Canadian bill to allow medical suicide even if death not 'reasonably foreseeable'

Ottawa, Canada, Feb 25, 2020 / 15:00 pm

A bill has been introduced by the Canadian government that would further liberalize the country's "Medical Assistance in Dying" (MAiD) laws and allow those without terminal illnesses to end their lives. Doctors have raised concerns that the psychological needs of MAiD patients are being ignored. 

The bill, introduced on Monday, Feb. 23, would "remove the requirement for a person's natural death to be reasonably foreseeable in order to be eligible for medical assistance in dying," and would "introduce a two-track approach to procedural safeguards" depending on if a person's natural death is "reasonably foreseeable." 

The changes will introduce "new and modified safeguards" for people who are deemed eligible for euthanasia but who are not predicted to die in the immediate future. For persons who were previously eligible for MAiD prior to the new law, such as those with cancer or a neurodegenerative disease, "existing safeguards will be maintained and certain ones will be eased." 

The bill also creates advance directives for persons with a reasonably foreseeable death "who may lose capacity to consent before MAiD can be provided," as in the case of someone diagnosed with dementia. 

Those with mental illness as their only underlying condition will not be permitted to access an assisted death under the new bill. 

The bill was written in response to the September 2019 decision by the Supreme Court of Quebec that found that the previous regulations regarding a "reasonably foreseeable death" was in violation of the provisions in the Canadian Charter of Rights and Freedoms that guarantee all Canadians rights to life, liberty, and security of the person. 

That case concerned two Canadians who were stricken with incurable, but not terminal, illnesses that caused debilitating pain. They had both been denied euthanasia. 

The Canadian federal government announced that the decision would not be appealed, and new laws will take effect in Quebec in April.

During the leadup to the introduction of the new federal bill on Monday, a survey was posted online for Canadians to weigh in on the updated legislation. This survey concept was criticized by the Canadian Conference of Catholic Bishops, who said in a letter that while they "agree in principle with consulting Canadians," they found the questionnaire to be flawed on multiple levels. 

It is "inappropriate and superficial to use a survey to address grave moral questions concerning life and death," wrote Archbishop Richard Gagnon of Winnipeg, president of the conference. He added that he believed that the two-week for responses was "entirely insufficient" to study the issue of euthanasia.

Members of the Canadian government praised the new bill and the potential expansion of euthanasia in the country. 

"We are proud to announce proposed changes that have been informed by [Canadians'] views as well as by Canada's experiences to date in implementing the 2016 medical assistance in dying regime," said Minister of Justice and Attorney General of Canada David Lametti in a statement published by the government.

A 2019 CBC profile of Lametti upon his appointment as Minister of Justice described him as someone who was driven by his Catholic faith.

"He has a deep faith, but not the kind that goes out there and proselytizes, but it motivates him," said Richard Gold, a colleague of Lametti's. Gold characterized Lametti's faith as what made him "want to do good in the world." 

While parliament considers the new bill, a psychiatrist and a lawyer who works with palliative care are raising the alarm that the overwhelming majority of MAiD patients are not given a psychiatric examination prior to their deaths, even though 96% of MAiD patients say they have "psychological suffering." 

According to a study in the Canadian Medical Association Journal, only 6.2% of MAiD cases were given a psychiatric consultation, and only 15% of adults who died in Ontario from 2016-2017 received palliative care. 

In an article published in the Ottawa Citizen, Dr. Timothy Lau, a psychiatrist, and Dylan McGuinty, a lawyer and the director of a Catholic healthcare provider which provides palliative care, pointed out that studies have shown that palliative care is provided relatively late in the dying process-and that people are not being seen early enough. 

A 2018 study in Quebec found that "in 32 per cent of cases, palliative care consults came less than seven days prior to the request for MAiD, and in another 25 per cent of cases palliative care consults occurred the day of or after assisted death was requested," said Lau and McGuinty.

"If we believe in choice, then we are not offering true choice when palliative care consults are offered so late in the journey towards death," they added.

The Quebec study found that the earlier a person has access to palliative care, they experience fewer depressive side effects and have a higher quality of life, Lau and McGuinty wrote. They suggested that increased access to palliative care services could reduce the need for assisted deaths. 

"Instead of helping people die, is the answer not rather to accompany the dying compassionately on the journey towards death - with an early intervention of the full complement of palliative care services," which include treatments for the patients emotional, spiritual, and psychological needs, in addition to treatment for physical ailments. 

Lau and McGuinty worry that assisted suicide is becoming a "treatment" for depression, rather than a "tragic consequence" of the condition. 

"Therefore, we invite Canadians to join us in demanding timely, complete and universal palliative care and mental health services, especially for those crying for help through requests for MAiD," they said.