Slaw has kept you abreast of the renewed debate on euthanasia and assisted suicides here and here. In addition, we have focused on the public hearings on euthanasia and assisted suicide in Quebec held by the National Assembly’s Select Committee on Dying with Dignity. Well, after almost two years, this committee tabled its 180-page report in legislature, on March 22, 2012. Titled Dying With Dignity, the report proposes “medical aid to die” and 23 other recommendations.
Many of the recommendations revolve around improving palliative care in institutions and at home, which the report says would suffice in most medical cases. Quebecers should have a legally recognized right to receive palliative care, so that it is accessible to people with different illnesses no matter where they live, the committee says.
The committee recommends a legal option for medical assistance for dying, in cases where Quebecers are terminally ill and want to die. This may involve a contract in front of a notary public or a form of witnessed advance medical directive that would be kept in a person’s medical file and registered just like a last will and testament (in Quebec). These directive or contract would need to be updated regularly, thus, a process needs to be established.
An eligible patient must be an adult suffering from an incurable disease and demonstrating an inability to endure the physical or psychological pain. The request for help in dying must come directly from the patient, with two doctors certifying the request.
In addition, the person must be an adult residing in Quebec and be able to consent to treatment under the law. As a result, a person cannot come from another province or country and request doctor-assisted suicide in Quebec.
The report also recommends that doctors who assist a terminally ill patient in dying not be charged with a criminal offence. As it stands, euthanasia and assisted suicide are illegal under the Criminal Code of Canada (Section 241 makes it illegal to (a) counsel, or (b) aid or abet, a person to commit suicide), which applies in all provinces and territories including Quebec and cannot be amended by provincial/territorial enactment. However, it is up to the provinces and territories to enforce the law. As a result, decisions to proceed with criminal and penal prosecutions rest with each province and territory.
This means, Quebec could follow the province of British Columbia who around 1994 enacted stict guidelines on when criminal charges can be laid in a case of assisted suicide. Under the guidelines, Crown counsel will approve a prosecution only where there is a “substantial likelihood of conviction and the public interest requires a prosecution.”
In determining whether a substantial likelihood of conviction exists, Crown counsel must classify the conduct of the person involved in the death, and the resulting consequences as “active euthanasia”, “assisted suicide”, “palliative care” or “withholding or withdrawing medical treatment”. The factors to be considered in characterizing such conduct include the provable intention of the person and, in cases involving physicians and their patients, the position of the Canadian Medical Association and expert medical opinions as to generally accepted ethical medical practices.
The public interest criterion involves a consideration of the following factors:
- Society’s support of proper professional and ethical standards for health care professionals
- Society’s interest in protecting vulnerable persons
- Society’s interest in protecting the sanctity of human life, while recognizing this does not require life to be preserved at all costs
According to the guidelines, palliative care and withholding or withdrawing medical treatment will not be subject to criminal prosecution when provided or administered according to accepted ethical medical standards. The common law recognizes the right of an adult, competent person to refuse medical treatment or to demand that treatment, once begun, be withdrawn or discontinued.
Continuing on the report…
The report also call for the Collège des médecins du Québec to update its code of ethics and prepare practices, rules and procedures for such end-of-life situations. The committee recommends that the Collège amend its Code of Ethics so that physicians can practice “medical aid to die” under the criteria provided by law, while upholding their right to conscientious objection and their duty, if appropriate, to refer their patients to another physician.
The committee also recommends that a joint committee of experts be established under the auspices of the Collège des médecins to explore the possibility for a person with dementia caused by a degenerative disease of the brain to apply early for the right to die by medical assistance.
If the government listens, it will introduce a Bill in legislature implementing the recommendations of the report on the issue of dying with dignity, no later than June 2013.
The report clearly shows us that most Quebecers and the medical profession want change on the issue of euthanasia and assisted suicide and that the status quo cannot continue. This report cannot help but intensify the Canadian and global debate on doctor-assisted suicide and euthanasia.
The Quebec government has not yet responded to the report. Will the province’s elected representatives see the issue in the same way?