On April 14, 2016, Justin Trudeau’s Liberal government introduced bill C-14 “An Act to Amend the Criminal Code … (Medical Assistance in Dying)” in the house of commons, pursuant to the Canadian Supreme Court’s decision in Carter v. Attorney General of Canada, of February, 2015.
The law will make it legal for a competent adult with a “grievous and irremediable medical condition” to make a voluntary request and give informed consent to receive “medical aid in dying.” In the statute, a “grievous and irremediable medical condition” is defined as a “serious and incurable disease, illness or disability.” The person must be in an “advanced state of irreversible decline in capability” which causes “enduring physical or psychological suffering that is intolerable” and cannot be relieved in a way they find acceptable, and their natural death must be “reasonably foreseeable.” This is not a formal prognosis and sets no specific time limit. However the person must be informed of their reasonably foreseeable natural death.
Eligibility is determined by a doctor or nurse practitioner, with sign-off by a second doctor or nurse practitioner. The onus is on the person to be informed, and no provision is made to ensure communication access. The process by which decisional capacity is determined is not described.
The law allows for either euthanasia (performed by a doctor or nurse practitioner) or assisted suicide (a prescription the person can take at home). It also calls for a 15-day waiting period, unless the medical professional making the eligibility determination decides that the circumstances merit suspension of the waiting period. The application must be made in writing, and signed by two disinterested witnesses. However there is no restriction on who may write and sign the application on behalf of a person who is incapable of writing; thus an heir or employee of a nursing home could fill out the application for a non-verbal person, and their interpretation of the person’s wishes would probably go unquestioned.
The law allows an exemption for any person aiding a medical practitioner for actions in aid of assisted suicide/euthanasia (AS/E). Similarly, “No person commits an offence … if they do anything, at another person’s explicit request, for the purpose of aiding that other person to self-administer a substance that has been prescribed … as part of the provision of medical assistance in dying.” These exemptions apply “even if the person invoking the exemption has a reasonable but mistaken belief about any fact that is an element of the exemption.”
Some additional problems with the law:
- The “voluntariness” of the request relates only to “external pressure” not psychosocial conditions or “vulnerability.”
- There is no “vulnerability assessment” provided.
- There is no prior, external judicial review of the person’s eligibility for AS/E.
- There is no guarantee of palliative care or home care.
- There is no right of refusal for clinicians or organizations; no “safe spaces” for patients.
- (As in Oregon and Washington) lethal drugs left around the house could pose a danger to children or be sold on the street.
- The data gathering scope and process are not specified.
- The promises of the bill’s preamble are not fulfilled in the law.
Bill C-14 excludes persons under 18 years of age, and does not allow medical aid in dying by advance directive. The language of “decline in capability” and “reasonably foreseeable” natural death is meant to exclude people whose “suffering” is purely psychological. However the law provides that these three issues will be studied over the next five years to determine if the law should be amended to allow these practices and include these populations.
The bill is expected to go to second reading within the next week, then to the justice committee for hearings. If the bill is not passed by June 6, then the criminal code sections identified in the Carter case will simply cease to be in effect, creating an unstructured “right” to physician assisted death where virtually anything could happen.
The Euthanasia Prevention Coalition is calling upon local groups to organize rallies at the local offices of MPs (Members of Parliament) on April 27, and is planning a major event on June 1 in Ottawa.