Assisted suicide has been legal in Canada for over two years, but there is a concern that the current rules prevent many people from ending their life, despite their level of suffering. The federal government commissioned the Council of Canadian Academics to study a number of these issues, including advance requests for assistance in dying especially as it relates to dementia, how the rules impact those with mental illness and whether exceptions should be made for certain mature minors. After eighteen months, they produced an 800-page document that agreed these were significant issues. No recommendations were made.
This article will examine two issues:
- Rules related to doctor-assisted suicide
- Issues with the legislation
Effective June 6, 2016, doctor-assisted suicide or medical assistance in death (MAID) became legal in Canada. This was controversial legislation as some believed it should never be enacted, while others believe it did not go far enough to alleviate the suffering.
Rules Related to Doctor-Assisted Suicide
The legislation states patients should be eligible for medical aid in dying only when “natural death has become reasonably foreseeable,” although it does not say how close to death a person would need to be. There are two types of doctor-assisted suicide. A doctor or nurse practitioner can administer the lethal substance to the person who made the request, or the medical professionals can prescribe the legal substance and the patient can self-administer the substance that will cause death.
To be eligible for doctor-assisted suicide the following conditions must be met:
- The individual must be over the age of 17.
- They must be covered by provincial health insurance. This restricts non-residents from receiving the procedure.
- The request must be voluntary and the patient must be advised of the available options to relieve the suffering.
- The patient must suffer from a “grievous and irremediable medical condition.” This term is defined as a patient meets all of the following requirements:
Have an incurable illness or disability
Be in an advanced state of decline
Endure intolerable physical or psychological suffering
Natural death is foreseeable.
A patient will first make a written request to kick-start the process and that request must be signed by two “independent” witnesses. Neither of those witnesses can be providing medical or other personal care to the patient, own or operate the facility where they are being cared for, or be a beneficiary in the patient’s will. Two independent doctors or nurse practitioners must evaluate the request and provide their opinions on whether the patient qualifies. The law also requires a 15-day reflection period, although the delay could be waived if the person’s death or loss of capacity were imminent.
The government released the following stats related to assisted death:
- In the first 18 months of legalization, 3,714 people used the new law to end their life
- 14% of requests are not fulfilled because the patient dies before the procedures could be carried out
- Just under 10% of requests are denied, normally because of a loss of mental competency
Issues with Legislation
Although the current legislation may be perceived as a step in the right direction, there are a number of concerns that the legislation does not go far enough. Many people do not want to lie in a hospital bed with no chance of ever going home or living a normal life. However, if death is not in the foreseeable future, their suffering may continue.
The legislation addresses individuals that have been diagnosed with late-stage diseases such as cancer, but what about individuals with dementia and Alzheimer’s disease? They are considered to lack the mental capacity to make informed consent.
For example, an individual has been in long-term care for years with no friends or family. He is unable to walk but has no disease. He is just very old and frail. Such individuals do not qualify for the procedure.
Consider the case of Audrey Parker. She was 57 years of age with advanced breast cancer that had spread to her brain. Her goal was to make Christmas, but she was concerned that her brain would deteriorate to the point that she could no longer make informed consent for the end of life procedure. She had the option of ending her life immediately or taking a chance that her brain would retain its ability to make an appropriate decision for some unknown period of time. She was not allowed the option of being allowed to die after Christmas. As a result, she ended her life while her mind was still clear to avoid the position of having extreme pain and not being considered mentally competent to end her life. She never saw Christmas.
The legislation will evolve, but this should happen sooner, rather tha