Five years after assisted dying was legalized in Canada, lawmakers are preparing to overhaul the system that has allowed thousands of Canadians to choose when and where to die.
In 2016, Canada became one of the few countries to allow some adults to seek medical help in causing their own death. The federal government recently expanded access to the practice after the country’s highest court ruled the original law was too narrow.
A joint committee of deputies and senators begins its review of the law on May 17. It is responsible for answering some onerous questions, such as whether mature minors should have access to medical assistance in dying (MAI) and whether patients should be allowed to move forward. procedural demands before their suffering becomes intolerable.
“Physician-assisted dying is a complex and deeply personal issue for many Canadians and their families,” Justice Minister David Lametti’s office said in a statement.
“The five-year parliamentary review of the previous Bill C-14 will be an appropriate forum to consider a multitude of issues and questions.”
These are some of the issues before the committee.
The Trudeau government legalized MAID after the Supreme Court ruled that parts of the Criminal Code prohibiting assisted suicide violated the Charter of Rights and Freedoms.
Parliament passed a law allowing adults to obtain medical assistance in dying if they had a “serious and irremediable” medical condition and their death was “reasonably foreseeable”. In other words, people diagnosed with an incurable disease, illness or disability that caused unbearable mental or physical suffering might be eligible – but only if they were on the verge of death.
Critics have called the “foreseeable death” provision too restrictive. The Superior Court of Quebec invalidated it in 2019.
WATCH | A new law on medical assistance in dying is adopted:
The government responded with Bill C-7, which passed in March 2021.
The new law gave Canadians who are experiencing intolerable suffering and who are not near the natural end of their lives the right to apply for MAID immediately.
Those whose suffering is solely caused by mental illness will have access to MAID in March 2023.
Between 2016 and 2019, 13,946 people received medical assistance in dying in Canada, according to Health Canada. Most of them suffered from cancer-related diseases (67%), 10.8% suffered from respiratory diseases, 10.4% from neurological diseases and 10.1% from cardiovascular diseases.
The expansion of MAID to people primarily suffering from depression, schizophrenia, post-traumatic stress disorder and other mental illnesses has left lawmakers with a number of unanswered questions.
For example – how can physicians and nurse practitioners who assess patients’ suitability for MAID determine if a psychiatric condition is irremediable?
Many psychiatric conditions can be treated with drugs or other therapies, or can improve if living conditions that contribute to poor mental health – such as poverty, loneliness or lack of housing – are treated.
“There just isn’t enough evidence available in the mental health field … to determine whether a particular person has an irremediable mental illness,” the Center for Addiction and Mental Health said. Toronto in 2017.
WATCH: Ottawa gears up to expand MAID program to include mental illness
Dr Sonu Gaind, physician chair of the Humber River Hospital MDA team, said he was concerned that MDA would be provided to people who might otherwise recover.
“It’s sacrificing marginalized people who never had the autonomy to live with dignity to now choose death as a potential way to resolve their suffering,” said Gaind, who is also an associate professor of psychiatry at the University of Toronto.
“The safeguards we have in place have to be as strong as possible to minimize … the number of people who would seek MAID for things like social deprivation, where they could actually get help through a additional community or social support. “
The Liberal government is forming an expert panel to look at the issue of mental health and recommend safeguards to protect vulnerable people. The expert group is expected to provide recommendations by March 2022.
Jocelyn Downie, a law professor at Dalhousie University who has studied MAID for decades, said the committee will need to decide what role psychiatrists should play in conducting assessments of MAID.
Another unanswered question, Downie said, is whether patients with mental illness should have to prove that they have exhausted treatment options before they can access MAID.
The original law required that patients who had been approved for assisted dying to reconfirm their wishes just before the procedure.
Patients taking strong pain relievers or suffering from degenerative conditions feared losing the mental capacity to consent late – which forced them to consider opting for assisted dying early.
This is what happened to Audrey Parker, a Nova Scotia man with terminal breast cancer that has spread to her brain. In a video posted days after her assisted death in 2018, Parker said her fear of losing her lucidity led her to choose a date for her death earlier than she wanted.
Bill C-7 includes what supporters call “Audrey’s Amendment”. It allows MA recipients to waive the consent requirement at an advanced stage.
“This prior consent form means people don’t have to choose to leave early,” said Helen Long, CEO of Dying With Dignity, an advocacy group.
LISTEN | UN Watchdog Raises Concerns Over Canada’s Law on Physician-Assisted Dying
As it happens6:27UN Watchdog Raises Concerns Over Canada’s Law on Physician-Assisted Dying
But current law still requires MAID recipients to be in a state of irreversible decline and suffer intolerable suffering. Many advocates want patients to be allowed to seek assistance in dying after a diagnosis, but before their suffering becomes intolerable.
Long said this would allow people to describe a future state of distress which, once achieved, would allow a doctor to continue with the MAID procedure.
“It’s easy to think of a time when you might have a stroke or an aneurysm or even a catastrophic fall and never be able to make your wishes known again,” Long said.
“You make much better decisions when you’re not in a state of intolerable pain,” Downie said. “So we want people to have conversations and come to an agreement with their clinician on a future MAID service.
One of the most controversial issues in the right to die debate is the age of consent.
Currently, only people over 18 can apply for MAID.
The Canadian Pediatric Society has lobbied to exclude minors from access to MAID, while others have argued that the age limits are arbitrary.
Long said the concept of a “mature minor” who can make decisions about medical treatment is well established in the Canadian healthcare system.
“It would just be the same process of physician-assisted dying – making sure that a child with cancer that ends their life, for example, would be able to make the same choices as someone in their 70s. years can do. the ability, the maturity and the ability to do it, ”she said.
A provincial-territorial advisory group recommended in 2015 that access to MAID be based on competence, not age. A previous parliamentary committee also approved the access of competent mature minors, but only after a study of moral, ethical and legal issues.
Downie said that while mature minors have the legal right to refuse life-saving treatment, they should have the right to choose assisted dying.
“Clinicians can assess the ability to cope with these very serious consequences,” she said. “And they would do it exactly the same way they would for a denial of life-sustaining treatment.”