Webcast archive: Draft regulations for Canada’s euthanasia and assisted suicide law

This week, we’re looking at Health Canada’s long-awaited regulations for monitoring assisted suicide.

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

  • Draft regulations for Canada’s euthanasia and assisted suicide law

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


  • Happy New Year, everybody!  The day after our last webcast, on December 16, Health Canada issued draft regulations for monitoring the assisted suicide and euthanasia program.  We’re using that term instead of the program’s official name, Medical Assistance in Dying, (or MAiD), because of our policy to avoid softening the language around medical killing.
  • We’ve looked at the proposed regulations carefully and have a lot of comments to make, so let’s get started.
  • Canada Health said the primary purpose of the monitoring program was to “provide transparency and foster public trust.”  Among the program’s objectives were “support the protection of vulnerable individuals” and “help determine whether the legislation is meeting its objectives.  For several reasons, we don’t believe the proposed regulations will meet these goals:
    • The regulations were prepared following a secret “pre-regulatory” process where unnamed individuals and organizations were consulted in developing the first draft of the regulations.  We are not aware that any consumer or disability rights groups were invited to participate, and this lack of input shows in the proposed regulations.  Health Canada did not provide minutes of these meetings or a list of who participated.  So much for transparency and trust.
    • The proposed regulations do not collect enough information to tell us:
      • What are the “characteristics of individuals who request AS/E, the circumstances in which requests arise, and whether individuals are seeking assisted dying due to certain socio-demographic conditions, as opposed to suffering emanating from their medical condition and the dying process.”
      • Whether the safeguards are effective in preventing ineligible people from being euthanized, and protecting vulnerable people from being induced to commit suicide in a time of weakness.
  • The regulations don’t include any way to verify that doctors are actually filing reports.  As we’ve seen in Québec and European countries, non-reporting of medical killing by doctors is a major problem that leads to a distorted picture of how many people are dying by euthanasia and assisted suicide.
  • The regulations put the responsibility for enforcing the law back on local law enforcement agencies, but without a clear system for informing them of violations.  Nor do the regulations guarantee that local authorities will have the means and incentive to prosecute violations.
  • As is the case in Oregon and Washington, the regulations don’t track what happens to “assisted suicide” prescriptions for lethal drugs once they are written.  There is nothing to prevent a third party from stepping in to administer the lethal dose to the person against their will.  Not tracking the drugs means they could be left around the house, subject to theft and resale, or being accidentally taken by children.  Nor is any information about complications of self-administered drugs (choking, vomiting, waking from coma) collected.
  • The regulations say that doctors can file reports either with a provincial authority or via a federal online questionnaire, which is still to be developed.  But the regulations don’t explain what happens if the report provided by the doctor or the provincial authority is incomplete.  What is the process for getting more information or clarifying answers that are unclear?  What happens when (as is sometimes the case in Québec) a request for more information still doesn’t answer the questions, or doctors simply refused to provide the information asked for?
  • The regulations will not be effective in monitoring the program should eligibility be expanded to include minors, people whose suffering is purely psychological, or those using advance directives in case of dementia.  Obviously, the regulations would have to be updated, but this should be stated clearly.
  • There is still no effective safeguard in the law or regulations to prevent a third party from making a request on behalf of a person who has a communication disability or who is under the influence of the third party.  This is a loophole in the law itself, which could have been closed by the regulations.
    • By requiring practitioners to meet one-on-one with the person making the request (without any family or others in attendance) to verify that there is no coercion;
    • By making the requirement for communication accommodations more specific and applying it earlier in the eligibility determination process, to ensure effective and unbiased communication;
    • oBy adding a “protective services” evaluation to the capacity stage of the eligibility determination process to detect potential abuse.
  • The regulations do not attempt to track the participation of assisted suicide advocates in the request and eligibility determination process.  This is important in order to:
    • Avoid the potential for the advocacy group to persuade the person that AS/E is the best choice, even if the person is ambivalent.
    • Track how much money the advocacy group may be making for their services through “donations” or “legacies” made by the person.
    • Prevent advocacy organizations’ participation having an effect on the process.  Advocates may be asked to act as witnesses to the signing of the application, and practitioners may begin to off-load certain tasks (of informing or documentation) onto them.
  • Demographic information collected is insufficient to determine the role of economic factors in a decision to request AS/E.  Household composition and income, home-ownership (or lack thereof), date of onset of disability, and illness- and disability-related expenses are all factors that affect the person’s economic situation.
  • It appears that, during the closed pre-regulatory process, Health Canada bowed to pressure to push back deadlines for doctors’ reports.  Also, they have also broadcast their intention not to enforce the timelines; by stating that “events [don’t] occur within particular time frames.”  In other words, the regulations seem to allow that, if the request does not result in euthanasia, the obligation to report it will disappear after 90 days.
  • The proposal to allow for multiple systems for collecting data (federal or provincial “recipients”) could create confusion and a lack of uniformity.  Also, if provinces are submitting reports with data that’s already clumped together, will it be possible to find enough information about individual cases to tell if there is a violation?
  • There is no requirement to document the process of death by euthanasia; e.g. time between injections, onset of coma, time between administration and death, documenting complications, and what measures are taken to resolve them.
  • The proposed regulations don’t say how long the data will be kept.
  • Where the person making the request is determined ineligible, demographic data is not collected.  Information about the application of safeguards is also not required.  Some of these steps should be verified before the eligibility determination proceeds, including:
    • Ensure the request was made in writing and duly signed, dated and witnessed;
    • Ensure the person was informed they had a grievous and irremediable medical condition;
    • Inform the person they may withdraw the request at any time;
    • Take all necessary measures to ensure effective communication.
  • All safeguards should be verified where the person becomes ineligible during the assessment process.
  • The proposed demographic information to be collected includes place of residence (but does not offer the option of “homeless” or “long-term hospitalization”), postal code, marital status and occupation during working life.  Additional demographic information that should be collected:
    • Race
    • Religion
    • Ethnic background
    • Household composition
    • Income range
    • Is the person a home-owner?  Homeless?
    • Language spoken (whether person is receiving services in their first language)
    • Whether medical condition is:
      • Lifelong / onset in childhood
      • Adult onset
      • Recent (within one year) onset
    • Who is the primary health care provider?
    • How many hours of personal care are required per day?
    • Are the person’s personal assistance needs being met, and by whom?
    • Does the person report problems in their living situation?
    • Is there supplemental health insurance?
    • Expenses related to illness / disability
  • To read the draft regulations, visit the website (http://www.gazette.gc.ca/rp-pr/p1/2017/2017-12-16/html/reg6-eng.html) or find it by doing a google search on “Health Canada regulations MAiD” and following the links.  Comments are due on February 13, 2018.  We encourage you to submit your own comments.
  • We will post our draft comments on our website as soon as we finish the French translation.