The Parliamentary committee charged with providing the clay for shaping a much-needed and long-overdue law on assisted dying has produced a remarkably clear and concise blueprint for tackling this sensitive and emotional issue.
The 60-page report, Medical Assistance in Dying: A Patient-Centred Approach, is almost enough to restore your faith in the policy-making process.
Parliamentarians, led by MP Rob Oliphant, have taken the work of a non-partisan committee of experts, the Provincial-Territorial Advisory Group on Physician-Assisted Dying, massaged it a bit, and zeroed in on the key points that need to be covered in legislation.
Lawmakers issued 22 recommendations, touching on almost all the key issues:
- Assisted death should be available to anyone with a “grievous and irremediable medical condition,” but that condition need not be terminal;
- Psychiatric patients should not be denied assisted death, but they must be deemed competent;
- Patients with dementia can provide prior consent to assisted death, but can only do so after diagnosis and while still deemed competent;
- Teens and children should be able to request assisted death, but implementation should be delayed to work out the definition of the term “mature minor”;
- Physicians can refuse to perform assisted death, but they must provide an effective referral to someone who will carry out the patient’s wishes;
- All publicly funded health-care institutions must provide assisted death, including religious hospitals and hospices;
- A request for assisted death should be made in writing, and approved by two physicians; there should be no review by a judge or external panel;
- Assisted death can by provided by a physician, or by a nurse-practitioner or registered nurse under doctor’s supervision;
- In addition to providing access to assisted death, there must be a determined effort to bolster access to palliative care, and care more generally, especially for those with dementia and psychiatric illnesses.
The one contentious issue the committee did not address, surprisingly, is how the actual process of hastening death should (or should not be) carried out.
The recommendations all seem to be based on the premise that a medical professional will provide an injection that hastens death. There is no discussion of providing patients with a prescription for lethal drugs, which is done in jurisdictions like Oregon. Ultimately, that decision will be made by provinces, which are responsible for the actual delivery of care.
Now what has to happen is the drafting and passing of an actual law, and promptly. Let's not forget that the Supreme Court of Canada struck down the Criminal Code prohibitions against assisted dying, way back on Feb. 6, 2015. There is no reason for the Liberal government to stretch out the process until the Supreme Court-imposed June 6 deadline. There has been more than enough dithering already.
The provinces and the regulatory bodies for physicians, nurses and pharmacists also need to get all their ducks in a row because they will ultimately determine the practicalities of how assisted death will be provided.
What is especially not needed is for the provision of assisted death – about which there is remarkable consensus in the general public – to become a partisan issue featuring a tiresome rehashing of the arguments that we've been having for 20-plus years.
Sadly, there's a hint that this is exactly what we may be in for, given that the four Conservative MPs on the 16-member committee produced a rather puritanical dissent.
The dissenters raise some legitimate issues, notably that there must be protections for the vulnerable, such as people with disabilities or dementia, or children.
But the report actually addresses that point quite clearly, noting that informed consent is an essential story point, and "consent should be assessed using existing medical practices, emphasizing the need to pay particular attention to vulnerabilities in end-of-life circumstances."
The public is more than ready for an assisted-death law. The framework the committee has provided is a good one and, hopefully, injected a bit of urgency into the lawmaking process.
Right now, there are people being denied the constitutional right to die; they are suffering needlessly while we produce report after report saying the same thing.
Let's get on with it.