In this episode of Euthanasia & Disability, Amy Hasbrouck and Christian Debray discuss:
- Bill C-14 amendments
Please note that this text is only a script and that our webcast contains additional commentary.
PROPOSED AMENDMENTS TO BILL C-14
- Bill C-14 is headed to the Justice committee for hearings, which begin next week.
- Toujours Vivant-Not Dead Yet has prepared a set of amendments to try to address some of the problems with Bill C-14 that we described last week. We will be looking for Members of parliament and senators to introduce these amendments in hopes that the final bill will include as many of them as possible.
- Reasonable but mistaken belief: The law provides exemptions for errors made by health care providers and ordinary citizens relative to assisted suicide and euthanasia that could result in negligent or culpable homicides but for this blanket exemption. Amendment: Remove §§ 227 (3) and 241 (6) Exemption for “reasonable but mistaken belief.”
- The law allows an exemption for any person “if they do anything for the purpose of aiding a medical practitioner” to provide assisted suicide or euthanasia. These provisions are unnecessary and dangerous, and should be removed. Amendment: Remove §§ 227 (2) and 241(3).
- The exemption for person aiding patient allows a layperson to “do anything” to help the patient self-administer the lethal dose. This provision is also unnecessary and dangerous, and should be removed. Amendment: Remove § 241(5).
- § 241.2(1)(d) refers to voluntary requests for assisted suicide. By excluding only “external pressure,” this section is too narrow. It should be amended to include the Supreme Court’s standard of “vulnerable to inducement to commit suicide in a time of weakness.” Amendment: In section 241.2(1)(d) after the word “pressure,” add the phrase “nor is the result of circumstances that render him vulnerable to inducement to commit suicide;”
- Additional safeguards are necessary to ensure effective communication for people with communication disabilities, and that persons who are potentially vulnerable to inducement to commit suicide in a time of weakness are not wrongly directed to medical aid in dying.
- Access to communications: Access to effective communication in life-and-death matters is essential to people with communication and sensory disabilities, and is a right as well. Amendment: In § 241.2(3), insert new section (a) “Provide access to (written and oral) communications in all interactions between medical practitioners or nurse practitioners and the person making the request who has a sensory or communication disability. Access shall be provided by impartial, professional interpreters, speech-language pathologists, scribes and/or assistive technology to achieve effective communication.”
- Person meets eligibility criteria: Subsections (a), (c) and (f) of § 241.2 create subjective standards where objective standards would be preferable. Amendment: § 241.2(3)(a) should be changed by replacing the phrase “be of the opinion” with the word “ensure”. Similarly, the phrase “be satisfied” in subsections (c) and (f) should be replaced with the word “ensure”.
- Informed consent: The information provided in § 241.2(3)(b)(ii) is insufficient to ensure “informed consent.” Amendment: In §241.2 (3)(b)(ii) after the word “circumstances” add “. The medical practitioner or nurse practitioner must ensure that the person is informed of and understands the methods and potential complications of medical aid in dying, the availability of palliative care and other alternative treatments and supports.”
- Written opinion confirming: The language of § 241.2(3)(e) does not stipulate that the second medical practitioner or nurse practitioner must examine the person making the request for medical assistance in dying. Amendment: In § 241.2(3)(e) after the word “has” add the phrase “physically examined the person making the request and”.
- Prior vulnerability assessment and prior palliative care assessment: In order to determine that a person is or is not vulnerable to inducement to commit suicide in a time of weakness, an assessment of that person’s vulnerability must be conducted, and any vulnerabilities must be addressed before the person can be eligible for medical assistance in dying. Amendment: § 241.2(3) insert the following after (f): “(g) Ensure that the person has a psychosocial assessment to determine any vulnerability to inducement to commit suicide in a time of weakness. Address any such vulnerabilities that are identified to ensure that the request is completely voluntary.
- (h) Ensure that the person has consulted with a palliative care professional and received all appropriate palliative care services.”
- Prior judicial review: This is an indispensable safeguard to ensure compliance with legislated requirements and to identify and address vulnerability before the life-ending act has taken place. Amendment: Insert a new section following §241.2(3) which states.
“Each request must be submitted to the superior court in the jurisdiction in question for an expedited review to verify the determination that:
- the person meets the eligibility criteria for medical assistance in dying;
- The person has a grievous and irremediable medical condition;
- The person has been informed of his diagnosis, prognosis, (including that his natural death is reasonably foreseeable) and of the availability of alternative treatments and supports;
- The person has had access to communication assistance and professional, impartial interpreter services for effective communication, as necessary;
- The person has made a voluntary request and is not subject to external pressure or other circumstances that render the person vulnerable to inducement to commit suicide;
- The person is capable of making medical decisions free of depression, drug effects, demoralization, cognitive limitations or other conditions that affect mood, insight or judgment;
- The person has been given access to palliative care and other services to alleviate his suffering;
- The person has a settled, unambivalent wish to avail himself of medical assistance in dying.”
- Unable to sign: There is currently no restriction on who may write and sign the application on behalf of a person who cannot fill out the form himself. Thus an heir or employee of a nursing home could fill out the application for a person who has a communication disability, and their interpretation of the person’s wishes would probably go unchallenged. Amendment: In § 241.2(4) following “behalf”, replace the “.” With a “,” and add: “except if they:
- know or believe that they are a beneficiary under the will of the person making the request or a recipient, in any other way, of a financial or other material benefit resulting from the person’s death;
- are an owner or operator of any health care facility at which the person making the request is being treated or any facility in which the person resides;
- are directly involved in providing health care services to the person making the request; or
- Directly provide personal care to the person making the request.”
- Conscience protection: While the preamble of bill C-14 mentions “respect [for] the personal convictions of health care providers” there is nothing in the statute to protect conscience rights of doctors, nurses, pharmacists or others. Amendment: Insert the following after § 241.2(7)
“(8) Freedom of conscience
(a) No medical practitioner, nurse practitioner, pharmacist or other health care provider who objects to medical assistance in dying due to personal conviction shall be compelled to participate in any aspect of the medical assistance dying program.
(b) Hospices which operate on the principles of palliative care to neither delay nor accelerate natural death may elect not to participate in the medical assistance in dying program.
(c) Religious institutions are exempt from participation in the medical assistance in dying program.”
- Regulations: Require reporting on each case with obligations for the provinces to gather and report on reasons for the request, options considered, the decision, and ultimate disposition. The federal government should require each province to complete these reports as a pre-requisite for transfer of funds through the health act. The Federal government must table an annual report in parliament. This is left too uncertain in bill C-14, and should be specified. Amendment: § 241.31(3) replace the word “may” in the first sentence with the word “shall.”
- It would be unrealistic to expect that all, or even many, of these amendments will be adopted. But any improvement to the law could save lives.