Canadians should have equal access to publicly funded, doctor-assisted dying with no age limitations, and physicians and institutions that object should be obliged to provide a timely referral, says an expert panel advising provincial and territorial governments.
The report, released on Monday, comes as the new federal government considers its response to a Supreme Court ruling last year that struck down a law that made it illegal for doctors to help competent, consenting adults with “a grievous and irremediable condition that causes enduring suffering” to end their lives. The court suspended the effect of its decision until February. The Liberal government has asked for a six-month extension to that deadline to study the issue and come up with new laws.
Among the panel’s 43 recommendations are calls for uniform rules across the country and for other health professionals, such as nurse practitioners, to be involved as a way to increase access. The panel defines a grievous and irremediable medical condition as “a very severe or serious illness, disease or disability that cannot be alleviated by any means acceptable to the patient.”
The recommendations include a list of safeguards, such as requirements for assessments from two doctors and a witnessed declaration from the patient that would serve as a formal request. But the panel stops short of recommending a minimum age of consent, saying instead that eligibility should be based on competence, rather than “arbitrary age limits.”
Jennifer Gibson, the co-chair of the panel and the director of the University of Toronto Joint Centre for Bioethics, said the nine panelists were motivated most by a desire not to have a patchwork of rules across the country.
“If we are going to do this, let us do this right and in a way that doesn’t create a burden on patients,” she said in an interview.
While the experiences of other countries can provide some lessons, Ms. Gibson said the greatest insight that came during the months of study and consultation was the need for a made-in-Canada approach. “Canada is a big country with no single national health service, which together creates special challenges,” she said. “When we think about equitable access, we need to be creative about it.”
For that reason, the report recommends the use of technology to allow video-based consultations and changes to the Criminal Code so that regulated health-care professionals such as nurse practitioners, nurses and physician assistants can provide assisted-death under the direction of a doctor. It also recommends having no requirement for a doctor to be present at the time of death.
Individuals seeking help to end their lives will likely have difficulty travelling to receive treatment, Ms. Gibson said, so the report recommends doctor-assisted dying “should be available wherever patients live,” be that in a hospital, long-term care or at home.
Faith-based institutions could conscientiously object, but the report says they should have to “make arrangements for the safe and timely transfer of the patient to a non-objecting institution” for assessment and potentially help with dying.
Wanda Morris, head of Dying with Dignity, said the report did a good job of balancing the interests of vulnerable populations and ensuring that patients come first.
Given the comprehensiveness of the panel’s efforts, Ms. Morris said she believes the federal government does not need to conduct extensive consultations. “My hope is that the federal government will see the work that has been done,” she said.
Doris Grinspun, chief executive officer of the Registered Nurses’ Association of Ontario, said her group supports including registered nurses and nurse practitioners in providing assisted death. “It’s a matter of timely access to care,” she said.
Three territories and eight provinces were involved in the Ontario-led panel. Quebec had its own bipartisan committee that travelled the province to study the subject, and British Columbia participated as an observer.
An advisory panel commissioned by the former Conservative government is expected to report on Tuesday.
The Globe and Mail
Published Monday, Dec. 14, 2015 1:48PM EST
Last updated Monday, Dec. 14, 2015 10:46PM EST