A B.C. Supreme Court ruling allowing a terminally-ill woman a medically-assisted death has not opened the door to participation by nurses, the College of Registered Nurses of B.C. said Monday.
Instead, college registrar and CEO Cynthia Johansen said the ruling, which allows two nurses to help a doctor in an assisted death, applies only to two unnamed nurses. As well, the ruling offers no immunity from disciplinary action should the college receive a complaint about their professional conduct.
Ellen Wiebe, a B.C. physician who has been outspoken about her willingness to help terminally-ill people die, said the college is intimidating nurses who want to help.
On Friday, the court granted an injunction allowing for a medically-assisted death to a patient with advanced multiple sclerosis
. Chief Justice Christopher Hinkson banned the identification of the patient, as well as two nurses and two pharmacists who offered to help Wiebe perform the procedure. The publication ban doesn’t include Wiebe, who became the public face of physician-assisted dying in February when she was given legal permission in Alberta to help a Calgary woman die.
Johansen said the B.C. court ruling helped confirm “the courts are open to recognizing the critical role of nurses.”
But she said the college has not changed its advice to nurses to seek legal advice when approached to help with a medically-assisted death. Until the federal government clarifies the role of medical practitioners around assisted dying, nurses could be exposed to liability and professional sanctions, she said. The Supreme Court of Canada has given the Justin Trudeau government until June 6 to craft a law regulating assisted dying.
“It is extremely helpful to have this current (B.C.) court order. Even if we don’t know the two nurses involved, it provides some degree of understanding for the regulator about how things may proceed on June 6 or later,” Johansen said.
The college needs to change its views on the issue, Wiebe said. “I have nurses who are willing to help but are being told they could be sanctioned.”
Health authorities also appear to be punishing nurses if they offer information to people seeking to end their lives, Wiebe said.
She cited a case of a home care nurse on Vancouver Island who was suspended with pay last week by the Vancouver Island Health Authority after she looked up information for a terminally-ill woman.
The nurse, Emily Mulleda, told The Vancouver Sun she did so after a palliative care doctor she was with during a home hospice visit refused to give the woman help or advice on physician-assisted dying, other than to say she should consult a lawyer. She did not identify the patient or her location, other than to say it was on Vancouver Island.
Mulleda said that after the doctor left, the patient asked her to search the Internet for some reference sites. One of those they located together was the Hemlock Aid Society, the group involving Wiebe.
“I thought this was great information because the doctor clearly said he didn’t know where to offer information to her and he wasn’t going to go there (to assisted death),” Mulleda said.
The patient asked Mulleda to leave a message on the Hemlock Aid voicemail system, and promised to follow up with an email. The nurse helped the patient install a FaceTime app on her laptop.
Wiebe said she later had a FaceTime interview with the woman without the presence of Mulleda, and subsequently spoke to the patient’s family and a lawyer. She said she was appalled to discover Mulleda was subsequently suspended by the health authority.
“She did everything correctly. She should have referred the patient to a doctor and she did so.”
Mulleda said a clinical nursing supervisor claimed she had breached practice standards, compromised her licence and was “clearly aiding and abetting a suicide.” Mulleda broke down in tears as she relayed what happened.
“My whole background, my whole life has been all about hospice and palliative care,” she said. “There are some times in your life when somebody is drowning that you have to do something and this is one of those situations. I did not provide any drugs or a way for this client doing so. She is clearly looking for information. I have done this to provide information for her to make her own decisions.”
Mulleda said she has contacted a labour relations officer with the B.C. Nurses’ Union. Officials from both the union and the Vancouver Island Health Authority were not available to comment. In a brief email, the health authority said it does doesn’t comment on “circumstances related to specific staff,” but it is aware a person was suspended with pay and is reviewing the situation.
Johansen said she wasn’t familiar with the Mulleda case and couldn’t speak to it specifically. But she said it exemplifies “the ambiguous, ethereal, grey area” nurses find themselves in without clear professional standards around assisted dying.
“Because the law has not changed, and really any of these instances are related to very specific, unique circumstances, it would behoove the college to be appropriate in reminding and encouraging nurses to understand the current legal framework has not changed,” she said.