More Canadians will now have access to medical assistance while dying.
Federal government Bill C-7, which renews the country’s euthanasia regime, received royal approval and became law after the Senate signaled its agreement with the House of Commons on the content of the law on Wednesday.
“This law will respect the autonomy of Canadians while protecting the vulnerable,” Justice Secretary David Lametti tweeted after the Senate vote.
The passage of the bill follows more than a year of bitter debate over Medical Aid for Death (MAiD) in Canada. Some have argued that the government’s previous MAiD law didn’t go far enough and excluded too many people, while others vigorously denounced C-7 as having gone too far, sending the message that the lives of people with disabilities are less Has value.
Some proponents say that one of the main problems is that people with disabilities are being pushed to seek MAiD due to a chronic lack of support.
Bill C-7 is a direct response to a 2019 Quebec Supreme Court ruling that was found to be unconstitutional in the previous Ottawa MAiD Act stating that only persons whose natural death was “reasonably foreseeable” should could be eligible for MAiD.
The bill now provides a separate avenue for people whose death is not reasonably foreseeable to access MAiD as well.
The government stared at a court-ordered March 26 deadline, extended four times by the Quebec judges, to pass the bill.
C-7 was moved back and forth a bit between the House of Commons and the Senate after the Upper House proposed changes. The current version includes some significant changes from what was first put forward by the government after the Liberals accepted but changed some Senate changes.
According to the country’s first annual report on the practice, there were 5,631 medically assisted deaths in Canada in 2019, representing 2 percent of all deaths in the country and a 26 percent increase from such cases in 2018.
- WHO IS ALLOWED FOR MAID NOW?
Individuals whose death is reasonably foreseeable are still eligible.
The bill now also opens the door to people whose death is not reasonably foreseeable but who meet the other MAiD eligibility criteria, including: They have a severe and incurable “disease, illness or disability”, are in an advanced state of decline and are in an advanced state of excruciating suffering.
The invoice has a new title with requirements for these people. Most important of them: a period of at least 90 days between the start of the person’s initial assessment for MAiD and the day the MAiD procedure is carried out.
Bill C-7 states that the individual must undergo two MAiD proficiency tests by two different doctors.
The individual must sign their application for MAiD in front of an independent witness and be informed of “resources available to alleviate their suffering,” which may include counseling, mental health and disability support services, and palliative care. This includes offering consultations with professionals in connection with these services.
The person can withdraw their request at any time.
The Council of Canadians with Disabilities argues that the bill is aimed at people with disabilities and will particularly adversely affect marginalized groups, said Jewelles Smith, the council’s communications and government relations coordinator.
She said it was worrying that MAiD would now be available to people with disabilities, while many of them continued to chronically lack adequate support and services.
“For many people who are newly disabled, there is a period of time to adjust. Their whole lives change,” said Smith.
“Instead of reaching out to mentors – especially people with a disability who can provide support – people might decide that it is better to end their lives because they can experience the amazing life that we all have with disabilities live, could not yet imagine. ”
The president of the Canadian Association of MAiD Examiners and Providers said she agrees that there is not enough support for people with disabilities but disagrees that the bill will push people towards MAiD.
“It is always the clinician’s job to assess not only the ability to make this request – which is an important part of our job – but also assess the vulnerability of our patient, and we take that very, very seriously and we take it Time to get it right, “said Dr. Stefanie Green.
She said by removing the condition that the person’s death was reasonably foreseeable, the government has brought the MAiD regime closer to the framework set by the Canadian Supreme Court in the landmark 2015 Carter ruling the country’s ban on assisted death was lifted. The Supreme Court has never established reasonably foreseeable death as a condition of access to MAiD.
“The Canadian model was never intended to be a strict end-of-life regime,” she said. “It focuses more on the criteria of patient suffering than on the end of life.”
- WHO WILL BE ADMISSIBLE ON A LATER DATE FOR MAID?
Bill C-7 will also open the door – in at least two years – to people looking for MAiD solely for a mental disorder.
The bill initially banned these people from accessing MAiD. The government said the issue needed further investigation.
Ultimately, however, it agreed to a change by the Senate to include a sunset clause in the bill that would give governments and medical institutions time to work out guidelines and safeguards. The Senate had proposed a deadline of 18 months, which the government extended to two years.
Some experts and parliamentarians argued that the total ban was likely unconstitutional as it excluded a group of individuals.
Smith said it was “mind-boggling” to see the government accept the change, arguing that there wasn’t enough information available to understand the potential impact.
“For the majority of people in mental crisis, this is a temporary situation and this is a permanent solution,” she said, reiterating a chronic lack of support, including inability to access medicines, psychiatric support and counseling.
Even with persistent mental disorders, death shouldn’t be an option, according to Smith.
“This just further pushes into a corner where people who are already incredibly vulnerable in our community are going through something that can be supported,” she said.
Psychiatrists continue to disagree on whether MAiD can ever be done safely because of mental illness alone. Some have argued that this would only apply to a very small number of people who have lived with their disease for an extended period of time and who have undergone a range of different treatments.
However, a group of Quebec psychiatrists argued before a Senate committee that the prognosis of mental illness was always uncertain and that the discussion should instead shift to supports such as psychiatric palliative care for severe cases.
Green noted that individuals with mental illness will already receive MAiD if they have a physical illness that meets the eligibility criteria and that determining their ability to submit such an application is part of the assessment process.
“These are tough, rigorous assessments that have to follow a certain path and eligibility criteria. So we have to have some degree of trust in clinicians in this country,” she said.
- WHO REMAINS INADMISSIBLE FOR MAID?
Advance inquiries for MAiD are still prohibited. This would include people who do not currently meet the eligibility criteria but want to make their request now for fear of losing the ability to make such a decision later, an issue that is an advocacy issue for some people with dementia.
Senator Pamela Wallin proposed an amendment to C-7 that would have allowed pre-petitions but was shot down by the government. She said the issue is “beyond the scope of the draft law” and should be examined in a parliamentary review of the MAiD and the state of palliative care that has not yet taken place.
The government agreed to a streamlined Senate amendment that would initiate this review by a joint House and Senate committee within 30 days of C-7 going into effect and report back in a year.
The review also looks at the issue of “mature minors” – children – having access to MAiD. They remain locked under Bill C-7.
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