The five year review of MAiD: will parliament do its job?

Anything less would be a betrayal of the democratic process and the public trust.

In its 2015 decision in Carter v. Attorney General that struck down the prohibition on physician assisted dying, the Supreme court said that protecting “vulnerable” people (like elders, women, LGBTQI, disabled folks, indigenous and racialized people) would require a “carefully designed system imposing stringent limits that are scrupulously monitored and enforced.” This makes sense. If society is going to reverse public policy and allow doctors to kill people rather than helping them live, it would seem logical to put all possible safeguards in place, then to look carefully at how that program works in practice, to be sure the safeguards work as advertised.

It would seem logical, unless you are the Liberal Party of Canada, the New Democratic Party and the Bloc Québécois. These champions of individual liberties have determined that it’s appropriate to go ahead and expand access to euthanasia before doing the five year review required by the 2016 medical assistance in dying (MAiD) law.  They want to limit the mandated scope of that five-year review to only look at expanding eligibility to new populations, and to blow off any examination of how the law works in practice. 

Bill C-7, which is being fast-tracked by the liberal government to meet a court-imposed December 18 deadline, would expand access to euthanasia beyond what was called for in the Truchon c. procureur général decision. The Québec superior court in Truchon struck down the requirement that the person’s natural death must be “reasonably foreseeable,” and the Liberal government of Justin Trudeau chose not to appeal. In doing so, Trudeau’s government signaled it’s approval for euthanasia of people with disabilities who are not near the end of life, whether or not the 90-day “waiting period” ends up in the final version of Bill C-7 and withstands judicial scrutiny. Bill C-7 would reduce the number of witnesses required to sign the written request from two to one, and allow that person to be a care provider, thus setting the stage for an abusive caregiver to coerce a person to ask for death, and then serve as the only witness to the request. Rather than clarifying what it means for someone’s natural death to be “reasonably foreseeable” (or dispensing with the slippery and malleable term altogether), the bill puts those folks (pushing 20,000 deaths already) on a fast-track to death.  The bill would eliminate the ten-day reflection period, as well as the requirement that the person be able to verify their consent when the lethal injection is given, creating a de facto advance directive. So even if you have to wait months for psychiatric care, you can get the deadly dose right away.  That person with the abusive caregiver mentioned earlier; no one will even blink if they’re euthanized the same day they’re approved (as happened in Québec).  

Having put the statutory amendment cart before the five-year-review horse, the Liberals further propose to limit the scope of what will be considered in the mandated review. Instead of looking at “the provisions enacted by this Act” the Liberal government has decided that it will focus instead on expanding eligibility “to requests by mature minors, to advance requests and to requests where mental illness is the sole underlying medical condition.”  Those questions definitely need to be aired in a public forum, since the working groups of the Council of Canadian Academies didn’t make it easy for the public to have input into their 2018 studies. However, doing so is not a substitute for an in-depth review of the law and its impact.

Parliament must determine whether the MAiD law satisfies the mandate set out by the Supreme Court in the Carter case, whether the monitoring system is robust enough to detect problems, prevent the deaths of ineligible persons and impose consequences for those deaths. The five-year review could also answer the question whether it’s possible to enforce the MAiD law, let alone if it’s being enforced. Anything less would be a betrayal of the democratic process and the public trust.