Assisted dying bill raises fears of more restrictions
Experts see legislation as step in right direction, but concerns remain
OTTAWA—Some experts fear that legislation intended to make it easier for intolerably suffering Canadians to receive medical assistance to end their lives might actually make it harder in some cases and will create confusion among doctors who provide the procedure.
Bill C-7, introduced Monday, would remove a provision in the four-year-old assisted dying law that restricted the procedure to those whose natural death is “reasonably foreseeable” — a restriction that was struck down as unconstitutional by a Quebec court last fall.
But the revised law would still use the notion of reasonable foreseeability to impose a number of restrictions on those who are not near death that wouldn’t apply to those who are.
Dr. Stefanie Green, president of the Canadian Association of MAiD (medical assistance in dying) Assessors and Providers, says the bill muddies the already somewhat ambiguous notion of what constitutes reasonably foreseeable death and could mean some people who are currently eligible for an assisted death would not be eligible in future.
The bill also explicitly prohibits assisted dying in cases where mental illness is the sole underlying medical condition.
Jocelyn Downie, a professor of law and medicine at Dalhousie University in Halifax, says that exclusion is discriminatory and takes away access to the procedure that exists in the current law.
For those deemed to be near death, the government is proposing to drop the requirement that a person must wait 10 days after being approved for an assisted death before receiving the procedure. It would also reduce the number of witnesses required to one from two.
As well, it is proposing to drop the requirement that a person must be able to give consent a second time immediately prior to receiving the procedure. Both Downie and Green welcomed those changes.
But they have concerns about the more restrictive requirements for those whose natural deaths are not deemed to be reasonably foreseeable.
Such people would face a minimum 90-day period for assessments of their requests for assisted deaths. One of the two medical practitioners who assesses a request would have to have expertise in the person’s particular medical condition. And the person would have to be able to give final consent immediately prior to the assisted death.
Both Downie and Green said they’re concerned that the bill might narrow the concept of reasonably foreseeable death, which has been interpreted to mean that a person is on a trajectory towards death — be it in one, two, three or more years.
Downie and Green said a technical briefing Justice Department officials gave on the bill Monday left the impression that death must be relatively imminent to be considered reasonably foreseeable. Moreover, they noted that the preamble of the bill refers at one point to “dying persons.”
“If they want to narrow it, they need to own that they’re narrowing it and define it,” Downie said in an interview.
The wording in the preamble “raises a question,” Green said. “I’m not sure that’s the intention of the government and if it is, boy, we better know that.”
Green said that overall the members of her organization think the bill is “a step in the right direction” but they have some practical concerns, including “frustration” that they’re going to have to continue wrestling with the concept of foreseeable death to determine which of the two proposed eligibility tracks apply in each case.
Green said there’s also concern that those who are not deemed to be near death will have to be assessed by a medical practitioner with expertise in their medical condition. That expertise could be hard to find for patients in rural or remote areas.
Moreover, she said specialists are already consulted by doctors who are assessing a patient’s eligibility for an assisted death. The bill would require those specialists to actually be involved in the assessments, a burden she predicted few would be prepared to do.