Dr. David Amies: Old debates delay new laws for assisted dying

Dr. David Amies take a look at the people, policies and events over the past year that have stalled the implementation of physician assisted dying in Canada. (And the political tug of war, he warns, is only getting started.)

The legal saga surrounding physician-assisted death or medical aid in dying — call it what you will ­— drags on. Last Friday, the Supreme Court of Canada gave the new federal government a further four months in which to draft legislation to replace that which was struck down by the court's decision in early February 2015.

In Québec, the way is already clear for those who choose to end their lives because of intolerable suffering. That province drafted its own law and enacted it early December 2015. This law survived a court challenge and is now in place. Furthermore, one patient has already taken advantage of it. For the rest of us, those that live in all the other provinces and territories, the future is rather murkier. As well as announcing the four-month extension last Friday, the Supreme Court gave persons not living in Québec the right to appeal to a superior court judge in their home province if they wish to gain access to medical aid in dying. This is a temporary and interim measure put in place while the federal government gets its act together.

The last federal government, under the leadership of Stephen Harper, set up a panel of inquiry, chaired by Professor Harvey Chochinov, to look into the whole question. It has just reported its findings. A Provincial-Territorial panel led by Ontario conducted its own inquiry and published its findings before Christmas. The new government has announced the list of senators and members of Parliament who will constitute yet another group charged with looking into the matter of medical aid in dying. I am not quite certain what this latter committee’s terms of reference will be but perfectly sure that much old ground will be covered again.

I understand, but don't really sympathize, with the desire to have a made-in-Canada solution to all problems. We should not forget that a handful of respectable European countries and American states have had similar legislation on their books for some years. It is likely that these jurisdictions have solved many of the problems inherent with such legislation. In other words, is there any need to spend large sums of money and lots of time reinventing the wheel?

Laws won't please everybody

André Picard, medical columnist for The Globe and Mail, has recently suggested that all politicians should show as much courage as the general public in this matter. It is going to be very difficult to frame laws on such a matter that will please everybody. Some religious folk will argue that only God can determine the length of a human life. They are perfectly entitled to this view but must understand that sentiments of that sort are quite meaningless to those who do not share their faith. Consequently, they must not expect their views to apply to all. Many health professionals will argue that their job is to preserve life rather than to take it. This point of view must also be respected but it is not universally held.

Dr. David Amies

Lethbridge, Alberta's Dr. David Amies.

Any new laws should allow those, who wish to bring their own personal suffering to an end, to do so with the help of willing medical professionals. These new laws will surely have built-in precautions to ensure that all who are mentally competent, and faced with an incurable condition causing unendurable grief and who wish to end their lives with professional assistance may do so but that neither patient nor health professional, acts under coercion. Unfortunately, it is likely, that some people will seek to game the law. For example, venal heirs might persuade rich, old aunt Matilda that she has become a burden. We shall all have to do our best to ensure that such venality is very rare. On the other hand, we must not allow the perfect to become the enemy of the good.

More changes ahead

It must also be recognized that legislation concerning this matter due to be introduced in June of this year will not be the last word. Attitudes will evolve. It could be that emancipated minors will be allowed to apply for medical aid in dying. Perhaps advance directives will be accepted as legitimate applications. We shall have to see how things play out once physician-assisted dying is in place right across the country. I suspect that what obtains in 10 years’ time will be quite different from what comes to pass later this year.

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

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