Committee on Doctor-Assisted Dying Releases 21 Recommendations

A report from the Special Joint Committee on Physician-Assisted Dying has been released, with a total of 21 recommendations on the highly-debated matter.

The report was released February 25, 2016, in the House of Commons, after three months of consideration.

On February 6^th, 2015 in the case, Carter v. the Attorney General of Canada, the Supreme Court voided sections in the criminal code prohibiting doctor assisted death for adults who clearly consent to dying, and have a medical condition which heavily affects their quality of life. This doesn’t mean the person has to try every means of treatment if they don’t want to, before requesting doctor-assisted death.

The Court suspended the ruling, not to come into effect for a year, and on January 15, 2016, was granted a four-month extension on that.

A Special Joint Committee was established in December 2015 to review the decision and create a federal framework, to be considered. Since then, they’ve held 16 meeting and heard from 61 witnesses.

The Committee included members from the Senate and the House of Commons.

In the end they created eligibility criteria, and they recommend that anyone who fits it will be allowed medically assisted death, no matter where they live in the country.

Anyone with a “grievous” medical condition, which includes an illness, disease, or disability, who is enduring intolerable suffering fits the bill. They must give informed consent, and have the ability to put in a request at some point. Patients who make a doctor-assisted dying request must have insurance that allows them publically funded Canadian Health Care services.

Two independent doctors must determine that the patient is eligible and a request must be in writing and witnessed by two independent witnesses.

A waiting period is required, based on how the patient’s condition progresses.

The federal government will be expected to work with provincial governments to use the law most efficiently.

“[I]f a province doesn't have a physician-assisted dying regime, then your legislation will be the only game in town,” the recommendations read, referring to the laws to be pushed forward by the Government of Canada. “It will have to operate and it will have to include adequate safeguards.”

There was a strong consensus for not having a list of included conditions a person must have to be eligible, and a patient’s condition doesn’t necessarily have to be terminal for them to be eligible. As long as they are undergoing physical or psychological suffering that can’t be endured, they can access it.

Individuals won’t be excluded because they have a psychiatric condition.

People who apply must be 18 years or older, although there was debate surrounding the issue.

They also want to allow for advance requests for medical assistance in dying any time after someone is diagnosed with a condition that will likely lead to loss of competence, but before the suffering becomes intolerable.

An advance request may not, however, be made, prior to being diagnosed with such a condition. The advance request is subject to the same procedural safeguards as those in place for contemporaneous requests.

They suggest that the Government of Canada work with the provinces and territories and their medical regulatory bodies to ensure that, as much as possible, a request for doctor-assisted death must be made in writing, and be witnessed by two people who have no conflict of interest.

Doctors have to refer a patient if they object to doctor-assisted death.

All publically funded health care institutions should provide it, and nurses and pharmacists can legally provide information and help where needed.

The Committee recommends national reports by Health Canada on doctor-assisted dying, and should be reviewed by the House of Commons and senate every four years.

Medical professions should also work on providing culturally and spiritually appropriate end of life care for indigenous patients in the country.

The Committee said they want to emphasize the need “to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients” as recommended in the Final Report of the Truth and Reconciliation Commission of Canada.

They also recommended that palliative care needs to be approved generally, and work needs to be done to improve the lives of people with disabilities, mental health issues, and dementia.

Jody Wilson-Raybould, Minister of Justice and Attorney General of Canada, released a statement following the Committee’s recommendations.

“We are committed to developing an approach that is based on empathy and strikes the best balance among a range of interests,” she said. “The Committee's work positions us to achieve the best possible solution for Canada on this complex social and legal issue that must be addressed in a timely manner.

“We appreciate the diligent work that the members of this independent, multi-party Committee undertook over the past weeks, consulting with experts, stakeholders and Canadians.”

Raybould said the government will bring forward it’s response to the Supreme Court’s decision in the coming weeks.