Introduction

Webcast archive: CCD Statement of Principles – Part III

This week, we look at CCD’s recommendations for a new law following the Carter decision.

Webcast archive: CCD Statement of Principles – Part III

In this episode of Euthanasia & Disability, Amy Hasbrouck and Christian Debray discuss:

  • CCD Statement of Principles – Part III: Recommendations

Please note that this text is only a script and that our webcast contains additional commentary.

CCD’S STATEMENT OF PRINCIPLES FOR LEGISLATION FOLLOWING THE CARTER DECISION – PART III: RECOMMENDATIONS

  • Over the past two weeks, we’ve looked at the objections to assisted suicide, the myths on which the Supreme Court decision was based, and the principles that should guide parliament in drafting a bill on assisted suicide.
  • Today we’re going to jump right into the third part of CCD and TVNDY’s statement; our recommendations of procedures for an assisted suicide program.
  • Please note that there are several footnotes that we won’t read in order to save time.  To read the complete statement, visit our Facebook page.

Elements to include in assisted suicide legislation:

  1. Each person requesting assisted suicide will be guided by a Case Coordinator through each step of the process, (application, eligibility determination, court approval and assisted suicide) who is contracted and assigned by the Oversight Authority.
  2. Eligibility will be determined based in part on the materials provided in the application packet:
    1. A completed, signed and witnessed application form.
    2. The report of a physical examination (with accompanying tests), diagnosis, prognosis, and detailed consultation with a primary care physician.
    3. The report of a physical examination (with accompanying tests) , diagnosis, prognosis, and consultation with a second physician specializing in the life-threatening disease or condition
    4. The report from a consultation with a palliative care specialist.
    5. A psycho-social evaluation to determine:
      1. Whether the person is “vulnerable” as defined by the law;
      2. Whether the person is capable to give informed consent to suicide according to a modified standard;
      3. Whether the wish to die is unequivocal, persistent and settled over a period of at least three weeks or until palliative measures have time to take effect;
  3. Indications of abuse or coercion should trigger immediate protective intervention.
  4. Eligibility criteria must be narrowly defined to achieve the law’s goals.  In order to be eligible for assisted suicide, a person must:
    1. Be a resident of the jurisdiction for at least one year;
    2. Be at least 18 years old;
    3. Express an unequivocal, settled and persistent wish to die which is repeated over a period of at least three weeks.
    4. Be fully capable of giving informed consent to suicide, and fully competent to understand and appreciate the consequences of suicide;
    5. Not be “vulnerable” within the law’s definition, meaning:
      1. Free of depression, mental illness, brain injury, the effects of drugs or alcohol, medication side-effects or interactions, or other mental health or medical factors that could affect decision-making, mood, outlook, judgment, or a desire to live;
      2. Free of undue influence, coercion, abuse, economic or family pressures or any other external factors that could affect the desire to live.
      3. Possessed of the necessities of life, a reasonable standard of living, the means and supports to live independently and participate fully in his/her community, a healthy self-esteem, and a supportive social network;
      4. Be receiving state-of-the-art pain relief, symptom management, and other palliative care interventions.
    6. Have a “grievous and irremediable medical condition” which, according to the best clinical judgment of two physicians (following separate direct examinations), will likely result in death in less than six (6) months;
    7. Be unable to commit suicide without physical assistance;
    8. Have “enduring suffering that is intolerable,” meaning severe, unremitting physical pain and/or constant and severe symptoms (i.e. vomiting, seizures, coughing, choking, etc.) that cannot be controlled using state-of-the-art medication or techniques.
  5. Approval of assisted suicide requests will be done through a hearing in open session, before a judge or administrative law panel, which will determine:
    1. If the person meets the eligibility criteria for assisted suicide.
    2. If it is in the public interest to suspend the policy of suicide prevention in this case because of:
      1. The reason for the person’s request;
      2. The failure of alternative approaches to reduce suffering.
    3. If granting assisted suicide would violate the individual’s right to life or the right to be free of discrimination.
  6. In ruling on the request, the judge or panel will consider the following evidence:
    1. The application packet;
    2. Testimony by the individual;
    3. A recommendation or testimony by an amicus curiae standing in the public interest to offer an opinion on the issues of public policy, right to life and discrimination implications in the case;
    4. Testimony or documents submitted by interested parties;
    5. Any witnesses or documents the finder of fact may wish to subpoena.
  7. Clear definitions of terms, which avoid euphemisms such as “assisted death”.
  8. Clarify the distinction among withholding and withdrawing treatment, palliative sedation, assisted suicide, and euthanasia.
  9. Assisted suicides will be supervised by a medical technician contracted and assigned by the Oversight Authority.  This person will have emergency medical certification and additional specialized training.  The procedure will be overseen, witnessed and recorded by the Case Coordinator.
  10. Assisted suicide/euthanasia advocacy groups should be prohibited from helping or accompanying a person making the request through the process.
  11. Establish an oversight body whose responsibilities include:
    1. Overseeing administration of the program at the provincial level, setting standards for procedures and contracted employees.
    2. Ensuring the tracking of applicants who are refused or who withdraw their requests, to prevent “doctor shopping.”
    3. Keeping a public registry of all physicians and members of other professional colleges who are involved in providing assisted suicide.
    4. Keeping records and developing statistical reports of requests for assisted suicides (including tracking those which are approved, refused or withdrawn).
      1. How many assisted suicides per year,
      2. Using aggregate data, track medical condition, socio-economic circumstances, location and demographic factors of persons making the requests and professionals making recommendations on eligibility;
        • availability and acceptance or refusal of alternative courses of action identified;
        • efficacy of alternative interventions including access to medical treatment, disability related supports, and palliative care;
        • outcome of requests authorized and denied;
    5. Creating a mechanism for families and other interested parties to trigger an investigation where a person has died due to what appears to be an illegal act of medical homicide.
    6. Conducting periodic randomized studies of death reports throughout the country to verify that medical killing is not happening outside the scope of the law.
    7. Investigating anomalies in case records, and working with local law enforcement to follow up on problems.
    8. Tracking trends and providing analysis of the assisted suicide program.
    9. Making recommendations to improve assisted suicide administration, oversight, and safeguards in the legislation, palliative care and related programs and services.
  12. Sanctions must reflect a commitment to punishing crimes against people with disabilities equally to crimes against non-disabled persons.
  13. Where illegal medical homicide is found, family members should receive financial compensation.
  14. Establish a task-force within the CRTC to improve the quality of reporting on and portrayals of people with disabilities in Canadian media, particularly reports and portrayals which feature alternatives to assisted suicide.
  15. Develop and implement training modules for medical and mental health professionals in the social model of disability and the effects of discrimination on the physical and mental health of people with disabilities.

Include a provision that the law can only be amended to offer more protections, not decrease them.