Euthanasia and physician-assisted death, for those suffering from disease or illness is a subject that have been the centre of an ongoing debate for the past quarter-century in Canada. In the hospitals, medical schools, court rooms, and homes of this country; people have been asking if we have the right to ask for help in ending our own life. If so, why? What are the conditions? At what point does it become “okay”? With the recent passing of Bill C14 by the Canadian Supreme Court, the question of the right to die has been answered— or so it seems to some.
Canada’s Bill C14: Who Really Has the Right to Die?
Euthanasia in Canada
There is an important distinction between euthanasia and physician-assisted death. The former refers to doctors taking an active role in carrying out the patient’s request to die. The latter refers to doctors assisting patients by providing lethal medicine, as an example, but letting the patient end their own lives. In Canada, there is a distinction made between “passive” euthanasia, and “active” euthanasia: the first referring to the withholding of life-preserving procedures (i.e. providing food and water), and the second referring to the intentional killing of an individual to relieve pain. Passive euthanasia is legal in Canada, but active euthanasia has been considered a form of homicide until very recently. The public debate about assisted dying was most famously brought to the fore in 1992, with the Rodriguez v. British Columbia case. Sue Rodriguez, after being diagnosed with amyotrophic lateral sclerosis (ALS), made a request to the Canadian Supreme Court to allow someone to aid her in ending her life. She argued that her suffering was so great, that to continue living would cause her immeasurably pain.
Rodriquez’s case appealed mainly to the principle of autonomy, and every individual’s right to self-determination. However, she also appealed to the principle of equality and justice which states that everyone should be treated equally. Since suicide has not been a crime in Canada since 1972, Rodriguez argued that she was being discriminated against in her wish to commit suicide with the help of another person due to her disability. Though the Court refused her request, Rodriguez ended her life with the help of an unknown doctor. This particular case (though certainly not the first incident of a Canadian asking for assisted death), set in motion a tremendous series of legal and political motions that were to change the way Canada approached euthanasia forever.
The protection of the vulnerable is reflected in every aspect of this bill.
In June 2005, Francine Lalonde introduced Bill C-407 in Parliament, which would have legalized assisted suicide in Canada. The examination of this bill was short lived however, and ended in 2006. Lalonde reintroduced the bill in 2008 when she was re-elected, but it was once again ended that same year. On May 13, 2009, Lalonde introduced a second bill— Bill C-384— which was similar to her originally proposed bill. The bill was debated in the House of Commons, but was once again ended in 2010. Indeed, it appeared that the Canadian government was not yet ready to seriously consider such a bold political move— at least not nationwide. Québec, on the other hand, has been the province most adamantly pushing for change in assisted dying since this debate’s beginning.
Since the passing of Québec’s Bill 52 on June 5, 2014, physician-assisted death (or “medical aid in dying”) has been legal in the province of Québec. The bill permits assisted death in the case of an “incurable disease, and incurable illness, which is causing unbearable suffering”, and was the very first of its kind in Canada. When the bill was passed, the drafter of the bill, Parti Québécois member of the National Assembly Véronique Hivon declared that, “The protection of the vulnerable is reflected in every aspect of this bill.” She went on to say that “For me, dying with dignity means dying with the least amount of suffering… and respecting who that person always was during his or her whole life.” Indeed, with Bill 52, the way that Canadians viewed assisted death began to change dramatically.
The Rodriguez v. British Columbia case in 1992 truly set in motion a nationwide movement for change in how we care for those who are dying or extremely ill. This is made most evident by the Supreme Court’s deliberation on the recent Bill C-14 (Carter v. Canada), which states that the law banning assisted suicide of terminally-ill patients, as based on the Rodriguez v British Columbia case, was unconstitutional; and violates Section 7 of the Canadian Charter of Rights and Freedoms. This section dictates that “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice”. The Supreme Court had issued a 12-month suspended declaration of invalidity of Bill C-14 to allow time for the government to amend the Criminal Code in accordance with the Bill’s mandates. The new legislation, officially became law on June 17th, 2016, is thus intended to provide the opportunity for assisted suicide in accordance with this section of the Charter.
Who Really Has the Right to Die?
Bill C-14 “creates exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process”. The bill is restricted to “mentally competent adults” with “enduring and intolerable suffering” and in cases where death is “reasonably foreseeable”, while also mandating a 15-day reflection period on the part of the patient. Patients must also be eligible for publicly funded health care in Canada to be effected by the bill—a characteristic of the bill intended to discourage “suicide tourism”. Indeed, though this bill certainly provides the opportunity for assisted suicide that was perhaps never before thought possible in Canada, the restrictions of the application of both Bill C-14 and Québec’s Bill 52 respectively are already being critiqued by many Canadians.
I felt liberated. It is as simple as that.
An important example of one such critique would be the recent case in Sherbrooke, Québec involving a man named Jean Brault. Brault, aged 61, received a doctor’s help to end his life only after starving himself for 53 days and refusing water for 8. Only at this point was he enough to death to convince his doctors that he met all the criteria under Québec’s assisted-dying law. Brault died on April 7, 2016, declaring just days before to the CBC that: “I felt liberated. It is as simple as that. It’s as if a heavy weight has been lifted off [my] chest”. Brault was almost entirely paralyzed—a state that he slowly devolved into over a period of many decades, beginning at the age of 19 when a blood clot near his brain stem left him partially paralyzed. In the final five years of his life, Brault attempted to take his own life twice. Two days before his death, Brault said “My heart is happy.” Brault was openly critical of Quebec’s Bill 52, arguing that it needs to be more flexible and in compliance with the Carter v. Canada ruling. The Carter decision is not limited to people who have terminal illness, but also encompasses those who have a “grievous and irremediable medical condition”.
Though Bill C-14 may be more inclusive than Bill 52 in this regard, Dr. Brett Belchetz, the medical advisor for the advocacy group Dying With Dignity, has critiqued Bill C-14’s vague language—in particular, with regard to the term “reasonably foreseeable” used as a condition for the bill’s application. The joint committee of the House of Commons and the Senate tabled a report with recommendations regarding the federal bill in February 2016. The committee has suggested a three-year discussion around whether “mature minors” and those with mental illness should be allowed to ask for assisted dying as well. The bill at present is limited to those over the age of 18 years, an aspect of the bill which many have already contested. Furthermore, doctor-assisted death will be restricted to mentally competent adults who have serious and incurable illness, disease or disability. While the bill seeks to protect vulnerable Canadians, it does not include some of the most contentious recommendations from the parliamentary committee. This includes the extension of this right to mature minors and the mentally ill, as well as allowing advanced consent for patients with degenerative disorders such as dementia. Indeed, these characteristics of Bill C-14 and who it will be applicable to will certainly be discussed and developed moving forward.
Though some universities that are training the next generation of doctors are preparing medical students to incorporate assisted dying into their knowledge of patient care, many are yet unsure how to approach this new practice. The nature of the bill is still considered difficult to clearly interpret by some. As is, palliative care and the ethics surrounding end-of-life care are topics that take central roles in current curriculums across Canada. And yet, the incorporation of the new legislation remains a daunting task for many medical schools. This has much to do with the breadth of opinion regarding the bill, and who it should effect. The Supreme Court’s report has recommended that physicians have the right to “opt out”, and not be compelled to assist a patient in dying if it is against their beliefs; though they must refer the patient to someone willing to provide assistance. As it stands, though Bill C-14 in its current stages is critiqued as vague and exclusive by many Canadians, the the right to die will soon be— for the first time in Canadian history— a nationally acknowledged right.