The deadline to pass Bill C-7 is February 26, 2021. As we near the deadline, the ability to distinguish myth from fact has become complicated by an array of messages creating confusion around the bill and its scope, as well as the current medical assistance in dying (MAID) legislation and practice.
Below, you will find a list of key issues being debated by Canadians and studied by Parliamentarians – including the impact of Bill C-7 on people with disabilities, the removal or easing of certain safeguards, the issue of advance consent, conscience rights of clinicians, and DWDC’s position of support for increasing access to palliative care and other end-of-life supports.
Myth: The removal of reasonably foreseeable criterion singles out and devalues the lives of people with disabilities.
Removal of the reasonably foreseeable criterion will expand the constitutional right to seek access to MAID to people who are suffering intolerably but who are not near death. Those with a disability must have the same right to autonomy and end-of-life choice.
DWDC strongly advocates increasing investments into additional supports for people with disabilities, including those targeted at enhancing income and social supports, reducing waiting lists for housing, specialist care, day programs and assistive devices, and assisting with the navigation of a complex and confusing healthcare system.
- Bill C-7 is a response by the Department of Justice to a 2019 ruling in Quebec that found limiting access to MAID to people who are suffering intolerably but whose death is not reasonably foreseeable was unconstitutional as it infringed on the rights of individuals with a physical disability, such as the plaintiffs, Jean Truchon and Nicole Gladu
- Removal of the reasonably foreseeable eligibility criteria will expand the constitutional right to MAID to people who are suffering intolerably but who are not near death
- The proposed removal of the reasonably foreseeable criterion does not remove the requirement that a person must have a grievous and irremediable medical condition and meet all of the following criteria:
- The person has a serious and incurable illness, disease, or disability
- The person must be in an advanced state of irreversible decline in capability
- The person has enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable
- It does not remove the requirement that a person make a voluntary request for medical assistance in dying that is not the result of outside pressure or influence
- January 2020 Ipsos poll conducted on behalf of DWDC: Over 70% support removing the “reasonably foreseeable” requirement
Myth: People with disabilities will be coerced into seeking MAID
Though neither Bill C-7 nor C-14 explicitly speak to the practice of assessing for coercion, the information provided by MAID assessors and providers to DWDC indicates clearly that this is done through on-going and open and honest conversations between clinicians and their patients.
The questions raised by clinicians in their conversations, as they relate to possible coercion, seek to understand:
- whether anyone is pressuring the patient to seek MAID
- the origin of the patient’s request for MAID
- the value system held by the patient
- the consistency of thoughts around MAID
- confirmation of the reason for the consultation in the patient’s own words
- the context around the first time the patient thought about MAID
- whether the patient spoke with anyone else about their thoughts on MAID
Myth: People with disabilities are individuals of a vulnerable group in need of protection from themselves.
As Nicole Gladu states: “Vulnerability is a concept used ad nauseam by paternalistic people in good health (for) standing in the way of MAID”.
From Justice Baudouin, in the 2019 Quebec Superior Court ruling that found the reasonably foreseeable criterion to be unconstitutional as it infringed on the rights of people with disabilities:
- “In the Court’s view, however, we cannot, in the name of the principle of protecting certain persons from themselves or of socially affirming the inherent value of life, deny medical assistance in dying to an entire community of persons with disabilities precisely because of their disability”
- “the vulnerability of a person requesting medical assistance in dying must be assessed exclusively on a case-by-case basis, according to the characteristics of the person and not based on a reference group of so-called “vulnerable persons
- “the patient’s ability to understand and to consent is ultimately the decisive factor, in addition to the other legal criteria.”
Myth: Removing the 10-day reflection period means you can request and access MAID in a day
Forcing someone who has been assessed and approved for MAID to wait an additional 10 days only serves to prolong suffering. DWDC agrees with the proposed removal of the 10-day reflection period.
- The proposed removal of the 10-day reflection period is based on the lived experiences of clinicians, caregivers and family members over the last four years which have made clear that forcing someone who has already been assessed and approved for MAID to wait an additional ten days only serves to prolong suffering
- The argument that removal of the 10-day reflection period means one can request and receive MAID in one-day is misleading. Given the process, this is highly unlikely as can be seen when disease progression is so quick there is little time to implement the required steps in the MAID process
- It should be noted that the procedure may be scheduled to occur in a day where a patient is at risk of death or loss of capacity, and they have already been assessed and approved for MAID
Myth: Reducing the number of required witnesses from two to one just makes MAID easier to access
The requirement for two independent witnesses to witness a request for MAID serves as a barrier to accessing this constitutionally protected right.
- Bill C-7's proposal to reduce the witnessing requirement from two to one is based on the lived experiences of clinicians, caregivers and family members who over the last four years have found the requirement of two witnesses to serve as a barrier to accessing MAID for people living in rural and/or remote communities
- Considering that seeking access to MAID is a highly personal decision, reducing the number of witnesses from two to one will help those who are concerned about maintaining their privacy
- What is being witnessed is only the patient’s written request for MAID
- The witnessing requirement is not and has never been a part of the eligibility/assessment process
Myth: The ability to waive the requirement for final consent means people who have lost the capacity to consent will be killed
With this amendment, no one who has been assessed and approved for MAID will have to choose to end their life early because they fear they will not have capacity to consent at the time of the MAID procedure.
This amendment is of particular importance to people who fear a loss of capacity to consent at the time of the MAID procedure. Further, the amendment recognizes the real-world experiences of patients who feel they have no choice but to reduce or even stop taking their medication(s) for the sole purpose of maintaining their capacity to consent at the time of the MAID procedure.
The waiver of final consent is based on the end-of-life experience of Ms. Audrey Parker, whose last wish was to spend one last Christmas with her family but who was forced to reschedule her MAID procedure to an earlier date in fear of losing capacity.
- Bill C-7 proposes to include the opportunity to waive the requirement to provide final consent (consent just prior to the MAID procedure) if:
- the person's death is reasonably foreseeable, and
- they have already been assessed and approved for MAID, and
- A date has already been scheduled for the MAID procedure, and
- they have made in consultation with their MAID provider a written agreement to receive MAID on the scheduled day if they are no longer able to provide consent on that day
- Consent given in advance is invalidated if the person demonstrates refusal or resistance to the administration of MAID at the time of the procedure
- January 2020 Ipsos poll conducted on behalf of DWDC: 85% support MAID for “patients who meet all the criteria, have been approved and who are competent at the time of the request, but who lose competency before the procedure can be carried out”.
Myth: Bill C-7 completely ignores the protection of the conscience rights of health professionals who object to MAID
Bill C-7 does not propose any changes to any of the existing conscience protections. The rights of health professionals who object to MAID are already protected in Canada’s MAID legislation and in the Charter of Rights and Freedoms. Further:
- The Carter decision states, in paragraph 132, that, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying”
- Although DWDC believes that clinicians who are opposed to MAID should be required to provide patients an effective referral, we recognize this is a provincial issue that should/must be addressed by the respective regulatory bodies
Myth: The government wants to use Bill C-7 to make it easier for people to die rather than investing in end-of-life supports
DWDC strongly supports new investments to increase access to palliative care. DWDC points out that the 2019 report by Health Quality Ontario indicates that about 61% of Ontarians had received palliative care in their final year, an increase of about 3 percent over 2014-15, but about half of those only received it in their final month. DWDC therefore calls upon governments across Canada to increase information on and access to quality end-of-life supports, including palliative care.
- The Carter decision made clear that individuals seeking MAID are not required to pursue treatment that is unacceptable to them
- As per Health Canada’s first annual report on MAID (2019):
- Over 82% of persons receiving MAID were reported to have received palliative care services
- Of those MAID recipients who did not access palliative care services prior to receiving MAID, approximately 90% had access to these services but chose not to do so, according to the reporting practitioner