Canadian Report suggests that more research is needed on euthanasia for incompetent people who made an advanced request

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The long-awaited reports from the Council of Canadian Academies (CCA) concerning the possible extension of euthanasia to children (mature minors), to incompetent people who made an "advanced request," and to people for psychological conditions alone was released on December 12.

The Euthanasia Prevention Coalition opposes euthanasia but for the purpose of this article we will only comment on the issue within the report.

Canada legalized euthanasia in June 2016 in response to the Supreme Court of Canada Carter decision in February 2015 that struck down Canada's laws protecting people from euthanasia and assisted suicide.

Euthanasia and assisted suicide are now referred to as Medical Aid in Dying (MAiD) in Canada.

• Link to the CCA summary of the three reports.
• Link to the report: Advanced requests for Medical Assistance in Dying.

The CCA report offered "positive" and negative outcomes to extending euthanasia to incompetent people who made an "advanced request" for euthanasia but they concluded that more research is needed. They stated:

Allowing ARs for MAID could provide comfort and relieve anxiety and distress at end of life for people who want to receive MAID, but are concerned about losing decision-making capacity prior to the procedure. However, removing a requirement for express consent immediately prior to the MAID procedure raises the possibility that a person might receive MAID against their wishes.

The report recognized that the "advanced request" would only be implemented when the person becomes incompetent, meaning that a "Third-Party" would be required to make the decision for death. This becomes complicated with euthanasia decisions because the laws state that the person must be experiencing "intolerable suffering" which is determined by the person requesting euthanasia. The report then states:

However, the person must rely on others to recognize when the conditions described as intolerable suffering in their AR for MAID have been met. An AR for MAID would have to specify what criteria the person considers intolerable (e.g., being bedridden, not recognizing family members, difficulty breathing, or experiencing pain), but these are circumstances of anticipated suffering that may not reflect the lived experience of the person when they reach those circumstances. Uncertainty about how to approach an AR for MAID increases if the person who has lost capacity appears indifferent to receiving MAID, expresses a desire to continue living, or physically or verbally resists the MAID procedure.

The report also recognizes the difficulty with legislating advanced consent for euthanasia considering the fact that every province has its own advanced directive legislation.

Consider the recent case in the Netherlands concerning a woman (74) with dementia who made an advanced request for euthanasia. 

When the doctor came to do the euthanasia the woman resisted and said NO. The doctor, without telling her, put a sedative in her coffee, but the woman still resisted. The doctor then had her family hold her down while the doctor did the euthanasia injection.

In this case, the woman was incompetent and the doctor did not consider that she may have changed her mind. This case outlines how a supposed "advanced request" for euthanasia can result in a euthanasia death without consent.

Once again, the report leans toward the position that euthanasia is a medical act and it makes close comparisons between end-of-life treatment decisions and euthanasia. These comparisons are contentious considering that parliament legalized euthanasia (MAiD) by creating an exception in the criminal code and not by defining it as a medical act.

The report does not recommend extending euthanasia to incompetent people who have made an advanced request but rather it recommends that more research is required.

Canada’s euthanasia lobby is pushing hard to extend euthanasia based on advanced requests. The Audrey Parker campaign was designed to pressure the government to approve advanced request.