Mr. Speaker, I am pleased to join today's debate in response to the Supreme Court's decision in Carter, which found two Criminal Code provisions prohibiting physician-assisted death to be unconstitutional and provided one year to Parliament, to February 5, 2016, to develop its response.
Physician-assisted death raises complex ethical, legal, and medical issues. Many of these issues involve competing interests and values, such as preservation of human life, individual autonomy, the protection of vulnerable individuals and groups, and human dignity and suffering. End-of-life decisions are very personal and sensitive questions for many Canadians, with deeply held beliefs on both sides of the issue and far-reaching implications for our society as a whole.
At this early stage of the debate, I believe the experience and evidence from foreign jurisdictions that have implemented permissive regimes by regulating euthanasia, assisted death, or both, are invaluable in providing input to our discussion, including with respect to eligibility criteria or procedural safeguards to protect vulnerable individuals from unwarranted deaths.
In the United States, for instance, there are only three states that provide access to physician-assisted death: Oregon, since 1997; Washington, since 2008; and Vermont, since 2013. Their legislative schemes all allow terminally ill patients to end their lives through the voluntary self-administration of a lethal dose of medication prescribed by a physician, although presence of the physician is not required during the self-administration of the medication.
Eligibility criteria for making such a request include that the patient be diagnosed with a terminal illness, which is defined as “an incurable and irreversible disease which would, within a reasonable medical judgment, result in death within six months”; that the patient be a competent adult, over the age of 18, able to make and communicate health care decisions; that oral and written requests be submitted to the attending physician; and that the oral request be reiterated no less than 15 days after the initial demand.
The legislation also provides procedural safeguards that address the physician's responsibilities when granting such requests, including confirming that the patient is terminally ill; is capable of making a voluntary and uncoerced decision; has been duly informed of the diagnosis, prognosis, potential risks, and alternative options to the end-of-life medication; and has been referred to a second physician to confirm the diagnosis and other eligibility criteria.
Attending physicians must also refer patients for counselling when they may be suffering from a psychiatric or psychological disorder impairing their judgement.
In the U.S. state approach, as is the case in all permissive regimes, reporting requirements have also been enacted. In the three American states, physicians are required to report to health departments further to prescribing the lethal dose of medication. This process allows for relevant information on the implementation of the laws to be gathered, analyzed, and reported to the public. There is no question that such information and data will be invaluable to our Canadian discussion as we delve deeper into this societal debate.
In terms of enforcement provisions, although offences for falsifying and coercing patients have been enacted in the states of Washington and Oregon, it appears that no specific enforcement mechanism has been put in place to assess physicians' compliance with the applicable rules and safeguards.
If we now look at European regimes, which currently allow both assisted suicide and euthanasia, we will notice subtle differences.
By contrast to the U.S. state approach, the European countries, specifically Belgium, the Netherlands, and Luxembourg, have broader laws that permit euthanasia or assisted suicide to be administered to a person who is suffering unbearably, either physically or psychologically, from an incurable medical condition, regardless of any proximity to death.
Since 2002, in Belgium adult patients or emancipated minors who are in a “...medically futile condition of constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident” can request to be euthanized.
Patients must be legally competent and conscious at the time of the request, and their demand must be voluntary, repeated, and not result from external pressure. Procedural safeguards in place are similar to the ones in the three states in the United States, but also include the requirement to consult with a psychiatrist if the patient is not expected to die in the near future.
The legislation in Belgium was amended in 2014 and now allows euthanasia to be practised on children of any age if they are in constant and unbearable suffering that cannot be alleviated and are likely to die in the short term. In those very sensitive cases, an explicit request must be made and parental consent must be granted.
Once euthanasia has been performed, physicians must submit a detailed report to the Federal Control and Evaluation Commission, a panel of 16 experts that determines whether euthanasia was practised in accordance with the law and that has to turn cases involving non-compliance over to the Public Prosecution Service.
In the case of the Netherlands, although euthanasia and assisted suicide are both offences under the Dutch penal code, the Termination of Life and Assisted Suicide Act came into force in 2002, providing an exemption from criminal liability for physicians who perform such practices if they report their actions and comply with the due care criteria included in the act. The criteria are even broader in this jurisdiction, since patients are eligible to request that their life be terminated if they endure “...unbearable physical or psychological suffering with no prospect of improvement”, regardless of how close they may be to death.
Competent and informed adults are eligible to receive such assistance, but so too are children between the ages of 12 and 16 if their parents consent to the request, as well as minors between the ages of 16 and 18 if they consult with their parents prior to requesting euthanasia.
Here again, regional review committees are responsible for ensuring that physicians comply with the due care criteria provided in the law, and in the case of non-compliance with the safeguard measures, they must turn the case over to the Public Prosecution Service.
Most European laws also allow euthanasia of mentally incompetent individuals, such as patients suffering from dementia, when they have written, while they were still competent, advance directives requesting euthanasia under certain circumstances.
In all permissive regimes, physicians have the right to refuse to provide assistance in dying or to perform euthanasia and have at times refused to do so when there was treatment capable of addressing the suffering of the patient.
In conclusion, these are just a few examples of the manifold dimensions of this issue that will require close scrutiny and in-depth discussions over the next months.
The government opposes the motion to appoint a parliamentary committee to consult on a legislative framework and response to the Carter decision and instead plans to engage with Canadians, the provinces and territories, the medical profession, and the many affected groups in a national conversation on these very important issues.
This debate is one that concerns each of us individually, as well as all of us collectively. It speaks to our shared values and our responsibilities to protect the most vulnerable in our collective aspirations as a society.