As the Senate wrestles with new legislation around medically assisted death, physicians are protected against criminal prosecution, but the situation is less clear for the pharmacists and nurses they need to help them carry out the procedure.

"The only thing to us that's clear right now is that everything's super unclear," said Joelle Walker, director of government relations for the Canadian Pharmacists Association.

Senators are reviewing Bill C-14 on assisted dying and making amendments, meaning it will have to return to the House of Commons for another vote. In the absence of a new law, a Supreme Court ruling (Carter vs. Canada) came into effect after the government missed a June 6 deadline, allowing doctors to provide assisted dying for some patients with "grievous and irremediable" medical conditions.

'Doctors cannot do this alone'

But although the ruling legally protects physicians in assisted dying cases, it makes no such reference to pharmacists or nurses.

As it's worded now, Bill C-14 would provide legal protection for nurses and pharmacists participating in assisted dying procedures, as well as allow qualified nurse practitioners to take on the same role as a physician.

But until Bill C-14 becomes law, nurses are left "in limbo and by extension, it puts Canadians in limbo," said Doris Grinspun, CEO of the Registered Nurses' Association of Ontario.

Without legal protection, nurses can't even talk about assisted dying if their patients raise it with them, says Doris Grinspun, CEO of the Registered Nurses Association of Ontario. (Josh Lynn/CBC)

"Doctors cannot do this alone," said Grinspun. "I don't know how they can do this procedure without protecting [registered nurses] that stand next to the patients ... without protecting the pharmacists that prepare the medications."

That lack of protection needs to be addressed immediately, said Maureen Taylor, a former CBC health reporter who became a physician assistant and a prominent advocate for medically assisted dying in Canada.

Her late husband, microbiologist Dr. Donald Low, was suffering from brain cancer when he appeared in a video pleading with Canada to allow assisted death in 2013.

Taylor, who co-chaired the provincial/territorial expert advisory panel on assisted dying in Canada, said she is particularly concerned that physicians can't provide assisted dying without the help of pharmacists.

"One thing doctors can't do is walk into the pharmacy and just start taking drugs off the shelf," she said.

Physicians willing to participate in assisted death are "not uncomfortable in the absence of legislation," Taylor said. "What does make them frustrated is that they can't get their hands on the medications because the pharmacists aren't protected."

'No prosecution' directive in 3 provinces

Some provinces are enacting their own legal protections for pharmacists and nurses, who are provincially-regulated, in the absence of federal legislation. As of Friday afternoon, justice officials in Alberta, British Columbia and Newfoundland and Labrador had issued directives not to prosecute health-care workers involved in medically assisted deaths.

"No prosecution ... will be commenced or continued against physicians or any member of the health care team including pharmacists, nurses, other health professionals or their respective employers, who dispense a drug, provide physician-assisted death, or otherwise participate, under the direction of a physician, in a PAD [physician assisted death] that falls within the parameters described by the Supreme Court of Canada," said the directive issued by Newfoundland and Labrador on Thursday.

Pharmacists are dealing with a 'hodgepodge approach' across the country to legal protection if they help a physician provide assisted dying. (Canadian Pharmacists Association)

But those directives don't protect those working in other provinces and territories, leading to a "hodgepodge approach across the country," said Walker, noting that pharmacists in many areas will have to seek out their own legal advice if faced with an assisted dying case.

What's needed, Walker said, is a federal legal "framework" to help ensure consistency in all provinces and territories.

"While it may not be a lot of numbers ... there are still people who are going to request assisted dying," she said. "We need to have a sort of a system in place and process to help them get the access that they need."

Where there's no legal protection, patients can't even broach the subject of assisted dying with their nurses, Grinspun said, noting that "registered nurses are the ones that are in the most contact with people, period."

"They cannot even talk with patients about this now," she said.