Canada has its first doctor-assisted dying law, which excludes those who are suffering intolerably but not at the end of life, after senators backed down from their fight against the House of Commons and passed the Liberal government's historic bill.
The law, which received royal assent on Friday evening, sets out national guidelines with strict safeguards for medical assistance in dying. The law clarifies who is eligible for assisted death and outlines the process, such as requiring two independent witnesses and medical opinions.
Most notably, it excludes those whose natural deaths are not "reasonably foreseeable" – a major point of contention between elected MPs and senators, who wanted the bill to include patients who are not terminally ill.
"I am convinced the government is making a serious and cruel mistake by taking away the right to medically assisted dying from a group of patients, those who are not terminally ill yet suffering terribly," newly appointed independent senator André Pratte said. "But the government will answer to the people for that error. And hopefully, in the not too distant future, the courts will remedy that mistake."
The House of Commons agreed on Thursday to accept most of the Senate's seven amendments to Bill C-14, such as providing a consultation on palliative-care options and banning beneficiaries from signing consent forms on behalf a patient, but not the major proposal to remove the end-of-life requirement.
The Senate had rejected a proposal to include advance consent for those suffering from dementia and other degenerative diseases in the bill. But both houses adopted an amendment to study that issue and others within two years.
The bill was sent back to the Senate for further review, with some senators suggesting the Red Chamber should stand its ground on the end-of-life requirement, which many felt was a constitutional matter.
But in the end, senators on all sides deferred to the elected Commons and passed the bill in a vote of 44 to 28. Some senators said they worried about access issues without a federal law, while others believed safeguards will be stronger in legislation.
"We are grateful to all Parliamentarians for their hard work in seeing this through under such demanding circumstances," Justice Minister Jody Wilson-Raybould and Health Minister Jane Philpott said in a joint statement.
Ellen Wiebe, a Vancouver doctor who has been assisting in deaths, said she sees the new law as flexible. In her view, patients with advanced multiple sclerosis, who would die if they did not accept treatment, could be deemed to face a "reasonably foreseeable" natural death, and therefore be eligible for medical assistance to end their lives.
Cindy Forbes, president of the Canadian Medical Association, said the law brings clarity and balance to assisted dying. "I feel very confident the government has done the right thing," she said.
"It also addresses concerns about vulnerable patients who are not near the end of their lives, about prematurely ending their lives. That's a very serious concern of physicians, and the public as well."
Many experts, however, say the end of life provision is unconstitutional because it narrows the eligibility criteria beyond the 2015 Supreme Court ruling that struck down the ban on assisted death.
The BC Civil Liberties Association, which challenged the old laws, said it will "seriously consider" its legal options.
"The government's bill will trap patients in intolerable suffering, and takes away their hard-won Charter right to choose assistance in dying," executive director Josh Paterson said in a statement. "It allows terminal patients to ease their death with a doctor's assistance, but eliminates the right of non-terminal patients to escape years and decades of torturous pain."
Independent Liberal Senator Serge Joyal tried again on Friday to amend the bill by introducing a motion asking the government to refer the end-of-life criterion to the Supreme Court but pass all other elements of the bill. It failed in a vote of 42-28, with three abstentions.
Newly appointed independent Senator Ratna Omidvar, who voted to support the government's bill, said it was a difficult decision, but she hopes the Senate's debates will help influence any future developments on the issue.
Many senators said they felt the law will be challenged in the courts and asked the government to refer it to the Supreme Court, even though the motion to do so was voted down in the Red Chamber.