Canadians suffering from serious cancers and the fatal neurological disease ALS – amyotrophic lateral sclerosis, or Lou Gehrig's disease – are most likely to qualify for physician-assisted dying under the Liberal government's new legislation, experts say.
People with kidney or advanced cardiac diseases, liver failure, some forms of multiple sclerosis and some neurological disorders, such as Parkinson's and Huntington's diseases, may also be eligible depending on the circumstances – although some say those with such conditions will have to wait much longer under the bill.
The legislation released this week takes a cautious approach to the issue of doctor-assisted death, and is narrower in scope than the 2015 Supreme Court ruling that led to it and the recommendations of a Parliamentary committee.
The bill sets out specific criteria for adults over 18 with "grievous and irremediable" medical conditions to be eligible for doctor-assisted death, but it puts off key recommendations made by the committee to include advance requests for dementia patients and mature minors who want to end their lives.
The legislation itself does not specify the types of serious and incurable illnesses, diseases or disabilities that patients must have to qualify to end their lives with the help of a doctor or nurse practitioner.
Although these serious illnesses do not need to be terminal, the bill includes wording that says "natural death has become reasonably foreseeable" – a term defined in background documents as "a real possibility of the patient's death within a period of time that is not too remote."
Jeff Blackmer, vice-president of medical professionalism at the Canadian Medical Association, says "foreseeable" does not mean patients must be on the verge of death.
"In a situation as serious and significant as the issue of requesting assisted dying, it's helpful to have a little bit of guidance as to where along that spectrum this illness should have to fall for that patient to be eligible," Dr. Blackmer said in an interview.
"It doesn't say that dying has to be imminent, it doesn't say the patient has to have a condition that's terminal in nature, but what it does is it rules out things like episodic conditions."
Dr. Blackmer said these could include a bad case of the shingles or diabetic neuropathy, a painful condition that occurs when nerves die in diabetes patients.
He observed that nothing in the legislation says the medical condition has to be permanent, and the "foreseeable death" provision is the only qualifier that could prevent people with painful but temporary conditions from making a rash decision.
But others say the inclusion of "foreseeable death" in the bill means patients will suffer for longer if they are not deemed by doctors to be close enough to death to qualify, or if they deteriorate to the point where they cannot consent to ending their lives.
"You cannot have the law be that vague and that subject to interpretation by the health care providers, who are going to range in their willingness to interpret that," said Jocelyn Downie, a Dalhousie University professor of law and medicine.
Parliament has five weeks to study, debate and pass the bill before the June 6 deadline set by the Supreme Court, after which the old law that banned assisted death will be void.
The Liberals plan to debate the bill in the House of Commons for the first time next Wednesday after all parties have had a chance to discuss and debate it in caucus meetings.