St. Albert MP Michael Cooper says the parliamentary report on physician-assisted dying, released last week, doesn’t go far enough in some places and goes too far in others.
After a month of public consultations, which included 61 witnesses and more than 100 written submissions, the special joint committee on physician-assisted dying released a list of 21 recommendations that will help craft new legislation on medical aid in dying.
Cooper, who sat as vice-chair of the committee, along with four other Conservative committee members, co-authored a dissenting report criticizing the scope of the main report, as well as a lack of safeguards for vulnerable Canadians.
The dissenting report argues that the committee did not conform to the legal framework set out by the Carter decision, which concluded that competent adults suffering from a grievous and irremediable medical condition should have access to medical aid in dying, and “fails to protect the Charter rights of vulnerable persons and medical health professionals.”
It takes issue with the suggestion that the service could be extended to mature minors (children under the age of 16 deemed capable of consent) in the future and that patients diagnosed with a potentially lethal or debilitating disease could be allowed to fill out an advance directive.
“It raises issues about consent generally and whether that person is truly consenting,” said Cooper on the subject of advanced directives.
“Ultimately it’s impossible for any individual to know what to do (in the future). It’s an irreversible decision,” he said.
In Belgium, where physician-assisted dying has been legal since 2002, advanced directives only accounted for less than two per cent (69) of all reported cases in 2012 and 2013 (3,239 in total) and the majority of cases where physician-assisted dying was granted (87 per cent) the patients had a life expectancy of a few months.
Brad Peters, director of Dying with Dignity Canada and co-ordinator for the Edmonton Chapter, thought this was one of the report’s biggest successes.
“My initial reaction is that the recommendations did a really good job of reflecting the spirit of the Supreme Court’s decision. It’s as if they didn’t use the decision as a ceiling, but as a jumping off point,” said Peters.
He said that the committee was responsive to the desires of Canadians on the subject of advance directives.
“I think it’s one of the most common concerns people have: what if I lose competency? What if I make a request and between the time of the request and the time of receiving aid in dying, I lose competency?”
Peters agrees, however, with the dissenting report’s recommendation that psychiatrists be involved in evaluating the capacity to consent of patients suffering from mental illness.
Although physicians are able to recognize the signs and symptoms of mental illness, Cooper and the other authors of the dissenting report, believe that a specialist is better suited to determine whether a mentally ill individual is capable of consenting.
These committee members also felt that the report fell short of protecting the conscience rights of health professionals, which allow them to object to procedures that fall outside their moral or religious belief system.
The dissenting voices disagreed with the main report’s recommendation for an “effective referral” regime. Instead, they suggest that objecting physicians refer patients to a government agency.
The third-party agency would connect the patient with a doctor that provides the service.
“The effective referral regime would be the first such in the world," said Cooper. “In no country that has physician-assisted dying is there an effective referral provision.”
The dissenting report notes a “significant” concern over the timeline given to the committee, pointing out that Quebec took six years under three different legislatures to come up with a law that was still not unanimously supported by members of the Legislative Assembly.
In a previous interview, Cooper criticized the Trudeau government for not forming the special joint committee earlier.
“What I hope is that the government looks at both reports and looks to the Carter decision and crafts legislation that strikes the balance, as the Supreme Court called upon the government to do, to respect individual autonomy and protect vulnerable persons,” said Cooper.