Canada would be venturing into barely charted waters if it were to expand its assisted-dying law to cover young teenagers and patients with mental illness or severe dementia, according to three long-awaited reports exploring how other countries handle ethically challenging requests for the procedure.
The trio of independent reports, tabled in Parliament on Wednesday, were prepared at the request of the federal government after the Liberals passed their assisted-dying law in June, 2016.
Although deeply researched and hundreds of pages long, the reports reveal just how little international experience Canada would have to draw upon if it chose to broaden the law.
The expert panelists who studied assisted death for patients under the age of 18 could find only 16 cases in two countries where such requests had been granted, and they couldn’t determine how often mature minors made requests that went unfulfilled.
“The fact that only two jurisdictions allow MAID [medical-assistance-in-dying] for minors, and that cases remain extremely rare within those jurisdictions, means little is known for certain about the practice,” one of the reports reads. “There is minimal information about the 16 documented cases, and none about the families in Belgium and Netherlands whose children have gone through the process.”
The reports do not contain any specific recommendations on how – or even if – Canada should change the legislation that allows doctors to help qualifying patients end their lives.
The federal government asked the Council of Canadian Academies (CCA,) a non-profit evidence-gathering organization, to study and sum up all that is known about how Canada and a handful of other countries treat requests for three kinds of patients currently excluded from Canada’s law.
The CCA and panel chairwoman Marie Deschamps, a former Supreme Court of Canada justice, oversaw 43 experts on three different working groups.
One studied cases in which mental illness is the sole reason for requesting an assisted death. Another looked at patients who want to make an advance, written request for assisted death before they lose the capacity to consent. A third studied assisted death for mature minors, who are patients younger than 18 deemed capable of making their own medical decisions.
Shanaaz Gokool, the chief executive officer of the advocacy group Dying with Dignity Canada, called the reports “impressive” and “comprehensive,” with clear, “jumping off points,” for expanding the law, especially in the realm of advance requests.
“It’s really up to the government now, and failing that, the courts, to move these issues forward,” Ms. Gokool said.
Federal Justice Minister Jody Wilson-Raybould and Health Minister Ginette Petitpas Taylor welcomed the reports in a joint statement on Wednesday, but did not say anything about changing the law.
However, last month, after a Halifax breast-cancer patient chose an assisted death earlier than she would have liked because she feared losing the capacity to consent, Ms. Wilson-Raybould told reporters her government has no intention of expanding the law.
That is disappointing for caregivers such as Gail Thompson, 75, of Richmond, B.C., whose heart broke as she watched her husband of 53 years, Frank Thompson, succumb to Alzheimer’s disease and Lewy Body dementia.
Mr. Thompson, who died in March at the age of 79, was a retired high-school math and gym teacher, father of two and avid athlete who cycled across Canada in his mid-60s.
Long before dementia took hold, Mr. Thompson made it clear in speaking to his family – and in a written advance directive – that he never would have wanted to keep living as he did in his final years, confined to a nursing-home bed, unable to speak or feed himself.
“Can you imagine how frustrating it was for him when I used to go in and talk to him and he couldn’t talk back to me? He couldn’t say he loved me. He couldn’t tell the kids he loved them. The best he could do was open his arms a little bit,” Ms. Thompson said. “That is not living. It’s existing. And it’s existing at somebody else’s will.”
Editor’s note: (Dec 13, 2018) A previous version of this story said the CCA report found just 16 cases of requests for assisted dying for minors in other countries. This version has been corrected.