Saturday, February 07, 2015

Physician-assisted suicide to be legal in Canada

Canada is joining the ranks of iconoclastic firebrand countries like Belgium, the Netherlands, Switzerland and Colombia (as well as the odd renegade US states like Washington and Oregon, and the Canadian province of Quebec), in making doctor-assisted suicide legal.
The Supreme Court of Canada yesterday ruled unanimously that people should be allowed legal access to assisted suicide, rather than being forced to take their own lives in a violent, dangerous or unreliable way, or continuing to suffer in the hope of an early natural death. As the articles (not, I think, the court) succinctly put it, the right to live is not a duty to live.
Yet again, the (largely Conservative-appointed) Supreme Court has given a slap in the face to Mr. Harper, which is maybe a good indication of just how far to the right Harper and his government have wandered.
The Court has given the government a year in which to implement the ruling, and establish the necessary safeguards. But it also offered a few general parameters to help with this, including the injunction that it should only be administered to a "competent adult person" who "clearly consents to the termination of life" and who has a "grievous and irremediable condition that causes enduring suffering that is intolerable to the individual", either physically or psychologically.
Of course, the Conservatives and the religionists are not happy, and, as usual with these morally ambiguous issues, there are other objections. For example, some advocates of the disabled have condemned the ruling, claiming it is too permissive in that it is not restricted to the terminally ill. But it does apparently reflect the will of the Canadian people and the current Zeitgeist: a November 2014 Ipsos Reid survey of more than 2,500 Canadians found 84% support assisted dying, provided strong safeguards were in place.
The task now is to institute a proper legal framework to make the ruling work, and to establish those safeguards. It sounds easy when you say it like that, but I've a suspicion that the hard work is just about to begin.

Fast forward to April 2016, and the new Liberal government in Canada introduces a parliamentary bill to enact the Supreme Court ruling on doctor-assisted dying. While the bill does the necessary in effectively legalizing medical assistance in dying, and lays out the general process for doing so, it has been criticised by many for being too cautious and narrow in its remit.
It is indeed narrower than the Supreme Court ruling in that it allows for doctor-assisted suicide only for mentally competent adults over the age of 18, where "natural death has become reasonably foreseeable". The latter part in particular is contentious because of its vagueness, and because it may exclude people with degenerative neurological diseases like dementia, Huntington's disease, Parkinson's disease, ALS, multiple sclerosis, etc. The bill allows for no mechanism for advance consent for people with degenerative diseases or worsening psychological conditions. It also puts the current Quebec law, which specifically requires a terminal condition, in limbo.
So, a good start, perhaps, but this is far from over. All major parties have promised a free vote on the bill, and even if passed it may still be subject to legal challenges.

The bill was finally passed on June 17th,  a week or two after the court-prescribed deadline, and after a lot of toing-and-froing and argy-bargying between the House of Commons and the Senate. Many of the Senate's recommended amendments were accepted, but in the end the Senate backed down on its most important proposal, namely to remove the "reasonably foreseeable" end-of -life requirement. Thus, patients with a disease like multiple sclerosis probably will be covered by the law, but those with non-terminal or psychiatric illnesses will not, regardless of the pain and distress being experienced. I can see those legal challenges being drawn up even now.

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