Report recommends most permissive options

A committee of the Canadian parliament has recommended that the federal government make doctor-assisted dying immediately available to all adults with “grievous and irremediable” medical conditions — including mental illnesses — and eventually allow “mature minors” to end their lives.

The committee released 21 recommendations on Thursday to help the government draft euthanasia legislation in accordance with the Supreme Court of Canada ruling in Carter v. Canada last year. Belgium’s permissive euthanasia regime appears to be the model for Canada’s new right-to-die law.

The committee says that new rules should be implemented in two stages. The first would apply immediately to those over 18 experiencing “intolerable” physical or mental suffering. The second stage — “no later than three years after the first” would extend it to “competent mature minors.”

Patients must be fully assessed by two doctors, independent of each other, to ensure that they have capacity to provide informed consent.

The report recommends that physicians with conscientious objections should be compelled to find someone willing to do so. It also recommends that all publicly funded facilities – even faith-based institutions – be compelled to provide euthanasia and assisted suicide. This goes beyond recommendations made by others that objecting institutions should allow an external provider to perform the procedures on their premises. It also ignores the advice of the Canadian Medical Association, which told the Committee that euthanasia and assisted suicide could be provided without suppressing freedom of conscience by forcing objecting physicians to refer for the procedures.

The Supreme Court ruled last year last year that denying patients euthanasia or assisted suicide was a violation of the Canadian Charter of Rights and Freedoms. However, it did not settle the multiple complications involved. So it is possible to interpret the decision in a restrictive or permissive way. The committee has taken the permissive option, treating Carter as a floor, not a ceiling. This is clearest in its recommendation on euthanasia for mental illness, in which it cited the opinion of bioethicist Jocelyn Downie:

[M]ental illness should not be an exclusion criterion. It was not excluded by the Supreme Court, and not all individuals with mental illness are incompetent. Physicians already routinely determine whether someone is competent, even when they have a mental illness. Furthermore, the suffering that can accompany mental illness can be as excruciating as any suffering that can accompany physical illness. Finally, I would argue that excluding individuals on the basis of mental illness would violate the charter.

Similarly, the Court had said nothing about age limits. The committee adopted the most liberal view:

[Given] the obvious fact that minors can suffer as much as any adult, the Committee feels that it is difficult to justify an outright ban on access to MAID [medical assistance in dying] for minors. As with issues of mental health, by instituting appropriate safeguards, health care practitioners can be relied upon to identify appropriate cases for MAID and to refuse MAID to minors that do not satisfy the criteria.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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