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.
- 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.
- Youth (individuals under the age of 18) are excluded from seeking assisted death.
- 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
- The legislation includes a 15-day waiting period to ensure that the patient is confident in their decision.
- 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.
Thank you to Jen Valberg for her assistance in preparing this blog.