Physician Assisted Suicide (PAS) in Canada
2017: Court clears up law's ambiguity.
Catholic hospital conflict over PAS.
2020: Federal government considers
to the PAS law.
2021: Canadian Senate passes amendments
2017-JUN: Ontario court issues ruling to clarify the ambiguity in the PAS law:
An unidentified Ontario woman, "AB," age 77, is suffering from chronic osteoarthritis which she finds intolerable. She requested medical aid in dying from two physicians who both assessed her as eligible for assistance under Bill C-14. However, the physician who was going to give her that help in dying refused to proceed. The problem involved the interpretation of the law's phrase: "natural death must be reasonably foreseeable." It might take years for her body to finally collapse and cause death. It is quite conceivable that a prosecutor could conclude that the woman had many years before a natural death, and charge the physician with murder if he helped her commit suicide.
AB filed a case with the Ontario Superior Court of Justice.
Paul M. Perell Associate Chief Justice of the court issued his ruling. He concluded that the doctor's:
"... abundance of caution and apprehensive misunderstanding"
of Bill C-14 was the issue causing the conflict. He ruled that to be reasonably foreseeable, the person’s natural death doesn’t have be imminent or within a specific time frame, or be the result of a terminal condition. He wrote that the legislation is intended to apply to a person who is:
"... on a trajectory toward death because he or she a) has a serious and incurable illness, disease or disability; b) is in an advanced state of irreversible decline in capability; and c) is enduring physical or psychological suffering that is intolerable and that cannot be relieved under conditions that they consider acceptable."
[This case case clearly qualifies as she is an] ... almost 80-year-old woman in an advanced stated of incurable, irreversible, worsening illness with excruciating pain and no quality of life. ..."
"All the court can do in the circumstances of the immediate case is to clarify what Parliament meant in [C-14] so the Physician-1 and other physicians have no misunderstanding about how to comply with the legislation. There is no floodgates concern because the court need do this only once for whatever benefit it may provide to AB and others."
Shanaaz Gokool, the CEO of the Canadian non-profit "Dying with Dignity" believes that the law does not assign a specific time-frame like six months or a year. She said:
"The government has said repeatedly you don’t have to have to be terminally ill, you don’t have to have a time frame, the prognosis that you have doesn’t have to be what leads to your natural death.
We have found an inconsistent application when it comes to the eligibility criteria . . . and I think this decision will go a long way to extinguish that sort of myth." 1
2017-OCT-26: Conflict experienced by a patient seeking MAID in a faith-based hospital:
Cheppudira Gopalkrishna was an 88-year-old patient in the Misericordia Health Centre in Winnipeg, Manitoba. He suffered from Lou Gehrig's disease, a.k.a. ALS. He had lost almost all of his mobility. The Centre is affiliated with the Roman Catholic Church which bans medically assisted death to occur in their facilities. They also do not allow assessments of patients on their site to determine their elibibility for MAID. In this patient's case, Misericordia allegedly delayed providing medical records on several occasions. It took almost six months from the initial contact with the area MAID committee before Gopalkrishna was temporarily moved out of the hospital to be formally assessed.
Holly Caruk and Bryce Hoye, writing for CBC News said:
"Arthur Schafer, who was part of a panel of experts that provided recommendations to provincial governments on assisted dying legislation, says any delays in accessing end of life services, including forcing a patient to be transferred to access services, are unacceptable.
'They are obstructing the rights of the most vulnerable, frail patients to have access to information about their legally entitled end of life options. It's shameful, it's cruel, and it's inhumane,' he said." 2
Shaver said that:
"The [MAID] committee requested the hospital to provide them with the patient's records, because they can't proceed without seeing whether the patient is eligible based on their medical records. And the hospital obstructed those efforts. ... We need an effective education campaign, and we need the WRHA [Winnipeg Regional Health Authority] to defend patients against institutions that put religious dogma ahead of patients' rights of access to health-care services." 2
On 2017-OCT-27, he was temporarily taken out of the hospital and finally received his assessment for MAID. The MAID team determined that he was not yet eligible for the procedure. He apparently died on 2018-APR-25, but there is no indication in media whether it was a result of old age, ALS, or MAID.
2017-NOV-17: Secobarbital medication expected to change MAID in Canada:
Joan Bryden,, writing for the Canadian Press, said:
"Health Canada reports that from June 2016 to June 2017 — the first year in which medical assistance in dying (MAID) was legal in Canada — a total of 1,982 individuals received an assisted death. Of those, just five were self-administered deaths. ... But that could change now that secobarbital — the drug most commonly used for assisted suicide in other countries — is available in Canada."
Secobartital is an ideal medication to use to commit suicide, because after it is ingested, the person falls asleep within minutes and dies within hours. Other medication taste bad, and/or need to be taken in considerable volume so that some individuals are not able to ingest sufficient medication to cause death. 3
2020: Federal Government considers changes to MAID law:
On 2019-SEP-11, the Superior Court of Québec issued a ruling in the case Truchon v. Attorney General of Canada. It determined that the law's provison restricting access to MAID only to those Quebeckers close to the end of their life is unconstitutional. The Court’s ruling will come into effect on 2020-MAR-11 in Quebec, unless the Court grants an extension.
All, or almost all, of the MAID laws in the U.S. have similar restrictions. As a result, when a person in North America develops a medical problem that causes their quality of life to degenerate to the point when continued living is intolerable to them, they may have no access to MAID, simply because they are not in immediate danger of dying.
The court ruled that Federal Government has until 2020-MAR-11 to ovedrhaul the law to widen access to MAID. The Government has started an online consultation that closes on JAN-27. 4 Although the court ruling only applies to individuals in Quebec, the Federal Government has decided to change the Federal law as it applies across Canada.
The Honourable David Lametti,
Minister of Justice and Attorney General of Canada, said:
"Medical assistance in dying is a profoundly complex and personal issue for many Canadians across the country. It touches people and families facing some of the most difficult and painful times in their lives. Our Government has committed to updating Canada’s legislation on medical assistance in dying in response to the Superior Court of Québec’s decision in Truchon v. Attorney General of Canada. We have a responsibility to do this in a way that is compassionate, balanced, and reflects Canadians’ views on this important issue. The consultations we are launching today will allow us to hear directly from Canadians and guide the path forward."
The Honourable Patty Hajdu,
Minister of Health, said:
“Canadians who are deciding whether they wish to receive medical assistance in dying are often experiencing prolonged suffering. Their situations are diverse, and extremely personal. Accessing medical assistance to die raises questions about how a person’s autonomy to make this choice is respected while their safety is protected. I look forward to hearing from people across the country about how to respond to the Court’s decision. I encourage Canadians to participate in the consultation process so the government can proceed with the safety and autonomy of Canadians at the centre of our work."
The Honourable Carla Qualtrough,
Minister of Employment, Workforce Development and Disability Inclusion, said:
"The Government of Canada is committed to ensuring that the voices of all Canadians, in particular Canadians with disabilities, are heard on the issue of medical assistance in dying. In the spirit of “nothing without us” and the human rights-based approach taken in the Accessible Canada Act, we will work with the disability community to address concerns around vulnerability and choice, while protecting equality rights. Together we have made a lot of progress in the area of disability rights. We look forward to receiving thoughtful feedback, and will continue to work together to ensure that every person is treated with the dignity and respect they deserve." 5
On 2020-JAN-25, W.Clifford-Jones MC published an article that discusses the present MAID law. 6 He wrote:
"How long will patients, those dying in pain, have to endure the political nonsense surrounding the law, Medical Assistance in Dying (MAID)? The government has announced it will conduct yet another survey to determine if Canadians want to modify its incomplete law. Why another survey, another expense?
The current MAID law has horrendous and painful consequences. For instance, a signed “Advanced Directive” of a patient diagnosed with Alzheimer’s disease or, another type of dementia, has no bearing once a patient has lost capacity to give consent. It’s lunacy to expect a patient to reconfirm consent when their brain is comatose, they’re incontinent of urine and feces, and living in diapers. Why won’t MPs and Senators realize this is unspeakable cruelty to force life [to continue] this way?
Another unconscionable condition is that MAID cannot be used until a dying patient’s death is imminent. This means that patients dying of cancer, or gasping for air from heart failure, or dementia, whose lives are a living hell, must continue to suffer because death may not be fast approaching. The psychological and physical suffering may go on for months, sometimes years.
We don’t let dogs suffer this way. But for unfathomable reasons some show no remorse for letting humans suffer at the end of life." 6
The Canadian Federal Department of Justice's questionnaire can be viewed at: https://justice.gc.ca/eng/cons/ad-am/ If you are a Canadian, please consider filling it out.
2020 and 2021: Webmaster's personal note:
I am 83 years of age and am in good health. However, I expect to die naturally within about the next five years. Severe mental decline is widespread among my entire family of origin. I expect to develope a degenerative disease that so limits my quality of life that I would want to take advantage of M.A.I.D. Yet under the federal law as it existed in early 2021, I might not be eligible for M.A.I.D. because there may no reason to expect that my natural death would ocurr in the very near future. And so, I would be required to suffer -- potentially for many years. I am REALLY pleaased with the changes in the Federal law!
2021-FEB-23: Canadian Senate passes C-7 euthanasia bill:
Bill C7 received 54 hours of hearings before the Senate's Legal and Constitutional Affairs Committee. The bill would expand the categories of who can obtain M.A.I.D.
Amendments include passages that would:
- Allow persons anticipating mental decline in their future to make an advance request for an assisted death. Sen. Pamela Wallin, a member of the Canadian Senators Group who proposed the amendment, noted that, under the original version of the bill a person may have already lost the mental competence to consent to M.A.I.D. by the time that they are diagnosed with Alzheimer's or a simlar disease. She said:
"As someone with a history of dementia in my family, I seek the peace of mind that an advance request and consent to it will provide. I am certainly not alone in this belief. The majority of Canadians have come to the same conclusion." 7
- Impose an 18-month time limit on the bill's proposed ban on assisted dying for persons suffering solely from mental illness.
- Require the government to collect race-based data about who requested and received M.A.I.D.
- Establish a parliamentary committee to review the assisted dying regime within 20 days of the bill becomng law.
- No longer require that the person's natural death be "reasonably foreseeable."
On 2021-FEB-17, the Senate adopted the bill with five amendments.
On the evening of 2021-MAR-17, the Senate passed the law with 47 in favor, 28 opposed and eight abstentions. The acting Governor General and Chief Justice of the Supreme Court signed Bill C-7 into law!
On MAR-18, Helen Long, the CEO of Dying With Dignity Canada email their followers with the following list of changes caused by the new law:
- Canadians no longer must have a reasonably foreseeable death in order to be eligible for medical assistance in dying;
- There are now two sets of safeguards in place: One for those whose death is reasonably foreseeable, and one for those who death is not reasonably foreseeable;
- Canadians who have been assessed and approved for medical assistance in dying, but risk losing capacity to consent prior to the MAID procedure, will be able to sign a waiver of final consent;
- During the two-year mental illness exclusion, the Government of Canada will hear from experts and develop safeguards and protocols for people who seek access to MAID, but whose sole underlying medical condition is a mental illness.
The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.
- Alyshah Hasham, "Advocates hail judge’s decision in woman’s assisted death appeal," Our Windsor, 2017-JUN-19, at: https://www.ourwindsor.ca/
- Holly Caruk & Bryce Hoye, "Waiting to die: Winnipeg man says faith-based hospital delayed access to assisted death," CBC News, 2017-OCT-26, at: https://www.cbc.ca/
- Joan Bryden, "Newly available drug secobarbital could boost number of self-administered assisted deaths," Canadian Press, 2017-NOV-17, at: https://www.cbc.ca/
- "Medical assistance in dying: Share your views online," at: https://www.justice.gc.ca/
- "Government of Canada consults Canadians on medical assistance in dying." Department of Justice Canada, 2020-JAN-13, at: https://www.lifesitenews.com/
- W.Clifford-Jones, "The Saga Continues: Rotten Law, Rotten Politicians, and Rotten Eggs," 2020-JAN-25, at: https://www.docgiff.com/ticle/the-saga-continues-rotten-law-rotten-politicians-and-rotten-eggs/
- Joan Bryden, "Canadian senators approve amendment to assisted dying bill to allow advance requests," Global News, 2021-FEB-10, at: Canadian senators approve amendment to assisted dying bill
Copyright © 2017 & 2020, by Ontario Consultants on Religious Tolerance
Original posting: 2016-MAR-04
Latest update: 2021-MAR-18
Author: B.A. Robinson