OTTAWA — Medical assistance to die should be available to eligible Canadians in hospitals or at home as long as two doctors approve the request, a patient gives “informed” written consent witnessed by two independent witnesses, and a certain waiting period is observed before the act.
Released Thursday in Ottawa, the report by a joint Senate-Commons committee says it looked how to put the Supreme Court of Canada’s 2015 ruling into effect through criminal code changes as well as other procedural supports.
It coined its own term for physician-assisted suicide, saying it endorsed medical assistance in dying, or “MAID.”
It says patients should be able to give advance consent to die “any time after one is diagnosed with a condition that is reasonably likely to cause loss of competence or after a diagnosis of a grievous or irremediable condition, but before the suffering becomes intolerable.
“The committee has worked diligently and in a non-partisan manner to present the government with a report that balances the rights of Canadians to access medical assistance in dying and protects vulnerable populations and our medical professionals,” said Rob Oliphant, committee chair and Liberal MP, in a statement.
“We trust doctors with our lives and our living, we also need to trust them with our deaths and our dying,” added Oliphant.
Speaking to reporters, Justice Minister Jody Wilson-Raybould wouldn’t say when the government would introduce legislation, but did say she expects cabinet to consider the issue in the upcoming weeks.
She said she had not yet read the report herself and declined to say what recommendations might make their way into the new law.
“We’re looking to ensure we continue to take an empathetic approach. We want to create balance in our approach that recognizes the autonomy of individuals, that recognizes the need to protect the vulnerable, that respects the conscience rights of medical practitioners,” Wilson-Raybould said.
“That will take a little bit of time,” she said.
Among the conclusions, the committee said medical assistance in dying “should be able to be performed in any appropriate location, not only in hospitals, including in a person’s home.”
It set out a framework that largely followed last February’s Supreme Court ruling in the case known as Carter vs. Canada after a B.C. woman, who, among others, challenged the law’s ban on assisted suicide.
The report sets out how doctor-assisted suicide for grievously suffering Canadians should work, and provided what the committee said were additional “substantive safeguards.”
It said such medical assistance in dying should only be available where:
• There is a “grievous and irremediable medical condition (including an illness, disease or disability).
• Enduring suffering that is intolerable to the individual in the circumstances of his or her condition is required.
• Informed consent is required.
• Capacity to make the decision is required at the time of the request, whether it be made in advance or not.
• Eligible individuals must be insured persons eligible for publicly funded health care services in Canada.
Among what it called “procedural safeguards” were:
• The requirement that two independent doctors must conclude that a person is eligible.
• A request must be in writing and witnessed by two independent witnesses.
• A waiting period is required based, in part, on the rapidity of progression and nature of the patient’s medical condition as determined by the patient’s attending physician.
It called for annual reports analyzing medical assistance in dying cases to be tabled in Parliament as a way to oversee how the process is working across Canada.
It recommended support and services for the grievously ill, and said that “culturally and spiritually appropriate end-of-life care services for indigenous patients” should be improved to ensure that requests are based on free choice, particularly for vulnerable people.
Conservative vice-chair of the committee MP Michael Cooper said the Conservatives decided to issue a minority report because the majority “failed to follow the roadmap of the Supreme Court” that assisted suicide should be a “right of competent adult persons” only.
“We find it very troubling that the committee would open the door to physician-assisted suicide to minors,” Cooper told reporters, and it fails to recommend safeguards “for vulnerable persons.”
Cooper said “the most glaring example” is that there “are almost no safeguards for persons with underlying mental health challenges.”
He said the scheme as set out puts vulnerable persons “at risk and does not protect their rights, nor those of medical professionals.”
One advocacy group responded quickly to the report. The head of Dying With Dignity Canada, Shanaaz Gokool, welcomed the recommendation to allow people to consent to a medically assisted death in advance of when it becomes impossible to do so.
“Patients deserve real choice,” she said.
“Without the option to consent in advance to assisted dying, Canadians with dementia who want to die in peace with the help of a physician face a dire choice: access assisted dying prematurely, while they are still competent, or risk losing competence before their wishes can be carried out, only to be condemned to the exact fate they sought to avoid.”
In a written release, Gokool thanked the committee for recommending that all publicly funded hospitals, hospices and long-term care facilities be required to allow assisted dying on their premises.
“Unless taxpayer-funded healthcare facilities are required to allow aid in dying on-site, then terminally ill patients in many regions of the country will effectively be denied their right to die with the help of a doctor,” she said.