The Government of Ontario's online survey on physician assisted dying is not a math test. It's anonymous, and you're not being marked, so don't feel that your answers have to be perfect.
Dying With Dignity Canada believes that the questions posed in this survey are generally good and the overall tone of the online survey is positive. That said, we want to flag a few of the questions and would like you to consider the following questions as you complete the survey.
Question #30: Who do you think should have the final say about whether someone has a "grievous and irremediable medical condition that creates enduring suffering that is intolerable" and therefore can participate in physician assisted dying? Select one only.
Background: It may be helpful to know that in all other health-care related issues, it is solely up to the competent adult patient to make their own informed health care decisions. If you consider a different option, it may be interpreted by the provincial expert panel that physician assisted dying should be treated in a fundamentally different way than other health care practices. DWD Canada opposes limiting patient autonomy.
You may wish to indicate in your written letter to the province that a physician who does not think that their patient is suffering intolerably should not be forced to provide assisted dying (but they should be required to provide an effective referral). It is still ultimately the patient who should have the final say.
Question #31: If you could choose, which conditions do you think would make a person eligible for physician assisted dying if they expressed consent for this option? Select all that apply.
- Diagnosis of a terminal illness and given 6 months or less to live (e.g. stage 4 cancer)
- Diagnosis of a degenerative incurable medical condition that eventually (more than 6 months) will result in death (e.g. multiple sclerosis, Lou Gehrig’s Disease (ALS), Alzheimer’s)
- Diagnosis of a chronic condition or serious disability (e.g. chronic pain, quadriplegic following car accident)
- Person suffering from unbearable psychological suffering (e.g. bipolar, schizophrenia, depression, etc.)
- None of the above
Background: According to the Supreme Court's decision in Carter v. Canada, a person with any of the above conditions would be eligible for physician assisted dying.
Question #34: If a patient is eligible and wishes to have physician assisted dying, in which setting should this be allowed to occur? Select all that apply.
Background: DWD Canada believes institutions that receive government funding must allow physician assisted dying on their premises. We also support the right of a person to die at home.
Question #35: This question asks you to rate how much you agree or disagree with a series of statements regarding assisted dying.
The statements are as follows:
a) A patient should have to undergo a psychological assessment if he or she requests physician-assisted dying.
Background: Mandatory psychological assessments are not required in any jurisdictions that currently allow physician assisted dying. Canadian doctors deal with patients' life-and-death decisions daily ("I want to stop chemotherapy," "I would like a DNR order," and "I want to be removed from life support," for example). Physicians routinely consider whether psychological assessments are required to establish consent in these cases. Such assessments will continue when PAD is legal, but should not be mandatory in every case.
b) There should be a waiting or "cooling off" period between when a patient requests physician assisted dying and when it is performed.
Background: The process of asking for assistance to die will take time. There will be forms to complete and assessments from two physicians. Dying With Dignity Canada does not believe a further wait should be imposed on people who are terminally ill. Dying With Dignity Canada is not opposed to a reasonable waiting period, say three weeks, for people who are not terminally ill or imminently dying.
c) Patients who request physician-assisted dying must have two physicians agree the patient is competent and acting voluntarily.
Background: Dying With Dignity Canada believes that is a reasonable safeguard.
d) Family and friends should be allowed to be present during physician-assisted dying.
Background: Yes, if the patient requests it.
e) There should be a formal dispute process if a family member does not agree with a patient’s request for physician-assisted dying.
Background: This is not necessary because a competent adult patient will be able to make their own end-of-life decisions. A formal dispute process would suggest that a party other than the patient should have the final say.
Question #35a: If you strongly or somewhat agree to a cooling off period in the above question, you will also be asked the following: In the previous question, you agreed that there should be a waiting or "cooling off" period between when the patient requests physician-assisted dying and when it is performed. In your opinion, approximately how long should the waiting period be?
Your choices are:
- Less than 1 week
- 1 week
- 2 weeks
- 3 weeks
- 1 month
- 2 months
- Between 3 and 6 months
- Between 6 month and a year
- More than a year
Background: It might be helpful to note that in other jurisdictions where physician assisted dying is allowed, waiting periods vary from none (for Quebec, the Netherlands and terminally ill patients in Belgium) to 15 days (in Oregon and Washington) to one month (for non-terminally ill patients in Belgium).
Question #38: "Do you strongly agree, somewhat agree, somewhat disagree or strongly disagree that doctors/physicians should be required to…"
Background: Here's some context to keep in mind when responding to the third statement ("Discuss alternatives to physician-assisted dying for someone who requests it"). As with all critical care decisions, a doctor should be required to lay out all options available for their patients as part of obtaining informed consent.
Question #39: What are your concerns about physician-assisted dying being legal? Please list your top three concerns.
Your choices are:
- Choosing physician-assisted dying because the patient feels like a burden
- A patient may not actually die (complications etc.)
- Leaving a mess for family
- Being forced/coerced/pressured into it
- Not having access to other alternative care options
- Social stigma of “killing yourself”
- Impact on life insurance
- Other (specify)
- I do not have any concerns about physician-assisted dying
Note: There are other concerns that individuals may have that are not on the list. You may want to address them if you're making a written submission. Here are few issues to consider:
- A doctor with a particular religious background or worldview preventing a patient from accessing PAD
- The prospect of PAD not being accessible in all regions of all provinces and territories
- Onerous barriers to access that prevent patients from accessing PAD and will result in unnecessary suffering