Introduction

Webcast archive: Senate removes end-of-life requirement

This week, we discuss the latest amendment to Bill C-14, as well as the ways each province will provide assisted suicide.

Webcast archive: Senate removes end-of-life requirement

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

  • The Senate removes the end-of-life requirement for Bill C-14
  • A variety of regulations across Canada

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

THE SENATE REMOVES THE “END OF LIFE” REQUIREMENT

  • On Wednesday the Senate voted to amend Bill C-14 to remove the requirement that a person’s death be “reasonably foreseeable” in order to qualify for assisted suicide or euthanasia.
  • According to Michael Bach of the Canadian Association for Community Living, this move is “profoundly concerning and we believe this crosses a bottom line for all of us.”
  • CACL is calling on all supporters of the vulnerable persons standard to contact their MPs and ask them to reject the amendment.  The action alert pointed out that respected constitutional experts believe the “end-of-life” requirement does not violate the Charter or the Supreme Court’s decision in the Carter case.  CACL also believes it’s more important to respond to people’s suffering with supportive services rather than assisted suicide and euthanasia.
  • To reach the Senators or your member of parliament, visit www.parl.gc.ca and click on the “Senators and Members” tab.

A VARIETY OF REGULATIONS ACROSS CANADA

  • With the June 6 deadline past, and still no federal law governing assisted suicide and euthanasia, each province is regulating assisted suicide in its own way.
  • This situation will continue until the Senate finishes amending Bill C-14, and the House of Commons and the Senate come to an agreement on the final bill, which could take months, or never happen at all.
  • Aside from Québec, which already has a statute on the books, some provinces have already said they will not prosecute doctors who carry out assisted suicide or euthanasia according to the terms of the Carter decision, and the guidelines issued by each province’s Colleges of Physicians and Surgeons.
  • While these guidelines have some things in common, they do not create a complete or uniform system across the country to regulate assisted suicide and euthanasia.
  • Some things all of the guidelines share in common:
    • Two doctors must independently agree that the person meets the criteria laid out by the Supreme Court
    • The person must have a grievous and irremediable medical condition (including an illness, disease or disability)
that causes enduring suffering that is intolerable to that person.
    • The person must be capable of giving consent throughout the process; no advance directives are allowed.
    • Doctors must ensure the request is voluntary (free from coercion) and informed.
    • Doctors may refuse to perform assisted suicide or euthanasia.
    • Requests must be in writing
    • The request must be persistent, though a waiting period is not always required.
  • However some requirements vary from place to place.
    • That the person be an adult – Alberta may allow access for “mature minors” in some cases, and age of consent in New Brunswick is 16 years.
    • That the doctor who refuses to provide assisted suicide must refer the person to another doctor – Manitoba and New Brunswick do not require doctors to make a referral.
    • Ontario’s guidelines openly encourage doctor-shopping, where “the patient is entitled to make a request for physician-assisted death to another physician” if he is refused by a doctor.
    • In some provinces the written request must be witnessed by only one person, elsewhere two witnesses are required.
  • Other province-specific provisions include the following (information derived in part from an article posted on the CBC website on May 26, 2016).
  • Alberta
    • Requests must be in writing, signed by the patient and two witnesses, at least one of whom can not be related to the patient, entitled to any portion of the patient’s estate or involved in treatment of the patient.
    • Where capacity is unclear or where a person is suffering from depression or other mental illness, a psychiatric or psychological consult is required.
  • British Columbia
    • A formal written request is required, signed by the patient and one witness who is not related, entitled to a portion of the patient’s estate, or involved in treatment.
    • Consultation with a physician by video is allowed.
    • The death certificate should indicate that death was caused by assisted suicide or euthanasia arising from the underlying medical condition.
  • Manitoba
    • An independent psychiatric assessment is required where a patient
      • does not have a terminal illness (prognosis of less than six months)
      • is not suffering from a “catastrophic and irreversible physical injury” or
      • intractable physical pain or
      • an advanced state of irreversible, significantly impaired function or imminent decline to that state.
    • The assessment must rule out a treatable psychiatric disorder that is impairing the person’s ability to tolerate suffering or assess treatment options.
    • A waiting period of at least seven days is required, except for those whose death is imminent.
    • The doctor must be qualified to administer euthanasia or assisted suicide.
  • New Brunswick
    • Patients with progressive illnesses who are also suffering from “intractable depression” are not automatically ineligible but doctors should proceed with “extraordinary caution” in such cases.
    • The person must make two requests for medical aid in dying two weeks apart, and again just before assisted suicide or euthanasia is administered.
    • The physician should obtain additional medical opinions as deemed appropriate to confirm prognosis, alternative options, and patient’s capacity to make a free, fully informed choice.
    • Information should not be reported to an oversight authority, except “anonymized epidemiological data.”
  • Newfoundland and Labrador
    • Written request required, signed by patient and one independent witness.
    • The age of adulthood is 19 years.
    • The doctor must ensure effective communication with the person.
    • The cause of death is the underlying condition; the mechanism of death is assisted suicide/euthanasia.
  • Northwest Territories
    • The guidelines follows very closely the version of bill C-14 that was adopted by the House of Commons, including the requirement of a reasonably foreseeable death.  The NWT version offers more structured safeguards.
    • The medical practitioner must assess the patient in person.    The consulting doctor may make the assessment by distance.
  • Nova Scotia
    • If the underlying condition includes mental health, one of the doctors must be a psychiatrist.
    • The doctor must ensure effective communication.
    • The consulting doctor can carry out the euthanasia/assisted suicide.
  • Ontario
    • The guidelines note that the Supreme court did not define the term “adult.”
    • A formal written request is required, signed by the patient, the attending physician and an independent witness.
  • Prince Edward Island
    • The doctor must have qualifications to diagnose the condition and administer euthanasia or assisted suicide.
    • The doctor must inform the person of alternatives and help the person access them if they so desire.
  • Quebec’s law, adopted before the Supreme Court ruling, requires that:
    • A person must be:
      • covered by provincial health care, be of “full age” (18 years) and capable of giving consent
      • at the end of life,
      • suffering from a serious and incurable illness, in an advanced state of irreversible decline and
      • experiencing constant and unbearable physical or psychological suffering which can’t be relieved in a manner acceptable to the person.
    • Two doctors must agree that the person meets the criteria for euthanasia.
    • The request must be made in writing.
    • No advance requests.
    • Physicians may refuse to provide euthanasia but must immediately notify authorities who will take steps to find another doctor.
  • Saskatchewan
    • The person must fill out a prescribed form confirming informed consent to receive assisted suicide or euthanasia.
    • In case of doubt regarding capacity, the person must be referred for a “further capacity assessment.”
    • The doctor must inform the person of alternatives and help the person access them.
  • Yukon
    • If a physician believes the person suffers from psychiatric or psychological disorder or depression that could impair capacity to make an informed choice, the person must be referred for assessment.
  • None of the provincial guidelines requires doctors to report the assisted suicide or euthanasia.