Dr. David Amies: We've come a long way, but there's so much more to do

Dr. David Amies takes a look back at the progress of the right-to-die movement since that monumental February day and the bumps along the way: from changing prime ministers to the granting of a four-month extension. He then predicts what we can expect to happen in the next three months as we count down to June 6th, when assisted dying will finally become legal.

Events are moving quickly, and in three months’ time, physician-assisted dying will be legal across Canada. Therefore, I thought it might be useful to write a progress report detailing where we have come from and where it looks like we will end up.

Looking back

In February 2015, the Supreme Court of Canada unanimously struck down the prohibition against assisted dying. In Carter v. Canada, the court ruled that, under certain circumstances, denying a grievously ill person the right to seek to have his or her life ended was a denial of freedom. It then gave the federal government one year to enact new legislation. Unfortunately, not much happened for four months until the government under Stephen Harper set up a committee of inquiry to look into the problem and to advise. Almost immediately thereafter, Harper called a general election for October, which he eventually lost.

His replacement, Prime Minister Justin Trudeau, found that the federal government did not have sufficient time to look into the matter properly and to write suitable legislation by the deadline of February 6, 2016. His government returned to the Supreme Court and asked for an extension which was granted, giving them until June 6, 2016 to complete the task. The Supreme Court also made interim arrangements to enable suitably qualified persons to apply to provincial courts in order to obtain personal exemptions, thereby giving them access to physician-aided dying.

Since February 2015, provincial and territorial governments of which there are thirteen in total, along with the various licensing authorities, have been examining the problem and advising physicians on how to proceed.

A joint parliamentary committee was struck early this year. It held public hearings, invited numerous witnesses and issued its report at the end of February. The committee widened the scope of the Supreme Court's Carter decision. For example, it mused over the definition of adulthood: is an adult one who has reached the age of majority or does an emancipated minor qualify? After all, the age at which one can give consent in sexual matters is 16 years. One can vote at the age of 18 but cannot legally buy a drink in a pub. It would be a brave and foolish physician who carried out a surgical procedure on an intelligent 15-year-old who did not wish it to take place.

The committee also pondered the question of whether registered nurses or nurse practitioners could administer lethal medications intended to bring life to an end or whether such a task should be limited to licensed medical practitioners. It suggested that, under certain circumstances, advanced requests and directives be honoured even though the patient might not be able to give consent at the moment immediately before death.

The committee threw cold water on the notion that arbitrary mandatory waiting periods be necessary. It suggested that such periods be related to the clinical situation. It leaned in favour of having two unrelated physicians make the decision jointly before going ahead. It seemed not to object to considering severe psychological disease grounds for physician-assisted death. It recognized that psychological disease added additional complexity in determining competence.

The question of protecting the rights of healthcare workers to not take part because of conscientious, moral or religious reasons took a great deal of the committee's time. The committee acknowledged that religiously run and operated institutions, such as hospices and nursing homes, might not wish to have physician-assisted dying performed on their premises. Clearly no one who has such objections can be forced to bring another's life to an end, but physicians are under an obligation not to abandon their patients.

Moving forward

The federal government has declared that it will write new legislation. If that is so, then we can expect a draft to be tabled in the House of Commons during the next week or two. Passing such legislation will take most of the time left before June 6. Provincial governments and licensing authorities are hard at work trying to resolve the many and various dilemmas that the Carter decision has thrown up: a definition of adulthood and procedures to deal with conscientious objection, oversight, record-keeping, and review. There does seem to be a concerted effort to institute uniform procedures so that a ghastly patchwork of rules and regulations does not eventuate.

If the polls are to be believed, an overwhelming majority of Canadian citizens are in favour of physician-assisted dying. We can expect lively debates in the house, as well as rearguard actions by religious groups and such organizations as the Coalition Against Euthanasia. I am confident that we shall have new laws in place by June 6, although there are many very large “t’s” to be crossed and “i’s” to be dotted. 

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.

(Header photo credit: kevandotorg/Flickr)

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