Panel looking at assisted dying learns much from European experience

The head of a panel looking into legislative options to govern doctor-assisted death says a recent fact-finding tour in Europe has opened members' eyes to the many complexities surrounding a practice that's soon to become legal in Canada.

Dr. Harvey Max Chochinov said he and the two other members of the External Panel recently returned from an intensive 11-day study of how physician-aided dying has been implemented in the Netherlands, Belgium and Switzerland, where patients can legally have their deaths hastened.

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"We learned a tremendous amount from experts who have a great deal of experience with end-of-life regimes in their countries," said Chochinov, Canada Research Chair in Palliative Care at the University of Manitoba.

"We saw people from such diverse perspectives — people who still continue to struggle with the issue of physician-hastened dying and are very much opposed to it," he said Monday from Winnipeg.

"And we saw others who were, of course, much more comfortable and described this as something that has become part of their cultural experience around death and dying."

Chochinov, Ryerson professor emerita Catherine Frazee and University of Ottawa law professor Benoit Pelletier were appointed to the panel by the Harper government in July, following the Supreme Court of Canada's February decision to overturn the ban on doctor-assisted suicide and euthanasia.

The high court ruled that Canadians with unbearable and irremediable suffering could be eligible to end their lives with a doctor's aid, but the justices stayed their decision until February 2016 to give Parliament time to replace the existing law if it so chooses.

The panel was appointed to consult experts and the Canadian public before providing the government with potential options for crafting new legislation, but their work, for the most part, is on hold until the federal election is decided Oct. 19.

Chochinov, Frazee and Pelletier met with a broad range of experts in the three European countries, including general-medicine and palliative-care physicians, lawyers, government officials and bio ethicists.

The panel also consulted with two major groups offering assisted-dying services in Switzerland: Dignitas, a group that helps people — including foreigners — with a terminal illness or severe physical and mental illnesses to die; and EXIT, an aid-in-dying organization that helps people plan for the end of life with the best available information and the support of family and friends.

"We really tried to get a sense from them as to ... what is the connection, for example, between these death-hastening organizations and medical practitioners," said Chochinov.

The panel wanted to know how people with abject suffering who seek help in dying are referred to services and whether people can self-refer, he said, adding that members also wanted to determine the role of right-to-die organizations and doctors in assessing whether patients meet the criteria for assisted death.

"I think we learned there is a very close relationship between the role of physician and the role of organizations such as Dignitas and EXIT, and it really is that connection between those two that seems to facilitate the ability in Switzerland and to deliver physician-assisted dying.

"I don't think I understood the complexities of that as well before as I do now after visiting Switzerland."

Chochinov said the challenge for the panel is to lay out options for regulations that honour the values inherent in Canada's health-care system, which approaches suffering "with compassion, integrity and wisdom."

"One thing that's critically important — we very much need Canadians to weigh in and to provide us their guidance on the issue of physician-hastened dying and how that can be enacted in Canada in a way that is going to be in keeping with those core values in health care."

The public is encouraged to provide their insights on the panel's website: www.externalpanel.ca.

"That's what our panel is looking for," he said. "We are open to any and all opinions that will guide our work."