Advocates on both sides unhappy
On April 14, Justice Minister Jody Wilson-Raybould and Health Minister Jane Philpott, held a press conference in Ottawa to announce the contents of the government’s proposed “medical assistance in dying” bill, C-14. The bill, formerly known as “An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying),” is the government’s response to the 2015 Carter decision in which the government struck down the Criminal Code prohibitions on assisted-suicide and instructed Parliament to come up with a new, permissive law.
The government’s press release stated C-14 “would give dying patients, who are suffering intolerably from a serious medical condition, the choice of a medically-assisted death” and that “this is a compassionate approach that considers all these interests,” including respecting personal autonomy and providing safeguards to “protect against errors and abuses in the system.” It states that “the proposed approach was carefully designed to recognize and respect the individual choice of a medically assisted death for adults who are suffering intolerably and are on a foreseeable course toward the end of their lives.”
Wilson-Raybould said, “Recognizing the inherent dignity and equality of all Canadians, we are proposing the choice of a peaceful death for patients with a serious medical condition who are irreversibly declining and suffering intolerably. After the Supreme Court of Canada’s unanimous decision in Carter, it was no longer a question of whether we would have medical assistance in dying in Canada, but how it would be made available.”
Philpott said, “we will engage with the provinces and territories to support consistency in the delivery of medical assistance in dying, as well as to develop a pan-Canadian monitoring system to collect and analyze data, monitor trends and publicly report on the new regime.”
In their press conference, in the background papers, and in media interviews, the ministers repeatedly said the bill would give dying patients who are suffering intolerably the “choice of a peaceful death.”
In February, the Special House-Senate Joint Committee recommended a broad regime of assisted-suicide and euthanasia, including allowing psychiatric illness to be the sole reason to make a request to be killed, giving “mature minors” (children) access to physician-assisted suicide, and permitting people diagnosed with dementia or other ailments that might affect future competency to spell out their wishes to be killed in advance directives. Polls show the public is much less inclined to support euthanasia or assisted-suicide in these cases, and the government’s bill does not include them.
Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, analyzed C-14. He said that superficially C-14 looks moderate compared to the parliamentary committee report but in reality it does little to protect vulnerable individuals. He said, “Bill C-14 appears more restrictive in comparison to the radical recommendations from the government assisted dying committee. The bill does not extend euthanasia to mature minors, to people with dementia, or to people who seek death by lethal injection based only on psychological reasons and it appears to require the person to have a terminal condition.” However, Schadenberg warned, “in reality the bill provides legal immunity to anyone, who kills another, while the bill fails to provide effective oversight of the law or conscience rights for healthcare professionals.”
The only assurance that conscience rights of health care workers will be protected is a statement Philpott made in a press release: “We will also explore options to support access to medical assistance in dying, while supporting the personal convictions of health care providers.”
Schadenberg outlined several problems with C-14. “The bill does not provide effective oversight of the law,” because it does not require an independent third-party to oversee the procedure; instead it opts to allow assisted-suicide when two physicians or nurse practitioners sign off on the procedure, commit the act, and file a report on the medically assisted-death. Schadenberg said, “Once the person is dead, it is too late to find out that the person who died was incompetent or coerced.”
Furthermore, under Section 241(3), the bill provides legal immunity to “any person” who directly participates in euthanasia and assisted suicide, and Section 241(5) gives legal immunity to anyone who aids a person who self-administers a deadly substance; because “any person” is not defined, Schadenberg argues it could apply to non-doctors and nurse-practitioners, and provide legal protection to anyone claiming to aid a suicide for medical reasons. Schadenberg says “this bill provides the perfect cover for acts of murder.”
Schadenberg also points out that the “15 clear days” between a request for assisted-suicide and the act being committed can be overridden if, in the estimation of the physician or nurse practitioner, death or “loss of their capacity” is “imminent.” Schadenberg said that imminent death is not a requirement for a euthanasia request, noting the preamble of the bill only mentions that death is “reasonably foreseeable,” although nowhere in C-14 is that phrase defined. Yet even then, C-14 does not limit assisted-suicide to the terminally ill. Section 241(2) says that anyone with a “grievous and irremediable medical condition,” is eligible, and defines those conditions as a “serious and incurable illness, disease or disability,” and it “causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.” In other words, Schadenberg says, a patient who refuses treatment that may address the suffering qualifies for assisted-suicide.
In a joint statement, Living with Dignity and Physicians’ Alliance against Euthanasia expressed concern that “there is no requirement that people who suffer be at the end of life to have access to assisted suicide,” but rather “only that ‘their natural death has become reasonably foreseeable (…) without a prognosis necessarily having been made as to the specific length of time that they have remaining.’ It seems to us that everyone’s death is reasonably foreseeable.”
The two groups, through their spokesmen Aubert Martin and Catherine Ferrier respectively, said C-14 is “already far from the idea that was sold to us when this debate began: from proposing death for a few exceptional cases, we’ve reached the point where it’s considered ‘health care’.”
Will Johnston, chair of the Euthanasia Prevention Coalition of British Columbia, said “ideally,” the law should be thrown out and instead require palliative care access, not suicide access, mandatory in law” to comply with the Supreme Court’s Carter decision. But if that is not possible, judicial oversight is necessary: “at a bare minimum ensure independent third party review before all proposed deaths.” EPC legal counsel, Hugh Scher, said in a statement, the best but still fallible way to protect vulnerable people is requiring “prior approval by the court or an expert panel.” Scher explained, “it is the only way to ensure compliance with legislative criteria established to identify vulnerability and prevent abuse of the law before people are put to death.”
Campaign Life Coalition wants the government to go back to the drawing board. Jim Hughes, CLC national president, told The Interim, “MPs must oppose this bill because killing innocent human beings is never justified.” He urged MPs and senators to defeat the bill, and to let the June 6 Supreme Court deadline pass without a law. “Euthanasia will operate within a vacuum, tolerated but not a legal right, much like abortion,” Hughes explained. “Once the law is passed, it will only get worse and will be impossible to reverse. Without a law, eventually we might be able to get some protection for vulnerable individuals at the provincial level or, God-willing, a constitutional amendment.”
Martin and Ferrier agree, saying, “anyone who still respects the inherent and inalienable dignity of every human person and is concerned for the common good has one thing to do right now: call his or her MP to try to block this Bill unworthy of Canadian society.”
All three party whips or leaders have said MPs will be allowed to vote their conscience – except for cabinet ministers who must support the government bill – although initially Liberal House Leader Dominic Leblanc indicated the full Liberal caucus would be whipped to support the government bill. Now the government faces the possibility of a massive revolt from those who consider the bill too stringent. Several senators who sat on the parliamentary committee are vowing to block passage of the bill in the Senate unless teenagers and psychiatric patients are given access to assisted suicide, and dementia patients can make requests through advance directives. Several Liberal MPs have indicated their displeasure with the government’s bill, including Rob Oliphant (Don Valley West), who co-chaired the parliamentary committee. He claims C-14 is not in compliance with the broader standards implied in the Carter decision. He told the CBC, “I’m going to watch to see how the bill is amended. I’d like to see the bill be clearer on the issue of terminality and be clearer on the issue of suffering.”
One Liberal MP, however, has spoken against the bill. Robert-Falcon Ouellette, (Winnipeg Centre), said he does not like the message the bill sends to First Nations communities that are currently plagued by a suicide epidemic. “I’m concerned that we haven’t thought out the complete ramifications that a decision like this might have on indigenous communities that seem to be suffering greatly,” he told the CBC. He warned that “once we make a decision on this, there will be no going back,” and that by permitting the practice, suicide will be normalized. He said his Sun Dance Chief, David Blacksmith, told him, “We must fight the spirit of suicide. We must work each and every day to defeat it.”
Meanwhile, the Justice Minister does not deny that letting mentally ill or children access euthanasia will be a possibility sometime soon. In her initial press conference she said assisted suicide will not be legalized for such people “yet.” She told both CTV and CBC that the country is not ready for such a broad law, but perhaps sometime in the future. C-14 requires statutory review of the law in five years, with Wilson-Raybould suggesting that the law would then be liberalized.