Special Parliamentary Committee on Medical Assistance in Dying
Testimony of Not Dead Yet (USA)
May 9, 2022
Not Dead Yet (USA) is a national disability group formed in 1996 to organize and give voice to disability rights opposition to legalization of assisted suicide and euthanasia. Over the succeeding 26 years, similar groups have formed in other countries, including Canada.
Disability advocates in the U.S. who learn of Canada’s C-7 law are shocked and horrified that Canada is euthanizing disabled people who are not at all near death but despair over the countless forms of discrimination and societal neglect that they face on a daily basis. The earlier Bill C-14 was bad enough with its eligibility based on the ridiculously vague criterion of “reasonably foreseeable natural death.”
We have gratefully followed the conscientious work of our sister organization, Toujours Vivant-Not Dead Yet (TVNDY) and the Council of Canadians with Disabilities (CCD). In 2015, they made detailed recommendations designed to eliminate disability discrimination as a causative factor in requests for assisted suicide, and to separate eligibility assessment and provision of assisted suicide from medical care. Among other things, CCD called for prerequisite psychosocial evaluations, “culturally competent”[1] mental health services, palliative care and home-based services to prevent institutionalization, and rigorous safeguards. Their recommendations reflect concerns that we share in the U.S. and point to the crushing prevalence of disability discrimination that must be stopped:
- Canada must meet its obligations under the United Nations Convention on the Rights of Persons with disabilities.
- A detailed psycho-social evaluation to assess undue influence, coercion, abuse, economic or family pressures or any other external factors that could affect the desire to live.
- Provision of the necessities of life, a reasonable standard of living, the means and supports to live independently and participate in their community.
- Receipt of state-of-the-art pain relief, symptom management, and other palliative care.
CCD also recommended critical methods of oversight and accountability including but not limited to establishing an oversight body whose responsibilities include:
- Administrating the program at the national and provincial levels, setting standards for procedures and contracted employees.
- Collecting demographic information.
- Keeping a public registry of all physicians and members of other professional colleges who are involved in providing assisted suicide.
- Keeping records and statistical reports of requests for assisted suicides (including those which are approved, refused or withdrawn).
- Creating a mechanism for families and others to trigger an investigation where a person has died due to what appears to be an illegal act of medical homicide.
- Conducting periodic randomized studies of death reports to verify that medical killing is not happening outside the scope of the law.
- Working with local law enforcement to follow up on problems.
Bill C-14 does not constitute a carefully-designed system as required by the Canadian Supreme Court.[2] In order to better protect disabled people, parliament must remove provisions in Bill C-14 that create broad exemptions for acts done by doctors, nurses, or anyone “aiding a medical practitioner” in providing medical assistance in dying, even if they act under “a reasonable but mistaken belief” about the facts of the case. This is especially dangerous given the prevalence of negative bias about disabilities among doctors. In a U.S. study published in 2021,[3] 82% of American doctors surveyed said disabled people had worse quality of life than non-disabled people.
In addition, several of the safeguards included in Bill C-14 are compromised by subjective and indeterminate standards of compliance. Rather than requiring medical practitioners to provide objective evidence of a person’s eligibility, they need only “be of the opinion” that the person meets all eligibility criteria. In addition, the medical practitioner need only “be satisfied” that the person has signed and dated the request before two independent witnesses,[4] and that the second medical practitioner who confirms eligibility is independent.
Bill C-14 bases its capacity requirement on a person’s ability to make “health care decisions,” an insufficiently rigorous standard given the life-or-death nature of the decision to accept assisted suicide or euthanasia. Most “health care decisions” require choosing between treatments which a) are designed to be curative or palliative, and b) may be interrupted or reversed if they do more harm than good. On the other hand, the decision to prematurely end one’s life has no curative or palliative function and is irreversible. In its 2015 recommendations, CCD suggested creating a new legal standard for capacity to accept assisted suicide that reflects the irrevocable nature of these life-ending decisions. This standard would include a formal assessment by a psychiatrist or psychologist trained to assess not only the person’s abilities, but the presence of factors which might impair those abilities, or influence a person’s mood, outlook, judgment or desire to live, as well as interpersonal or socio-economic factors that may influence the decision-making process.
These recommendations from TVNDY and CCD seem to be the bare minimum required to create protections for people with disabilities within the horrific framework of C-14 and C-7. As reported in Canadian news outlets[5], disabled people are already euthanized due to lack of housing and other basic supports to live. Some may try to portray this as “compassion”, but to us it looks like contempt.
[1] In the context of mental health care for people with disabilities, “culturally competent” means care that recognizes the political, social and economic status and discrimination faced by disabled people. See Artman, L. and Daniels, J., Disability and Psychotherapy Practice: Cultural Competence and Practical Tips, October 2010, Professional Psychology Research and Practice 41(5):442-448, DOI:10.1037/a0020864, https://www.dropbox.com/s/pwx6me61w8z7yak/ArtmanDaniels-Dis-Cult-Compet-2010.pdf?dl=0
[2] Carter v. Canada (Attorney General), 2015 SCC 5 (CanLII), [2015] 1 SCR 331, <https://canlii.ca/t/gg5z4>
[3] Iezzoni, Lisa I., et al, “Physicians’ Perceptions Of People With Disability And Their Health Care” Health Affairs 40:2, 297-306, February 2021https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.01452,
[4] The number of witnesses was reduced from two to one in Bill C-7, which received royal assent on 2021-03-17.
[5] Woman with disabilities nears medically assisted death after futile bid for affordable housing, CTV News, April 30, 2022, https://www.ctvnews.ca/health/woman-with-disabilities-nears-medically-assisted-death-after-futile-bid-for-affordable-housing-1.5882202