Report recommends euthanasia for: dementia, minors, psychiatric conditions and without effective oversight.

By Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

The Report of the Special Joint Committee on Physician-Assisted Dying (Committee) was released today under the veneer of a “Patient-Centred Approach.”

This report is not patient centred but rather it is oriented to how medical professionals will cause the death of their patients.

The report contains 21 recommendations that ensure access to euthanasia and assisted suicide, under the term “Assisted Dying” for people who seek to be killed by a medical professional, based on physical or psychological suffering.

The report recommendations go beyond the Carter Supreme Court decision that stated that a person must be: 

“a competent adult person who clearly consents to the termination of life.”

The report recommends assisted death, by lethal injection (also known as euthanasia), be done, without effective oversight (recommendations 12 & 15) for people who are not terminally ill (recommendation 2), who may be unable to clearly consent due to dementia (recommendation 7), or mature minors (recommendation 6), and for people with psychiatric conditions (recommendation 3), including treatable depression (recommendation 4).

The report also demands that medical professionals, who refuse to kill their patients, must refer those patients to a physician who will kill (recommendation 10) and that medical institutions must permit killing on their premises (recommendation 11)

Analysis of the recommendations:

Recommendation 1 states that the terminology does not require definitions.

One of the many problems with the Supreme Court decision was that the language of the decision was not defined. Definitions are important to ensure clarity of the law.

If parliament does not clearly define the law, it will lead to future court cases designed to define or expand the excepted definitions of the law.

Recommendation 2 states that assisted dying not be limited to people with a terminal illness.

Recommendation 3 states that assisted dying can apply to persons with psychiatric conditions. Based on Recommendation 4, recommendation 3 opens the door to people who have treatable psychiatric conditions being approved for death by lethal injection.

Recommendation 4 states that the reason for assisted death should be based on what is intolerable to the individual. Objective criteria are not required to determine who will live and who should die.

Recommendation 5 requires an assessment for capacity to provide informed consent.

This recommendation appears to ensure capacity to consent. The report states several times that safeguards and oversight will strike the balance between vulnerability and a clear request to die, and yet, the report rejects the necessary safeguards and oversight to accomplish that task.

Recommendation 6 states that the federal government should implement euthanasia in a two-stage process, whereby the first stage would limit euthanasia to competent adults, with euthanasia being extended to “mature minors” within three years of implementing stage 1.

Recommendation 7 states that an incompetent person could be approved for euthanasia, so long as the person made the request after receiving the diagnosis, while the person is still competent.

Assisted death based on advanced directives can lead to misuse of the law. If a person states in their advanced directive that they want to die by euthanasia, often the euthanasia will occur when the person cannot change their mind since, at that moment, the person may be incompetent. How can this be defined as clearly consenting?

Recommendation 8 states that the person who died must be eligible for publicly funded healthcare services in Canada. This recommendation will not prevent death tourism.

Recommendation 9 suggests that the request for assisted death should be made in writing and witnessed by two people who have no conflict of interest.

Recommendation 9 does not permit a request for assisted death by a substitute decision maker, and yet recommendation 7 will require the substitute decision maker to make the request.

Recommendation 10 requires health care practitioners, who object to killing their patients, to effectively refer their patients to someone who will kill their patient or arrange it. This report provides no conscience protection for medical professionals.

Recommendation 11 requires all publicly funded health care facilities to permit euthanasia and assisted suicide. This would requires all religiously affiliated health care facilities to kill patients.

Recommendation 12 requires two independent physicians to assess a person who requests assisted death.

In all jurisdictions, where assisted death is legal, the law allows two doctors to determine who lives and who dies. Recommendation 12 does not provide effective oversight since recommendation 15 rejects a prior review and approval process and recommendation 16 requires the doctor who causes the death to submit a report. Doctors do not self-report misuse of the law.

Recommendation 13 permits nurse practitioners and registered nurses to lethally inject patients under the direction of a physician and it protects pharmacists and other health care practitioners from possible prosecution for participating in killing people.

Recommendation 13 is worded as providing protection for nurses, but in fact it is based on ensuring that there is a sufficient number of medical professionals who are willing to kill.

Recommendation 14 discourages a “cooling off” period even though the Oregon and Washington State assisted suicide acts require a 15 day waiting or “cooling off” period.

Recommendation 15 rejects a before-the-death approval or review system to ensure that the requirements of the law are followed.

A before-the-death approval system enables effective oversight of the law. The report rejects a system of effective oversight for a system where doctors self-police and self-report compliance with the law.

Recommendation 16 mandates a system of data collection and reporting to be published on a yearly basis.

The data will come from the reports that physicians will be required to submit, after-the-death of the person. This system provides no effective oversight, because the person is dead when the report is submitted. Little or no information concerning inappropriate deaths will be uncovered since doctors do not self-report misuse of the law.

Recommendation 17 requires a mandatory review of the law, by the House of Commons and Senate, every four years.

Recommendation 18 recognizes that indigenous patients require culturally and spiritually appropriate care, including palliative care.

Recommendation 19 urges the federal, provincial and territorial governments to re-establish a Secretariat on Palliative Care and End-of-Life Care.

Recommendation 20 urges the federal, provincial and territorial governments to support the Changing Directions, Changing Lives Mental Health commission.

Recommendation 21 urges the federal, provincial and territorial governments to develop a pan-Canadian strategy for individuals living with dementia.

The report of the Special Joint Committee on Physician-Assisted Dying is very similar to the one-sided Provincial/Territorial report. 

The recommendations would permit a wider regime for euthanasia that exists in Belgium, where the law has grown out of control. 

The report allows assisted death without effective oversight (recommendations 12 & 15) for people who are not terminally ill (recommendation 2), who may be unable to clearly consent (recommendation 7), or for mature minors (recommendation 6), and for people with psychiatric conditions (recommendation 3), including treatable depression (recommendation 4). The report demands that medical professionals, who refuse to kill their patients, must refer those patients to the executioner (recommendation 10).