The Liberal government tabled legislation Monday to amend the rules on medical assistance in dying (MAID), repealing the requirement that a person’s natural death be “reasonably foreseeable” and disqualifying those whose sole underlying condition is a mental illness.
The proposed changes also would permit access to MAID to someone whose death is reasonably foreseeable — but who has lost the capacity to consent since deciding to do so through an agreement with a medical or nurse practitioner.
The bill removes the requirement for a 10-day “reflection period” and waives the requirement that a patient provide final consent.
During a news conference in Ottawa, Justice Minister David Lametti said the change to the rules on consent will prevent cases of patients opting to end their lives sooner than they might otherwise because they fear losing their ability to give consent.
“No one should be faced with such an impossible choice,” he said.
Lametti cited the case of Audrey Parker, a Nova Scotia woman who chose a medically assisted death earlier than she wanted because she feared that doctors would deny her the procedure if she lost her mental capacity to consent before the time arrived.
The 57-year-old had stage 4 breast cancer that had spread through her bones and to her brain.
Lametti said that while the legislation widens eligibility, those obtaining MAID must still experience intolerable suffering and be in an advanced state of decline due to an incurable condition.
“We’re talking about people … who are suffering, families going through some of the most difficult times of their lives,” he said.
“So when it comes to these deeply personal and complex issues, we must act responsibly and, most importantly, with compassion.”
In September 2019, a Quebec judge declared parts of the federal and provincial laws on assisted dying unconstitutional, and gave the federal government six months to pass new legislation.
Quebec Superior Court Justice Christine Baudouin said one portion of the federal law — requiring that a patient must face a “reasonably foreseeable” death before seeking medical assistance in dying — violated Canadians’ charter rights.
During the news conference Monday, Lametti said the new legislation responds directly to that ruling, and also reflects consultations with academics, medical professionals and the public.
Since MAID became legal in Canada in June 2016, there have been more than 13,000 medically assisted deaths, according to background material provided by Justice Canada. Cancer is the most frequently cited underlying medical condition, followed by neurological conditions and cardiovascular or respiratory conditions, according to the government document.
The bill arrived after the government launched an online survey on MAID and held roundtables in cities across the country. The survey drew about 300,000 responses.
‘Unreasonable and unjust’
Health Minister Patty Hajdu said ministers heard during those consultations from medical professionals and members of the public who argued that the requirement to give final consent was problematic because patients worried they could lose the capacity to give that consent.
Some, like Audrey Parker, chose to die early, and others — fearing they could lose capacity — refused to take pain medication.
“This is unreasonable and unjust,” Hajdu said.
Canada’s existing MAID law requires a parliamentary review and a study of the state of the palliative care in Canada by June 2020.
That review will also consider whether the law should allow advance requests, access for the so-called “mature minors” doctors consider capable of making their own decisions on medical care, and whether psychiatric conditions should be grounds for assisted death.
The government commissioned three independent reports on those issues, which were submitted to the government more than a year ago by the Council of Canadian Academies, a group that pulls together experts to consider public policy.
Employment, Workforce Development and Disability Inclusion Minister Carla Qualtrough said the government heard concerns that disabled people could be threatened by expanded access to MAID. She said the updated legislation includes safeguards so that people know their options include disability supports, counselling and palliative care.
“That’s what disability rights advocates were calling for, to make sure decisions were informed,” she said. “I think that has been achieved in this law.”
The Canadian Medical Association (CMA) issued a statement calling the proposed changes a “prudent step forward.”
The CMA said it had pushed for a balanced approach, which included ensuring appropriate safeguards and allowing physicians to act according to their “moral commitments.”
“We welcome the government’s staged approach in order to carefully examine more complex issues,” said CMA president Sandy Bachman.
“We look forward to working closely with Parliament during the upcoming legislative proceedings and the legislative review which is expected later this year.”