One year after « Medical Assistance in Dying “(MAID) was legalized in Canada, a number of emblematic cases have occurred and have led to the first requests for extending the scope of the law.

On June 17, 2016, a federal bill known as C-14 was passed in Canada, which decriminalized euthanasia and assisted suicide.

This federal law was passed just shortly after the province of Quebec had voted in favor of “Law 52”. This bill which was adopted in June 2014 became effective in December 2015. Since then, 400 cases of euthanasia have already been documented in Quebec.

Critiques rapidly voiced their opposition reproaching both the law in Quebec and the federal law as being too restrictive, and as being contrary to the Canadian Charter of Rights and Freedoms. The Canadian Government declared these restrictions to be justified on behalf of the fight against suicide.

Federal law allows euthanasia and assisted suicide for patients only when “natural death is reasonably foreseeable” meaning imminent or in the very near future. The law in Quebec is for patients at the end of their life, which should cover a broader time frame.

Two individuals from Quebec filed suit against the unconstitutionality of both the federal law and the Quebec law. Recently, the Quebec Health and Social Services Minister also personally announced that this issue would be considered and evaluated.

Euthanasia was refused in two recent cases in Montreal for patients with irremediable, serious and degenerative pathologies because they were not at the end-of-life. The criteria of “imminent death” must be met both for the federal law and the Quebec law before the right for medical assistance in dying is allowed. The two patients thus decided to file a court suit. According to their lawyer, the current laws are unconstitutional, since they do not respect the criteria established by the Supreme Court in the Carter ruling from February 2015.  The only criteria is “that the individual must be a mentally competent and consenting adult, with a serious and irremediable pathology, and experiencing suffering which healthcare cannot alleviate.” Thus according to the plaintiffs, euthanasia requests should not be prohibited on the basis of the end-of-life criteria.

In addition to the end-of-life criteria, other discussions are being held to extend the scope of the law, for instance practicing euthanasia on mentally ill individuals. Currently the law in Quebec prohibits any kind of euthanasia practice for individuals unable to consent on their own behalf. Nevertheless, last March, the husband of a woman suffering dementia (Alzheimer’s disease) put her to death “by compassion”. This event incited discussions of allowing euthanasia for the mentally ill.

Although MAID is only authorized for patients who are suffering, the Secretary of the College of Physicians in Quebec, Yves Robert warns against triggering a form of “death à la carte” mentality which could evolve into a form of assisted suicide managed by private companies, as in Switzerland. “Within a year of legalizing euthanasia, what is surprising is how quickly public opinion has changed from originally considering the law as a “major advance”, but now appears to judge the same law as being too restrictive. Let’s take time to think about the situation, before going even further. There’s no emergency rush to die.”  

Finances may also play a major role in practicing MAID in Canada.  Already, like in the USA, surveys have been conducted: potential cost-savings have been calculated ‘thanks’ to requests for assistance in dying. The Canadian Medical Association Journal published an analysis based on the data from Holland and Belgium where assisted dying has been legal for quite some time, combined with data from Ontario for medical healthcare costs for patients at the end-of-life. The authors concluded “If Canadians implemented medical assistance in dying in a similar manner and magnitude as Belgium and Holland, we could reduce healthcare costs by dozens of millions of dollars per year.” 

In these latter two European countries, cases of violating the law keep increasing. Alliance VITA recently published the results in Belgium after 15 years of legalized euthanasia.

 

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For further information : 

Testimony of an American woman who declines aid in dying (Center for Bioethics and Culture)