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Canada debates medically assisted dying law
World Report
Canada debates medically assisted dying law
New legislation tabled by the Canadian Government aims to place Canada among the small number of nations—including Belgium, Colombia, and the Netherlands—that permit medically assisted death. But the exact approach Canada will take on the issue remains a topic of heated debate. “It is not about whether or not to have medical assistance in dying; it is about how we will do it”, Canada’s Justice Minister, Jody Wilson-Raybould, explained during a debate on the draft legislation on April 22. “We are keenly aware of the diverse perspectives on this issue, and each of them raises worthy considerations.” Under the law, physicians and nurse practitioners will be permitted to supervise administration of substances causing death. But the people eligible for medical assistance in dying will be carefully vetted; according to the legislation, they must be at least 18 years old, and capable of making decisions with respect to their health. They must also have a “grievous and irremediable medical condition” such as a “serious and incurable illness, disease or disability”, an “advanced state of irreversible decline in capability”, or be “enduring physical or psychological suffering, caused by the medical condition, that is intolerable to them and that cannot be relieved under conditions that they consider acceptable”. The legislation also stipulates that medically assisted death can only be facilitated for patients when “natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining” and where the patient has “made a voluntary request for medical assistance in dying www.thelancet.com Vol 387 May 7, 2016
that, in particular, was not made as a result of external pressure”. The proposed legislation sets out multiple safeguards before physicians and nurse practitioners can provide medical assistance in dying. These include the stipulation that a second medical practitioner or nurse practitioner has provided a written opinion, and “that there are at least 15 clear days between the day on which the request was signed by the person and the day on which the medical assistance in dying is provided”. The legislation does not compel health facilities, physicians, or other health practitioners to provide end-of-life assistance.
”’It is not about whether or not to have medical assistance in dying; it is about how we will do it’...” Reaction to the proposed legislation, which must be passed by both chambers of the Canadian Parliament by June 6, has been mixed. The Canadian Medical Association (CMA), which represents 83 000 physicians, is supportive. “The overall approach”, says CMA president Cindy Forbes “is both thoughtful and comprehensive”. The Canadian Nurses Association, which represents 139 000 nurses, also endorsed the proposed law. CEO Anne Sutherland Boal says it will “promote a more compassionate health-care system that will empower patients with grievous and irremediable medical conditions to choose among a broader range of appropriate end-of-life options”. The Canadian Government was spurred to draft the legislation when the Supreme Court of Canada struck down a ban on physician-assisted dying on the grounds that it violated
Canadians’ constitutional rights—a decision that resulted from litigation initiated by the British Columbia Civil Liberties Association (BCCLA). The association now thinks that the draft legislation is inadequate. “While the legislation permits assisted dying for adults suffering from physical illnesses, and does not include some of the worst ideas recommended by opponents of assisted dying like requiring prior judicial approval”, BCCLA executive director Josh Paterson says, “it leaves out entire categories of suffering Canadians who should have a right to choose a safe and dignified assisted death”. That means “people will be trapped in intolerable suffering, or be left with no choice but to take their own lives prematurely in potentially dangerous situations”, Paterson warns. “In our opinion, by excluding people who are suffering intolerably on account of a mental illness, by excluding mature minors, and by refusing to respect advance requests this legislation plainly violates the Charter rights of suffering Canadians.” Shanaaz Gokool, CEO of Dying With Dignity Canada, is similarly critical of the new legislation, which she says risks depriving Canadians with dementia and other catastrophic chronic conditions of access to their hard-won right to die with the help of a doctor. “These harsh, discriminatory rules fly in the face of that expectation and will create unfair barriers to access to medical aid in dying”, Gokool warns. “Without the option of advance consent, Canadians with devastating conditions who want to exercise their right to physicianassisted dying may face a bleak choice: end their lives too early, while they are still competent; or risk waiting until it’s too late.”
Oleksiy Maksymenko/ImageBroker/Corbis
The Canadian Parliament is debating draft legislation that will decide the country’s rules and processes for medically assisted suicide. Paul C Webster reports from Toronto, Canada.
Canadian Parliament, Ottawa
Paul C Webster 1893
Canada debates medically assisted dying law
New legislation tabled by the Canadian Government aims to place Canada among the small number of nations—including Belgium, Colombia, and the Netherlands—that permit medically assisted death. But the exact approach Canada will take on the issue remains a topic of heated debate. “It is not about whether or not to have medical assistance in dying; it is about how we will do it”, Canada’s Justice Minister, Jody Wilson-Raybould, explained during a debate on the draft legislation on April 22. “We are keenly aware of the diverse perspectives on this issue, and each of them raises worthy considerations.” Under the law, physicians and nurse practitioners will be permitted to supervise administration of substances causing death. But the people eligible for medical assistance in dying will be carefully vetted; according to the legislation, they must be at least 18 years old, and capable of making decisions with respect to their health. They must also have a “grievous and irremediable medical condition” such as a “serious and incurable illness, disease or disability”, an “advanced state of irreversible decline in capability”, or be “enduring physical or psychological suffering, caused by the medical condition, that is intolerable to them and that cannot be relieved under conditions that they consider acceptable”. The legislation also stipulates that medically assisted death can only be facilitated for patients when “natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining” and where the patient has “made a voluntary request for medical assistance in dying www.thelancet.com Vol 387 May 7, 2016
that, in particular, was not made as a result of external pressure”. The proposed legislation sets out multiple safeguards before physicians and nurse practitioners can provide medical assistance in dying. These include the stipulation that a second medical practitioner or nurse practitioner has provided a written opinion, and “that there are at least 15 clear days between the day on which the request was signed by the person and the day on which the medical assistance in dying is provided”. The legislation does not compel health facilities, physicians, or other health practitioners to provide end-of-life assistance.
”’It is not about whether or not to have medical assistance in dying; it is about how we will do it’...” Reaction to the proposed legislation, which must be passed by both chambers of the Canadian Parliament by June 6, has been mixed. The Canadian Medical Association (CMA), which represents 83 000 physicians, is supportive. “The overall approach”, says CMA president Cindy Forbes “is both thoughtful and comprehensive”. The Canadian Nurses Association, which represents 139 000 nurses, also endorsed the proposed law. CEO Anne Sutherland Boal says it will “promote a more compassionate health-care system that will empower patients with grievous and irremediable medical conditions to choose among a broader range of appropriate end-of-life options”. The Canadian Government was spurred to draft the legislation when the Supreme Court of Canada struck down a ban on physician-assisted dying on the grounds that it violated
Canadians’ constitutional rights—a decision that resulted from litigation initiated by the British Columbia Civil Liberties Association (BCCLA). The association now thinks that the draft legislation is inadequate. “While the legislation permits assisted dying for adults suffering from physical illnesses, and does not include some of the worst ideas recommended by opponents of assisted dying like requiring prior judicial approval”, BCCLA executive director Josh Paterson says, “it leaves out entire categories of suffering Canadians who should have a right to choose a safe and dignified assisted death”. That means “people will be trapped in intolerable suffering, or be left with no choice but to take their own lives prematurely in potentially dangerous situations”, Paterson warns. “In our opinion, by excluding people who are suffering intolerably on account of a mental illness, by excluding mature minors, and by refusing to respect advance requests this legislation plainly violates the Charter rights of suffering Canadians.” Shanaaz Gokool, CEO of Dying With Dignity Canada, is similarly critical of the new legislation, which she says risks depriving Canadians with dementia and other catastrophic chronic conditions of access to their hard-won right to die with the help of a doctor. “These harsh, discriminatory rules fly in the face of that expectation and will create unfair barriers to access to medical aid in dying”, Gokool warns. “Without the option of advance consent, Canadians with devastating conditions who want to exercise their right to physicianassisted dying may face a bleak choice: end their lives too early, while they are still competent; or risk waiting until it’s too late.”
Oleksiy Maksymenko/ImageBroker/Corbis
The Canadian Parliament is debating draft legislation that will decide the country’s rules and processes for medically assisted suicide. Paul C Webster reports from Toronto, Canada.
Canadian Parliament, Ottawa
Paul C Webster 1893