Canada’s euthanasia bill: overstepping broader extremes

On Friday June 17, 2016 the Canadian Parliament voted a law for medically assisted dying, legalizing euthanasia and assisted suicide in a widely encompassing manner, and seen as worrisome for those who defend the most vulnerable individuals.

Known under the title “Medical Assistance in Dying (MAID)”, it’s really euthanasia and assisted suicide which have been legalized in a widely encompassing manner, in contradiction to what was announced by the majority of the French media.

A Supreme Court judgment in the country – in the case of Carter vs. Canada, on February 6, 2015, – found that articles in the Criminal Law prohibiting assisted suicide and euthanasia were in violation of the Canadian Charter of Rights and Freedoms and thereby unconstitutional. In view of this decision, completely opposite of that made in 1993; the government was given one year to revise its legislation, with a 6-month extension given at the beginning of 2016.

The government could have contested this judgment, but it decided to legislate and thus introduced its C-14 bill on medical assistance in dying last April 14. This federal law arrives after the province of Quebec legalized euthanasia in 2015, following heated controversy.

Article 241.1 of the new law provides the following definition of medical assistance in dying « According to the situation, the fact for a doctor or nurse practitioner:

  1. a) to administer to an individual, at his request, a substance which causes his death;
  2. b) to prescribe or to furnish a substance to an individual, at his request, in order that the product be administered and thus cause his death.”

In addition, the pharmacists who deliver the lethal products are also concerned.

On the other hand, it is foreseen that supplementary individuals may be involved. According to article 227(2): “An individual who does something in view of helping the doctor or nurse practitioner furnish medical aid to die is not liable of participating in a homicide (…)».

As well as the eligibility criteria being broad and highly subjective, according to article 227(3), the doctor or nurse establishing the requirements is allowed to have “a mistaken belief” without being held liable.

According to article 241.2 establishing the prerequisite requirements, the individual must be at least 18 years old and be « in grievous and irremediable medical conditions ». This expression signifies that “the disease, illness, disability or the advanced state of irreversible decline in capability causes enduring and unbearable physical or psychological pain which cannot be alleviated in a manner the person deems tolerable”, and that “natural death is reasonably foreseeable as an inevitable outcome due to the overall medical situation, without, however, any specific prognosis having been established concerning the individual’s life-expectancy.”

In addition to a second opinion from a doctor or nurse practitioner, a 10 day waiting period is mandated from the time of the written request by the individual, and the enactment of euthanasia or assisted suicide. Only the medical personnel can authorize shortening this waiting period, when “the individual’s death or his incapacity to provide an informed consent appears imminent”. In the event of his incapacity to sign and date the request “ a third party, at least 18 years of age and who understands the nature of the request for medical aid in dying, can sign for him, in his presence and according to his wishes.”

A « clarification » was added at the end of the 241.2 article, introducing a conscience clause stating “It is understood that the present article does not compel anyone to furnish or to help furnish medical help to die.”

During the discussions and in view of the bill’s content, it appears to merely be a step and that very soon euthanasia of minors or individuals suffering from mental illness will be examined. In fact, article 9.1 stipulates that “Within 180 days following the date of the act receiving assent, the Ministers of Justice and Health submit one or more independent examinations of questions concerning request for medical aid in dying from mature minors, future requests, and requests where mental illness is the only medical condition specified.”

In contrast to the regulatory framework in the Netherlands or in Belgium, no prior or subsequent control commission has been put into place. It is only planned that following four years of enactment, a Parliamentary committee examine the bill’s provisions as well as the situation of palliative care in Canada. This committee is then to submit a report “which would include any modifications they might want to recommend”.