Vulnerable Canadians 'at risk of being encouraged to seek an assisted death,' panel hears

People suffering with illnesses that are terminal or cause intolerable suffering are at risk of being encouraged to seek an assisted death, a special Commons-Senate committee heard Tuesday.

"All persons are potentially vulnerable," Benoît Pelletier told the committee. "Being vulnerable does not disqualify them from seeking an assisted death, but it does put them at risk of being encouraged to seek an assisted death," he said. 

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Pelletier is a professor of law at the University of Ottawa. He was one of three people appointed to a panel by the previous government to study the issue of assisted dying and report back to Parliament.

The panel was struck in response to a Supreme Court of Canada decision in early 2015 which ruled that a ban on physician-assisted dying violated Canadians' charter rights, and gave the government a year to pass new legislation. The high court recently extended the deadline until June to allow the Liberal government time to hold public consultations and deliver a new law. 

Five senators and 11 MPs — including six Liberals, three Conservatives and two New Democrats — form the committee, which convened Monday. They are holding a series of public consultations to hear from experts and stakeholders with the goal of reporting back with legislative suggestions by Feb. 26. 

Based on the answers contained in the 15,000 questionnaires filled out by stakeholders during the panel's consultation process, Pelletier said it became clear there was broad backing for such a law but there was more support for the legislation to apply to people with physical illnesses than there was for it to apply to people with mental illnesses. 

"The implementation of physician-assisted death has to be managed in a consistent manner across the country," Pelletier said.

Pelletier went on to tell the committee that there is a strong public desire for the practice of physician-assisted dying to be studied once implemented, to see how it works in practice and also to better comprehend its impact on human rights.

Mental competency should determine eligibility

Pelletier said that any assisted-dying law should be guided by four principles:

• All Canadians should have equal access to end their lives if they fit the criteria.
• There has to be efficient oversight of the service.
• Patients must have improved access to palliative care services.
• There must be robust safeguards for the vulnerable.

Jennifer Gibson and Maureen Taylor, co-chairs of the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, also attended the session.

Gibson, director of the University of Toronto's Joint Centre for Bioethics, said that if assisted-dying services are made available to Canadians, they should be a part of an integrated end-of-life strategy for patients that includes improvements to palliative care services which are currently underfunded.

She also said that when it comes to the law being applied to people under the age of majority, mental competency, not age, should be used to determine eligibility.

"Some children, especially adolescents, have the competence and capacity to make end of life decisions," said Gibson. "What that turns on is not their age, not what their birth certificate says, but it's really their ability to appreciate their diagnosis, their options."

Taylor, a physician's assistant whose late husband, Dr. Donald Low, shot to public attention during the SARS crisis, and was again in the public eye when he made a video plea for physician-assisted death in the final days of his fight with brain cancer, also gave evidence. Taylor said after his death that she would keep advocating for medically-assisted dying.

Not family's decision

Taylor, who has previously worked as a health reporter for CBC News, told the committee that appropriate safeguards need to be in place to protect vulnerable persons from having their decisions overturned by family members if they make a request for an assisted-death.

"We do not believe the family should be able to overturn a patient's request if they do not agree," she said. "At the same time we do not believe a family should be able to initiate this for a patient whether competent or not."

Taylor and Gibson also told the panel that while the high court decision references 'physician assisted-death', nurse practitioners should be able to perform the service in some cases.

On Monday, the panel heard from constitutional lawyer Peter Hogg, who said the federal government should ensure any new law covers all Canadians regardless of whether provinces have their own assisted-dying laws. Quebec is currently the only province that has enacted doctor-assisted death legislation.

The committee will continue to hear witnesses Wednesday.