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Canada’s draft law on doctor assisted death is welcomed and criticised

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2209 (Published 18 April 2016) Cite this as: BMJ 2016;353:i2209
  1. Barbara Kermode-Scott
  1. Vancouver Island

The Canadian government has tabled a new law, Bill C-14, to decriminalise euthanasia and doctor assisted suicide. The draft law has been met with praise and criticism since it was introduced on 14 April.

Bill C-14 will amend the nation’s criminal code (and make related amendments to other laws) to exempt “medical assistance in dying” from prosecution. The proposed new law will apply only to mentally competent adults with a “grievous and irremediable” medical condition, and only where a natural death has become “reasonably foreseeable.”

Bill C-14 was drafted by Canada’s government in response to a ruling by the Supreme Court on 6 February 2015 which struck down a ban on assisted suicide on the grounds that it violated Canadians’ charter rights.

The province of Quebec legalised voluntary euthanasia in December 20151 with the first terminally ill patient ending their life with the help of a doctor in January this year.2

The Supreme Court required the federal government to legalise physician assisted suicide by 6 June 2016.

But the draft bill was criticised for failing to observe the recommendations of a government appointed Special Joint Committee on Physician-Assisted Dying which advised that the new legislation should also include “mature minors” (children under 18) and the mentally ill, and give people diagnosed with degenerative disorders an option to provide advance consent for assisted suicide.

The advocacy group, Dying with Dignity Canada, said that the proposed legislation was “deeply disappointing.” The group’s CEO, Shanaaz Gokool, criticised the law’s “harsh and discriminatory rules” for creating unfair barriers to access to medical aid in dying.

The Canadian Medical Association lauded the tabled legislation, saying that it closely followed the recommendations of Canadian doctors. The association also welcomed the Liberal government’s commitment to respect the personal convictions of healthcare providers and to develop non-legislative measures to support access to the full range of end of life care. “The overall approach announced today is both thoughtful and comprehensive,” said president, Cindy Forbes.

Jennifer Hall, president of the College of Family Physicians of Canada, said, “Our family physician members are already having discussions with patients about end of life care, including physician assisted death, so federal leadership is critical to providing a legal framework. What we heard today represents a prudent first step for the government and we look forward to seeing how things unfold during debates.”

Francine Lemire, the colleges’ executive director and CEO, said, “We are looking for assurances that physician conscientious objection will be considered and balanced with both the rights of the provider and ensuring patients are not abandoned when most vulnerable.”

The Canadian Psychiatric Association said that it was pleased that the federal government had committed to study the unique implications of requests for medical assistance in dying where mental illness was the sole underlying medical condition.

“The lack of established standards and guidelines, compounded by barriers to mental illness services and treatments, leaves people with mental illness vulnerable and must be addressed before making physician assisted death available to them,” said the association’s president K Sonu Gaind.

The Canadian Paediatric Society said that it believed it was prudent to learn from the experience of physician assisted death among adult patients before considering the practice among minors.

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