Report urges Ottawa to provide clarity over assisted dying

Some people near the end of their lives may be unable to access medical assistance in dying (MAiD) or suffer needlessly through waiting periods unless Ottawa clarifies who is eligible and under what circumstances, a new report says.

“Individuals who should have access may be denied, while others may be given access who should not,” say authors Jocelyn Downie of Dalhousie University and Jennifer Chandler of the University of Ottawa.

“This uncertainty may also result in a chilling effect on medical and nurse practitioners’ willingness to provide MAiD.”

The federal government passed legislation in June 2016 that allows Canadians to receive medical assistance in dying.

Nearly 2,000 people received an assisted death in the first year.

The procedure is particularly popular in British Columbia where 932 people have received MAiD over the past two years.

The authors also worry that “some patients may forgo drugs needed for effective pain control and remain in a state of intolerable suffering in order to maintain the necessary level of decision-making capacity to reiterate their request at the time of MAiD administration.”

The report — drafted after extensive consultation with MAiD providers — identifies six phrases in the legislation that create uncertainty and attempts to better define them for doctors and the courts.

Downie and Chandler are calling on the federal Justice Minister Jody Wilson-Raybould to provide public assurance that report’s interpretations are consistent with the intent of the legislation.

Doctors starting out in this field need to feel confident that they are doing the right thing “ethically and legally,” said B.C. physician Stefanie Green, a MAiD provider.

The report highlights the importance of clarifying what the term “natural death has become reasonably foreseeable” means.

“It doesn’t mean that your death is within six months, two years or two weeks,” she said.

“It’s about a trajectory towards death caused by your illness, not a time frame.”

An Ontario court decision last year reinforced the notion that “reasonably foreseeable” does not mean within a certain period of time.

This is especially important when dealing with patients dying due to diseases such as Parkinson’s who may suffer for years with death as a certainty, said Green.

She hopes the report’s refined definitions give more physicians the confidence to take on MAiD cases.

However, the requirement that patients be “suffering intolerably” before patients can request MAiD and start the clock on the mandatory reflection period is “cruel” and should be rewritten, said Green.

The condition was added to a later draft of the legislation and has led to unintended consequences.

“The patient is not allowed to even request assisted dying until they are already in a state of intolerable suffering and then they have to wait 10 days before we can proceed,” said Green.

“We are imposing 10 days of intolerable suffering on these patients and I am sure that was not the intention of the law. It’s a mistake.”