Medical Assistance in Dying

Backgrounder

In 2015, the Supreme Court of Canada ruled in the Carter decision that sections of the Criminal Code that make it illegal for anyone, including a doctor, to cause the death of another person who consents to die or to assist a person to end their own life, are unconstitutional.

To respond to this court decision, the federal government has proposed a framework to provide access to medical assistance in dying to those who are eligible. This approach has been informed by consultations that have taken place across the country, including the federal External Panel on options for a legislative response to Carter v. Canada and the Special Joint Committee on Physician-Assisted Dying.

The proposed approach was carefully designed to:

• recognize individual choice of a medically assisted death for adults who are suffering intolerably and for whom death is reasonably foreseeable;
• affirm the inherent and equal value of every person's life;
• avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled;
• protect vulnerable people from being encouraged to die in moments of weakness;
• re-affirm society's goals with regard to preventing suicide; and
• encourage a consistent approach to medical assistance in dying across Canada.

What the legislation would do

To enable access to medical assistance in dying in Canada, the Criminal Code would be changed so that:

• Physicians, nurse practitioners - and those who help them - can provide assistance to die to eligible patients without the risk of being charged with assisted suicide or homicide.
• There will be safeguards to make sure those who receive medical assistance in dying are eligible, can give informed consent, and voluntarily request it.
• The foundation is laid for the Minister of Health to make regulations to establish a process for monitoring and reporting on the use of medical assistance in dying.

Who would be eligible

A person who wants access to medical assistance in dying would have to:

• Be a mentally competent adult (18 years or older);
• Make a voluntary request and give informed consent to receive medical assistance in dying;
• Have a serious and incurable illness, disease or disability;
• Be in an advanced state of irreversible decline in capability;
• Experience enduring and intolerable suffering as a result of their medical condition; and,
• Be on a course toward the end of life. Death would have to be reasonably foreseeable in all of the circumstances of a person's health, but there would not have to be a specific prognosis or prospected time period before death.

Protective measures

The following safeguards would ensure that patients are eligible and have given informed consent:

• Patients would have to make a written request for medical assistance in dying (a designated person can do so if the patient cannot write), and have it signed by two independent witnesses;
• Two independent physicians or authorized nurse practitioners would be required to evaluate the request;
• There would be a mandatory period of at least 15 days of reflection, unless death or loss of capacity to consent is imminent;
• Patients would be able to withdraw a request at any time.

Implementation

Health is an area of shared federal-provincial-territorial jurisdiction, but provinces and territories hold primary responsibility for delivering health services in Canada. They may choose to adopt additional laws and regulations around medical assistance in dying or set out more requirements for health professionals. The federal government will work with the provinces and territories to support a consistent approach to medical assistance in dying across Canada.

Access

The government is proposing to work with provinces and territories on the development of mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying. This system would help connect patients with a physician or nurse practitioner willing to provide medical assistance in dying, and support the personal convictions of health care providers who chose not to participate. It would also respect the privacy of those who are willing to provide this assistance. This system could also offer other end-of-life care options to both patients and providers.

Monitoring

The government is proposing to develop a system to collect and analyze data, monitor trends and report on medical assistance in dying in Canada in order to ensure there is transparency and openness around its use. The government would work with provinces and territories to discuss criteria and protocols for collecting data so that reporting would be consistent across Canada. This system, and the obligations on providers to submit the necessary data, would come into force when the detailed regulatory measures are ready.

Palliative care

The government is committed to supporting quality end-of-life services. To this end, the government will work to improve palliative and end-of-life care during discussions with provinces and territories on a new Health Accord.

Existing end-of-life medical practices

Patients can already choose to accept palliative care, refuse or withdraw voluntarily from any life-saving treatment, or have intermittent or terminal sedation. These choices will not be affected by new provisions allowing for medical assistance in dying.

Quebec Legislation

Legislation that recently came into force in Quebec limits medical assistance in dying to patients who are at the end of their life, and allows only voluntary euthanasia. The proposed federal law is quite similar to the law in Quebec, except that individuals who meet all of the criteria and whose "death has become reasonably foreseeable" would be eligible for medical assistance in dying, while under Quebec's law, an eligible person needs to be "at end-of-life". The proposed federal law would also allow both assisted suicide and voluntary euthanasia as part of medical assistance in dying.

Further study

The government proposes to appoint one or more independent bodies to study the issues surrounding mature minors, people who suffer only from mental illness, and advance requests in the context of medical assistance in dying.

Coming into force

The Criminal Code prohibition on medical assistance in dying remains in effect until June 6, 2016 or until legislation is passed in Parliament and comes into effect.

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Government of Canada
April 2016

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Hon. Jody Wilson-Raybould Hon. Jane Philpott Justice Canada Health Canada Law Health and Safety