Canadians do not need to be terminally ill to access doctor-assisted dying, and it should be available to those with mental illness or psychiatric conditions, says a new parliamentary report.
The report, released by a 16-member joint parliamentary committee on Thursday, lays out 21 recommendations for the federal government to consider as it sets out to craft a new law for assisted death in response to last year's Supreme Court decision.
It also leaves the door open to assisted death for competent minors once the initial law is set into place.
Not everyone agrees with the report: Four Conservative MPs on the committee released their own dissenting report, saying the majority on the committee failed to include enough 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," Conservative MP Michael Cooper, vice-chair of the committee, said.
The committee report argues otherwise, saying sufficient safeguards will be in place.
"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 majority report lays out a broad criteria for the practice: It says medical assistance in dying should be available to Canadians with terminal and non-terminal grievous and irremediable medical conditions, which causes enduring and intolerable suffering.
That includes those with mental illness or a psychiatric condition, the committee 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.
It also outlines a recommended process: 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 also determine eligibility. The report also calls for a waiting period to be determined by the patient's doctor.
The committee says the person must also show a capacity to make the decision, either at the time or in advance of the request.
In their dissenting report, the Conservatives called for the government to require patients with underlying mental health issues to undergo a psychiatric assessment to determine whether they have the capacity to consent to assisted dying.
They argue Quebec's law, the only province to adopt its own end-of-life legislation, is much more stringent – only allowing adults over 18 with incurable physical illnesses to undergo the process.
As first reported in The Globe, the report also recommends advance consent for those who have been already been diagnosed with debilitating diseases, such as dementia.
"Allowing advance requests also provides comfort to individuals, reducing their psychological suffering, knowing their lives will not end in a way that is against their wishes," it says.
Dying with Dignity Canada urged the government to adapt the committee's recommendations into law – in particular, allowing patients with debilitating diseases to consent in advance.
"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.
The report recommends the government create a "two-stage" legislative process: first for adults, followed three years later by a second law for minors once the issue has been studied.
Other recommendations include:
- allowing doctors to “conscientiously object” to the practice, as long as they can effectively refer the patient to another doctor;
- the federal government work with provinces and territories to ensure all publicly-funded institutions provide medical assistance in dying;
- that Health Canada re-establish a secretariat on palliative and end-of-life care.
The NDP, which agreed with the recommendations, also released a supplementary report asking for expanded palliative care and increased benefits for caregivers.