Good start on assisted dying
Although the federal government has crafted a cautious framework to allow for physician-assisted dying in Canada, the proposed law is far from the last word. Its restrictions will somewhat ease the concerns of those who worry about a “slippery slope” leading to unnecessary deaths, while they fall short of the “my life, my choice” view of those who want few, if any, limitations on assisted death.
Still, given the reality of a 2015 Supreme Court decision that ruled unconstitutional parts of the Criminal Code and set a deadline to change the law, the Trudeau government had to start somewhere.
Certainly, the majority of Canadians who told pollsters they didn’t approve of physicianassisted death for those with mental illness or for “mature minors” will be relieved about the first guideline: An applicant must be “a mentally competent adult, 18 years or older.”
Mental competence is key. The prospect of someone with severe depression or other mental illness having access to assisted death while their thinking is impaired is unacceptable. However, the age requirement doesn’t address the plight of a 17-year-old with a terminal illness who is considered mature enough to join the military, but not to end his suffering with a doctor’s help. Expect more debate on this issue.
The law requires assisted death applicants to make a “voluntary request” that’s signed by two independent witnesses. Requests would then be evaluated by two independent physicians or nurse practitioners. A mandatory 15-day period of reflection then follows “unless death or loss of capacity to consent is imminent,” and applicants would be able to withdraw a request “at any time.”
We wonder if the medical evaluation would be thorough enough to uncover a frail patient being coerced to choose assisted death by family members for whom the burden of care is proving too onerous.
There are questions about the requirement that applicants must be in “advanced” decline from a serious, incurable illness, disease or disability, where death is “reasonably foreseeable.” What about someone diagnosed with Alzheimer’s disease? Though ultimately fatal, according to the Alzheimer Society of Canada, the disease can take years to destroy the brain — a process some patients understandably would rather not endure. Would they be denied assisted death at the early stages of the disease, when they can still make an informed decision, but be unable to access it later when their mental competence becomes severely impaired?
Such issues will emerge during implementation of physician-assisted death. Canadians must insist the process is free from abuse and meets the needs of individuals, their families and society.