a coerced decision, that it is not a decision that is based on financial means, but that it truly is for a person to end their life,鈥� Wulf said.
With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip
