Cindy Forbes is president of the Canadian Medical Association.
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With its Bill C-14, the federal government has achieved an appropriate balance in its overall response to the Supreme Court of Canada ruling on medically assisted dying, and the Canadian Medical Association strongly supports its enactment, as amended by the justice committee.
Since 2014, the CMA has held physician and public consultations on end-of-life care, including assisted dying. That year, it led a national dialogue and a series of public and physician town halls across the country, focusing on advance-care planning, palliative care and physician-assisted dying. This work – along with advice from CMA's members, ethics committee and a study of other jurisdictions – led to development of the CMA's "Recommendations for a Canadian Approach to Assisted Dying."
Some are asking why the rush to pass Bill C-14 now? The answer lies in the need for four key deliverables:
1. Robust safeguards: The CMA supports the legislative objective of ensuring a system of strong safeguards in providing medical assistance in dying. Those proposed in Bill C-14 include: patient eligibility criteria, process requirements to request medical assistance in dying, as well as monitoring and reporting requirements.
2. A consistent, national framework: The CMA supports the legislative framework for medical assistance in dying. Key measures in Bill C-14 support the development of a consistent framework across jurisdictions, including legislating definitions for "medical assistance in dying" and "grievous and irremediable condition."
3. A system to co-ordinate care at end of life: The CMA supports development of measures to support provision of a full range of options for end-of-life care – including improving access to palliative care – and to respect the personal convictions of health-care providers. The fulfilment of these commitments with federal non-legislative measures will be integral to ensuring access to care, respecting the convictions of health-care providers and developing a consistent, national framework.
It is critical that the federal government rapidly advance its commitment to engage the provinces and territories in developing a national, end-of-life-care co-ordinating system. At least one jurisdiction has created such a system to connect patients with willing providers. Until a national system is available, there will be a disparity of support for patients and practitioners across jurisdictions.
4. Respect for personal convictions: The CMA believes that Bill C-14, to the extent constitutionally possible, must respect the personal convictions of health-care providers. The Supreme Court, in the Carter ruling, emphasized that any regulatory or legislative response must seek to reconcile the Charter rights of patients wanting to access assisted dying and physicians who choose not to participate on grounds of conscientious objection, while understanding that all doctors must respond to a request and cannot abandon their patients. This balance has been achieved in Bill C-14, but unless it is passed into law, different regulatory and provincial approaches will result in a patchwork system. Ottawa can mitigate this outcome by quickly establishing a national, end-of-life-care co-ordinating system.
It has been suggested that there are no negative consequences to not passing Bill C-14. But if Parliament does not act by June 6, there would be a legislative vacuum in the criminal law on these and other key issues.
Without federal legislation, confusion would remain about the fact that one doctor's involvement would be enough, even though there is widespread agreement that at least one other medical practitioner must agree that all of the eligibility criteria have been met. Further, no written request would be required, nor would a period of reflection or "cooling off" be required, even though these have been identified as key issues.
There would be no requirement for reporting on medically assisted dying, so there would be no data collected to assess and evaluate how the practice works. Another concern is that medical aid in dying would not be limited to only insured persons eligible for publicly funded health-care services in Canada; this could open the door to Canada becoming a destination for aid-in-dying "tourism."
Throughout its 149-year history, the CMA has defended the best health interests of Canadians. The association also supports a robust federal role in health, something that is urgently needed now as we near the deadline for the government to enact legislation on medically assisted dying.
Delays in passing Bill C-14 will serve no one. We urge parliamentarians to get on with the job at hand.