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Assisted Death: my thoughts on Bill C-14

Assisted Death: my thoughts on Bill C-14

On April 14, the federal government unveiled Bill C-14, its legislation, written in response to last year’s ruling by the Supreme Court that medically assisted death is no longer illegal.

The legislation was released following “a month-long joint committee study of how to implement the Supreme Court’s Carter v. Canada ruling, which struck down the country’s prohibition on assisted-death.”1 The committee, which produced a 70-page report calledMedical Assistance in Dying: A Patient-Centred Approach, said that “Canadians should have the right to make an ‘advance request’ for medical aid in dying after being diagnosed with certain debilitating but not necessarily terminal conditions.”2 The report also advocated that “assisted death should not be limited to physical conditions, and that Canadians with psychiatric conditions should not be excluded from doctor assistance to end suffering.”2And finally, the report recommended “extending the right for doctor-assisted death to ‘mature minors’” in three years’ time.2

While the controversy over whether assisted death should be legalized at all persists, the loudest conversations over the past two weeks have been about the language in the legislation itself. Some have expressed support, saying that it closely matches public opinion. Others argue that the legislation is restrictive, and misses the entire point; so much so, that some have predicted that it will not be passed by the Senate.3

At the heart of the debate are five parts of the legislation, some of which are in direct conflict to the recommendations in the Medical Assistance in Dying: A Patient-Centred Approach report.

  1. The bill does not allow for individuals to include wishes for medically assisted death in a living will. For example a person with dementia may not arrange to access medical assistance to die in advance of their deteriorating cognitive capacity.
  1. Youth (individuals under the age of 18) are excluded from seeking assisted death.
  1. Individuals with mental illness are also excluded; medically assisted death will be restricted to “mentally competent adults who have serious and incurable illness, disease or disability.” 2
  1. The legislation includes a 15-day waiting period to ensure that the patient is confident in their decision.
  1. Healthcare professionals will be required to offer referrals for patients seeking assisted death; they cannot object for moral reasons.

Dr. Chris Simpson, who served as the Canadian Medical Association’s president over the past year was an early advocate for the legalization of assisted death. He played a central role in pushing this file forward, and despite the controversy over the details of the legislation, I am sure that he takes personal pride in our country’s bold step.

Overall, I think the government has landed in an excellent spot. To have started on a journey in our country with assisted death using the comprehensive definition that was put forward by the committee, in my view, would have been problematic. There are so many potentially serious issues and slippery slopes with the issues of mental health, youth and what might or might not be put in a living will, that to start there, in my opinion would have been a mistake.

Through numerous consultations, the government has listened to many healthcare professional groups, the majority of whom have been arguing for this more moderate approach.

I personally applaud the fundamental decision that Canada has taken to enable medically assisted death. I do understand that there is a wide spectrum of views on this issue, and all of those views need to be respected. And it is widely recognized that we need to dramatically improve access to comprehensive palliative care. That said, I am of the personal opinion that in appropriate circumstances, assisted death will be of benefit to a selected group of patients who are facing severe and interminable suffering.

Please share your thoughts by commenting on the blog, or better yet, drop by the Macklem House…my door is always open.

 

Richard

Thank you to Jen Valberg for her assistance in preparing this blog.

  1. http://ipolitics.ca/2016/02/25/assisted-dying-recommendations-fall-short-on-referrals-cma/
  1. http://www.cbc.ca/news/politics/canada-physician-assisted-death-law-1.3535193
  1. http://www.thestar.com/news/canada/2016/04/19/liberals-restrictive-approach-to-assisted-death-could-sink-bill-c-14-in-senate-hbert.html

Vera

Thu, 06/22/2017 - 14:19

Mental illness does not mean you are an idiot or a lunatic, possessed by the devil or the victim of witchcraft. Carter used the phrase “medical”, and mental illness is certainly “medical”, the last time I checked. 95% of people suffering from those conditions certainly are competent. You can’t restrict their charter rights. So no, it’s not a good first step. The only people that would qualify are the ones who are currently in so-called palliative care being starved and dehydrated to death, dying of hypoxia. You wouldn’t even qualify if you presented with the early stages of Alzheimer’s doing your own cognitive testing, the health care system avoids testing like the plague so people don’t present until the incompetent phase – we need fodder for the elder-care system, can’t cut down on that can we, easy nursing and lots of kaching-kaching. The law will end up struck down like abortion was when they tried to restrict that.

Vera

Dear Vera,

Thanks for your comment and sharing your perspective. As mentioned in the blog, this is a much debated issue with many aspects to consider.

Richard

reznickr

I suffer from severe PTSD as a result of surgery that I didn’t receive proper informed consent for and do not believe in. I’m stuck living with the consequences of decisions I was not permitted to make…Now people want to tell me I’m not competent for assisted dying because I have a mental illness that was caused by denying me my rights to make my own decisions in the first place?

Elizabeth Hopkins

Hoshiar Abdollah

Thu, 06/22/2017 - 14:20

My reservation concerning the Committee’s recommendation are:
1. Large number of people who wishes to live with advanced dementia are denied this right since they are allowed to clearly state this wish in their living wills when they are fully competent.
2. Who should speak for patients with mental illness who deemed to be competent to make decision for themselves.

I believe the Committee’s report is in contradiction of the Supreme Court Judgement and I expect if the these recommendation are adopted as law there will be immediate challenges and will be reversed by courts.

Hoshiar Abdollah

Hoshi,

Thanks for your perspective. I am confident that you are correct that the issues you raise will be pivotal points in the ongoing discussion. My own perspective is that is is important to make this option available, and so starting in the way that is being proposed, is a reasonable initial step in the right direction.

Richard

reznickr

Douglas MacIntosh

Thu, 06/22/2017 - 14:20

It essential to ensure that “persons who have serious incurable illness,disease or disability”give consent in each case. This is the situation that must exist to avoid the transition from assisted death to execution.

Douglas MacIntosh

john arber. Medicine 1971

Thu, 06/22/2017 - 14:21

 

Dean Reznick. Thank you for stating your personal views in a firm and clear manner. I agree,this bill is a very important first step to bring this topic out of the closet and the bill leaps ahead of what was in existence before, as well said by an ethics professor at Queen’s. Please keep being forth right in your own opinions. We need more of this from our leaders!

john arber. Medicine 1971

reznickr

Thu, 06/22/2017 - 14:22

In reply to by student

Dear John

Thanks for your kind words and encouragement.

Richard

reznickr

D.H.Braden

Thu, 06/22/2017 - 14:22

I find it interesting to observe the language used. “Assisted dying” I guess is more acceptable than “killing”, which in fact is what is being talked about. As with all euphemisms it diverts one from the unpleasant. Having noted that, my major concern with the bill is the exclusion of allowing for “living will” or similar provision for individuals to request assisted dying in the event they develop dementia down the road.

D.H.Braden

Thanks very much Dr. Braden,

I appreciate your perspective on the controversial issue with respect to living wills. It is indeed, a difficult issue to wrestle with, but my own personal view is that in order to move the assisted dying issue forward, we will be best served to start with the “straight forward” issues.

Richard

reznickr

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