Assisted dying in Canada became legal in April of last year, which was a blessing to many who were suffering from a terminal illness with no possibility for a cure or relief from their pain. It’s a tough decision for a person to make – to give up on life and find a way out – and many do not want others to know that they made the decision to leave, for fear that choosing assisted suicide will leave a permanent stigma on their legacy. It can also be painful for those left behind to know that someone chose to leave this Earth, even if they were suffering.

Although the details are still being sorted out about the legal ramifications of assisted dying and circumstances under which someone can make that decision, many wonder what will be listed on the Manitoba death certificate. There is mandatory monitoring of what types of chronic conditions warranted assisted death and which do not. Although the disease itself would eventually have led to a person’s demise, if there was a physician-assisted death, should that be added to the death certificate or should the underlying condition be the reason that someone officially died?

There are many who are opposed to putting “physician-assisted” death on the Canadian death certificates, because some patients don’t want their family to know about their decision. In the same manner, many physicians – although they want to grant their patient mercy – do not want to be listed as the cause of their death. There is also the potential that if physician-assisted death is the official cause of death, the insurance company might try to deny death benefits since suicide is excluded under most life insurance policies.

A paper published in the Canadian Medical Association Journal argued not only that physician-assisted dying should be listed on the death certificate, but that it should be with the pre-existing condition that would have led someone to be suffering so much that they would no longer want to live.

The reason for this is that if there is no real tracking of assisted dying, then there is no way to know when it is being used officially, which can lead to a host of moral and legal questions that might complicate the entire system. Other places that allow assisted death, like Belgium, Oregon, and the Netherlands, have a commission that reviews the number of cases every five years to ensure that it is still a good practice and to monitor assisted-death incidents to make sure that they are justified and warranted.

For now, Ottawa is still considering whether or not mental illness is a condition for which someone can choose assisted dying. It is difficult for someone to make the decision not to live anymore if they aren’t even aware of the consequences or their surroundings to begin with. If you allow those who might not have the mental capacity to choose physician-assisted dying, then it is easy to see how the system might become fraught with corruption.

When physicians were polled, many don’t agree with helping someone take their own life. Only about 30% of those surveyed felt comfortable with assisting in a patient’s death. After all, many of those professionals chose medicine as a career to help preserve life, not to take it. So for now, the cause of death is listed as whatever illness predisposed someone to want to die, like cancer or MLS.

But there is still no standard in place, and until there is, assisted dying will remain an uncertain practice that can come with some severe moral implications and even more emotional ones. The decision of life or death is hard enough for someone who isn’t facing the inevitable. For someone who knows the end is coming, assisted dying can be a welcome blessing. But the government needs to ensure that it isn’t ever a curse for those who don’t have the capacity to make that choice through tracking and monitoring. The best setup for the system has yet to be determined.