The Canadian Medical Association suggests there should be a 14-day period to allow patients who want the help of a physician to end their lives to reconsider whether they are making the right decision.

The CMA has unveiled its guidelines for how it thinks doctor-assisted dying should work in Canada once the procedure becomes legal early next year.

Last February, the Supreme Court struck down the laws banning doctors from assisting a patient die who is enduring intolerable suffering. The court stayed its decision for a year, giving the federal government until Feb. 15, 2016 to draft replacement legislation.

With that deadline less than four months away and with no new legislation imminent, the CMA has drafted its own recommendations for any forthcoming legislation.

It recommends a system in which patients would have to make at least two oral requests for a doctor’s help with dying, and allow a “cooling-off period” of 14 days between requests.

The patient would also need to submit a written request for assistance with dying. The patient’s doctor would assess the request and ensure the patient is mentally capable of making an informed decision and giving consent to assisted dying. The physician would also have to assess whether the patient’s decision had been made freely, without coercion from family members, health-care providers or others.

The attending physician would need to ask a second, independent physician to also assess the patient for capacity and voluntariness. Both physicians would need to agree that the patient meets all the criteria in order to proceed.

The patient would also have to be informed that they could rescind their request at any time. The aim is to protect both the patient and the doctor, according to CMA’s president Dr. Cindy Forbes, in an interview with CTV News from Halifax.

“It’s a process that is meant to protect the vulnerable and to make sure there is a process in place so things happen consistently and in a patient’s best interests,” she told CTV News.

Under the CMA’s new recommendations, doctors would not be obligated to fulfill requests for assisted dying if they had moral opposition. But they would be expected to provide the patient with complete information on all options available to them, including assisted dying, and advise the patient on how to access any other services, such as counselling.

But not everyone agrees Doctors can “opt out” of providing their patient with an assisted death if they ask. University of Ottawa Law professor Amir Attaran has been reviewing Canadian law for a manuscript submitted for publication.

“You can’t say, ‘I object to giving a particular patient medical care that he or she needs.’ That’s discrimination; that’s illegal,” said Attaran.

“In the vast majority of legal cases that looked at doctors and conscientious objection, the judgement has gone against the doctors. And most of the doctors’ thinking on getting conscientious objection is wishful thinking, it is legally ignorant, and the CMA’s guidelines unfortunately is worse than nothing,” said Attaran.

He cited the case of a doctor in B.C. who said he would not provide fertility services to lesbians because it offended his conscience to do so.

“The decision was labelled discriminatory by the court, and predicted that if doctors actually follow the CMA guidelines to object, they could well be sued,” said Attaran.

“The doctor must take care of the patient’s needs not the doctor’s needs,” he added.

It illustrates the uncertainty and confusion over assisted dying in Canada still must be clarified.

Dr. Forbes, meanwhile, hopes to see national standards for assisted dying, rather than a collection of provincial and territorial regulations that won’t serve patients across the country equally.

“We don’t want to see a patchwork of different regulations and legislation across Canada. So I think this helps to focus the discussion,” she said.

Earlier this year, the CMA invited its 80,000 members to participate in an online survey about assisted death. Of the 1,407 members who responded, 29 per cent said they would consider providing assisted dying, while 63 per cent said they would not, the CMA reported.

With a report by CTV’s medical specialist Avis Favaro

CMA Guidelines for Assisted Dying