Canadians should not need to be terminally ill to access doctor-assisted dying, and those with mental illnesses or psychiatric conditions should not be excluded, a new parliamentary report says.
The Liberal cabinet will now weigh the 21 recommendations in the report from a joint parliamentary committee as the government sets out to draft a law for medically assisted death in response to a Supreme Court decision last year.
The report also calls on the federal government to work with provinces and territories to make medically assisted dying accessible in publicly funded health-care institutions.
But signs are already emerging it will prove difficult: A Catholic-run health authority in B.C. that receives millions in public funds and runs major hospitals – including St. Paul's in downtown Vancouver – has sent a memo to staff saying doctor-assisted death is not permitted in its institutions.
The committee, made up of 16 MPs and senators, also opened the door to assisted death for youth under 18. It calls on the government to address the issue of "mature minors," competent young people capable of consenting to doctor-assisted death, within three years of the initial law.
The report recommends assisted dying be available to Canadians with terminal and non-terminal grievous and irremediable medical conditions that cause enduring and intolerable suffering.
Patients with mental illnesses or psychiatric conditions should not be excluded from eligibility as long as they are competent and meet the other criteria set out in law, it said.
"Cases involving mental illness may prove challenging to address for health care practitioners, but the Committee has faith in the expertise of Canadian health care professionals to develop and apply appropriate guidelines for such cases," the report says.
"The requirements that the suffering is enduring and intolerable to the person are safeguards to ensure that someone in temporary or minor pain does not make a rash decision to die."
The report also outlines a recommended process for assisted dying: The request should be made in writing when possible, and witnessed by two people who have no conflict of interest. Two doctors, independent of each other, should determine eligibility. The report also calls for a waiting period to be decided by the patient's doctor.
Sonu Gaind, president of the Canadian Psychiatric Association, said physicians already assess a patient's capacity to make decisions – just not yet for the specific decision of physician-assisted death.
"We do need to fully understand how the symptoms of mental illness are affecting somebody's thought processes," he said.
Justice Minister Jody Wilson-Raybould said the Liberal cabinet will start studying the issue within the next two weeks, and her government is working "very diligently" to meet the court's deadline of June 6 to have a law in place.
"We're looking to ensure that we continue to take an empathetic approach, that we look to create balance in our approach that recognizes the autonomy of individuals, that recognizes the need to protect the vulnerable, that respects the conscience rights of medical practitioners. And that will take a little bit of time," Ms. Wilson-Raybould told reporters.
The report further recommends advance consent for patients diagnosed with debilitating medical conditions such as dementia.
Dying with Dignity Canada urged the government to adopt this measure in particular.
"Without the option to consent in advance to assisted dying, Canadians with dementia who want to die in peace with the help of a physician face a dire choice: access assisted dying prematurely, while they are still competent, or risk losing competence before their wishes can be carried out, only to be condemned to the exact fate they sought to avoid," CEO Shanaaz Gokool said in a statement.
Four Conservative MPs on the committee released a dissenting report, saying the recommendations failed to include safeguards for young people or the mentally ill.
"Unfortunately, what we have is a report that doesn't follow the evidence with the need to protect vulnerable persons," said Conservative MP Michael Cooper, vice-chair of the committee.
In their report, the Conservatives said they want the government to require patients with underlying mental health issues to undergo a psychiatric assessment by a professional to determine whether they have the capacity to consent to assisted dying.
Conservative Senator Denise Batters, whose husband died by suicide in 2009 after a battle with anxiety and depression, cautioned that psychological suffering on its own should be excluded from the criteria.
"I think that provokes a very slippery slope where we could have a situation where people who have severe anxiety or depression are able to access physician-assisted suicide," said Ms. Batters, who was not on the committee.
The report also recommends that doctors be able to "conscientiously object" to the practice, as long as they refer the patient to another physician, and the creation of a strategy to improve palliative and end-of-life care as alternatives to physician-assisted death.
The Canadian Medical Association, while praising the latter recommendation, said a balance must be found between the rights of patients and those of doctors.
"As the government moves forward in drafting legislation, we must focus on ensuring effective access while also respecting different views of conscientious objection. Both can be achieved," Cindy Forbes, CMA president, said in a statement.
"While not addressed by this report, a central mechanism to co-ordinate access must be a key part of the solution."