Dr. David Amies: With assisted dying report in hand, Ottawa has building blocks for new legislation

Dying With Dignity Canada Physicians Advisory Council member Dr. David Amies examines the recommendations put forward by Parliament's Special Joint Committee on Physician-Assisted Dying, describing the report's emphasis on patients as "gratifying."

The report from the special joint committee on physician-assisted dying was handed down on Thursday, February 25. The committee spent over 60 hours interviewing witnesses and reviewed over 100 written submissions. I sat in by video conference link on three of the committee sessions and was very impressed with the general tone of the proceedings and the seriousness and diligence with which committee members went about their work. Another important factor was that their report was entitled, “Medical assistance in dying: a patient-centred approach.” The emphasis on patients rather than on health professionals and institutions was very gratifying. The committee handed down more than 20 recommendations in this article will draw attention to those that I consider the most significant and important.

The committee report should make gratifying reading to the more than four out of five Canadians, who have expressed their support for physician aid in dying in poll after poll. Borrowing language from the Supreme Court’s decision, it recommends that eligible patients should be suffering "terminal or non-terminal grievous and irremediable conditions that cause enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” It has no truck with those that wish to end their lives, "because it has lost its sparkle," like the recent case of the 50-year-old Englishwoman, who attended a clinic in Switzerland. Similarly, the committee acknowledged those suffering from psychiatric disease, which has become unendurable, should not be barred from choosing to end their lives. It considered that informed consent was necessary and in cases where there was doubt about mental competence, psychiatric opinion should be obtained. Furthermore, the Supreme Court's ruling held that only adults (i.e. those 18 years of age and older) would qualify. The committee appeared willing to consider the plight of certain minors and to suggest that in the course of time the limits could be widened to include them.

Advance requests, conscientious objection

They did not stop there. They recommended that advanced requests should be acknowledged. They saw no reason why critically ill and terminal patients, who had made all of the appropriate arrangements and who then slipped into a coma, for example, a couple of days before their assisted dying could be carried out should not have their wishes granted.

Their views about conscientious objection on the part of healthcare professionals and the management of religiously run hospices and nursing homes inclined much more to the plight of the patient than to the discomfort of the objectors. In no way did it suggest that anyone should be obliged to take part in ending life prematurely. However, it was definitely of the view that mandatory regulations would be necessary to ensure that a patient would not be left to his or her own devices in arranging for a medically assisted death. It was even more firm in its views about institutions. In short, hospices and nursing homes in receipt of public funds should not forbid the commission of physician-assisted death on their premises.

The committee recommended that nurse practitioners and fully licensed nurses should be permitted to administer the medications required to bring life to an end. It pointed out, as well, that pharmacists had a role in the matter.

It recommended that arbitrary waiting periods had no part to play and that any such delays should be flexible and dependent upon the clinical situation.

Lastly, it acknowledged that Canada's indigenous people had special considerations which should be acknowledged and accommodated as far as possible.

Some committee members and representatives of the New Democratic Party submitted two dissenting reports. The NDP representatives were in overall agreement with the main report but wanted more provision for palliative care. The dissenting members had concerns about minors and the mentally ill. They wanted greater focus on palliative care, provisions for conscience and arrangements involving advanced directives.

It looks as if the Parliamentary joint committee has been sensitive to the views of the vast majority of Canadians. Its report is unexpectedly liberal. The dissenters and the NDP call for better palliative care, and no one could argue against that. In an ideal world, palliative care would ensure that everyone, regardless of any illness or condition, would die quietly and peacefully in their own bed surrounded by their nearest and dearest. Unfortunately, medical science and healthcare systems have a fair way to go before such a utopian state of affairs comes along. There are those, like the Roman Catholic bishops of Alberta, who hold that the deliberate ending of life is immoral. Such are welcome to their views and do not have to avail themselves of any legislation that may be written in the near future.

Time to get to work

We must all now hope that the Parliament will be guided by this report and produce simple and straightforward legislation. By the same token, we must hope that the various medical licensing bodies across the country do not concoct over-restrictive and contradictory regulations to control and confuse health care practitioners. The last thing that we need is a hodgepodge of arcane and unhelpful rules that differ from place to place.

(Header photo credit: Maria Azzurra Mugnai/Wikimedia)

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