Introduction

Webcast archive: Special Joint Committee recommendations

This week, we discuss the recommendations made by the Special Joint Committee on physician aid in dying.

Webcast archive: Special Joint Committee recommendations

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

  • The Special Joint Committee makes its recommendations
  • Liberals back off from party line on assisted suicide

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

THE SPECIAL JOINT COMMITTEE MAKES ITS RECOMMENDATIONS.

  • The report and recommendations of the Special Joint Parliamentary Committee on Physician Aid in Dying were published yesterday, and they were as bad as we expected.
  • The recommendations do nothing to protect vulnerable persons and prevent suicides, while opening the door wide to euthanasia and assisted suicides of old, ill and disabled people.
  • What the recommendations do:

RECOMMENDATION 1

  • That the terms relating to medical assistance in dying (grievous and irremediable medical conditions
that cause enduring suffering that is intolerable to the individual in the circumstances of his or her condition) do not require further statutory definition.

RECOMMENDATION 2

  • That medical assistance in dying be available to individuals with terminal and non-terminal conditions.

RECOMMENDATION 3

  • That individuals not be excluded from eligibility for medical assistance
in dying based on the fact that they have a psychiatric condition.

RECOMMENDATION 4

  • That physical OR psychological suffering should be recognized as a criterion to access medical assistance in dying.

RECOMMENDATION 5

  • That the capacity of a person requesting medical assistance in dying to provide informed consent should be assessed using existing medical practices, emphasizing the need to pay particular attention to vulnerabilities in end-of-life circumstances.

RECOMMENDATION 6

  • That the Government of Canada implement the law in two stages;, with the first stage applying immediately to competent adult persons 18 years or older, to be followed by a second stage applying to competent mature minors, coming into force no later than three years after the first stage has come into force.

RECOMMENDATION 7

  • That permission to use advance requests for medical assistance in 
dying be allowed any time after a person is diagnosed with a grievous or irremediable condition but before the suffering becomes intolerable.

RECOMMENDATION 8

  • That medical assistance in dying be available only to insured persons eligible for publicly funded health care services in Canada.

RECOMMENDATION 9

  • That where possible, a request for medical assistance in dying is made in writing and is witnessed by two people who have no conflict of interest.

RECOMMENDATION 10

  • That the freedom of conscience of health care practitioners be respected while at the same
time respecting the needs of a patient who seeks medical assistance in dying. At a minimum, the objecting practitioner must provide an effective referral for the patient.

RECOMMENDATION 11

  • That all publicly funded health care institutions provide medical assistance in dying.

RECOMMENDATION 12

  • That a request for medical assistance in dying can be carried out only if two physicians
who are independent of one another have determined that the person meets the eligibility criteria for medical assistance in dying.

RECOMMENDATION 13

  • That physicians, nurse practitioners and registered nurses working under the direction of a physician may provide medical assistance in dying.

RECOMMENDATION 14

  • That any period of reflection for medical assistance in dying is flexible, and based, in part, on the rapidity of progression and nature of the patient’s medical condition as determined
by the patient’s attending physician.

RECOMMENDATION 15

  • That the process to regulate medical assistance in dying does not include a prior review
and approval process.

RECOMMENDATION 16

  • That Health Canada lead a cooperative process with the provinces and territories creating and analyzing national reports on medical assistance
in dying cases, compiled on an annual basis
and tabled in Parliament.

RECOMMENDATION 17

  • That a statutory review of the federal legislation
be conducted by the appropriate committee(s) of the House Senate every four years.

RECOMMENDATION 18

  • That culturally and spiritually appropriate end-of-life care services, including palliative
care, are available to Indigenous patients.

RECOMMENDATION 19

  • That Health Canada re-establish a Secretariat on Palliative and End-of-
Life Care; to develop a flexible, integrated model of palliative care by implementing a pan-Canadian palliative and end-of-life strategy with dedicated funding.

RECOMMENDATION 20

  • That the Government of Canada support the pan-Canadian mental health strategy, Changing Directions, Changing Lives and ensure that appropriate mental health supports and services are in place for individuals requesting medical assistance in dying.

RECOMMENDATION 21

  • That Health Canada and the Public Health Agency of Canada work with
the provinces, territories and civil society organizations to develop a pan-Canadian strategy to improve the quality of care and services received by individuals living with dementia, as well as their families.

Other notes on the recommendation:

  • The person is not required to accept treatment for their suffering.
  • Eligibility is determined by agreement of two physicians.  The report is silent on what happens when the doctors disagree.
  • The doctors must assess:
    • Competence (physical and social factors that interfere with decision-making;
    • The informed and voluntary nature of the decision;
    • whether the person is vulnerable to inducement to commit suicide.
  • Either assisted suicide or euthanasia is allowed.  But no information about how death will be caused is included in the recommendations.
  • What the recommendations don’t do.
    • There is no requirement that the person be unable to commit suicide without help.
    • There are no provisions for accessibility to ensure effective communication in the application process; no scribes, interpreters, print materials in alternate formats, or communication technology.
    • No separate psycho-social evaluation is required to determine whether the person is “vulnerable to inducement to commit suicide”
    • There is no obligation that palliative care be available or provided to the person.
    • No provision is made for home access modifications or home-based personal assistance services to enable the person to age in place and avoid institutionalization or overburdening family carers.
    • There’s no mandate for peer counselling to deal with disability adjustment issues.
    • There is no requirement of a pre-existing relationship with the treating physician.
    • Administrative or judicial review of the eligibility determination are forbidden.
    • There is no oversight body recommended, nor indication of what information will be gathered for annual statistical reports.
    • There is no mechanism to enforce the requirement that physicians report assisted suicides or euthanasia they perform, especially where:
      • Assisted suicide, rather than euthanasia, is the method of choice;
      • The act is performed by a nurse or physician assistant.

THE LIBERALS BACK OFF FROM PARTY LINE ON ASSISTED SUICIDE

  • Contrary to what we told you last week, the iberals have back-tracked on their pledge to force a party-line vote on the assisted suicide bill … at least for the moment.
  • There’s no word on what they plan to do next week.