OTTAWA - The Supreme Court of Canada shifted the goalposts Friday on one of the most fundamental of human laws.
In a charter precedent that will go down in the history books as Carter vs. Canada, the court unanimously struck down the ban on providing a doctor-assisted death to mentally competent but suffering and "irremediable'' patients.
The emphatic, unanimous ruling prompted tears of joy and frustration on both sides of the debate, reverberated through provincial health ministries and doctor's offices across Canada, and left skittish federal parliamentarians groping for time to digest the implications.
"The prohibition on physician-assisted dying infringes on the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice,'' the nine justices flatly asserted.
The judgment — left unsigned to reflect the unanimous institutional weight of the court — gives Parliament a year to draft new legislation that recognizes the right of clearly consenting adults who are enduring intolerable physical or mental suffering to seek medical help in ending their lives.
It does not limit physician-assisted death to those suffering a terminal illness.
And to put an exclamation mark on the ruling, the court awarded special costs against the government of Canada for the entire five-year course of the litigation, less 10 per cent to be paid by the government of British Columbia.
The court suspended its judgment for 12 months, during which the current law continues to apply, placing enormous pressure on Parliament to act in what is an election year.
At least six reform bills on right-to-die issues have been defeated over the past two decades and the Conservative government of Stephen Harper insisted last fall that it would not support changing the status quo.
The political toxicity of the issue was immediately apparent Friday: Not a single MP asked the government a question about the decision during question period, despite the presence of Justice Minister Peter MacKay in the House.
"This is a sensitive issue for many Canadians, with deeply held beliefs on both sides," MacKay said in a subsequent release.
"We will study the decision and ensure all perspectives on this difficult issue are heard.''
For the families of Gloria Taylor and Kay Carter, two now-deceased women who originally sought a B.C. court's help to end their suffering, it was an unqualified victory.
Lee Carter, who accompanied her 89-year-old mother to Switzerland to legally end a life ravaged by debilitating disease, raised a bouquet of flowers to the heavens in the Supreme Court lobby as she tearfully recalled her mother's legacy.
"Justice, dignity and compassion were the defining qualities of my mother," Carter, flanked by her family, told a crush of reporters.
"We just felt that it was a fundamental right for Canadians that they should have this choice.''
A few steps away, Taylor Hyatt of the Euthanasia Prevention Coalition said the Supreme Court has abandoned the disabled, even though the judgment insists the most vulnerable can be protected.
"The ruling actually wants people with disabilities to end their lives when they believe their suffering, and the condition doesn't have to be terminal,'' said a distraught Hyatt.
"From my point of view, all legal protection has been stripped."
Others objected on religious grounds.
"The court has ruled that in some circumstances the killing of a person will be legal,'' said the Evangelical Fellowship of Canada. "Euthanasia has come to Canada."
The decision reverses the top court's 1993 ruling in the case of Sue Rodriguez, a fact the decision attributes to changing jurisprudence and an altered social landscape.
Two decades ago, the court was concerned that vulnerable persons could not be properly protected under physician-assisted suicide, even though courts recognized the existing law infringed a person's rights.
But the experience of existing jurisdictions that permit doctor-assisted dying compelled the courts to examine the record.
"An individual's response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy,'' says the judgment.
"The law allows people in this situation to request palliative sedation, refuse artificial nutrition and hydration, or request the removal of life-sustaining medical equipment, but denies the right to request a physician's assistance in dying.''
The 69-page judgment avoids the term "suicide'' throughout, using instead the less morally freighted "death'' and "dying."
The court also weighed in on the "existential formulation'' of right to life, which it said is not the same as a "duty to live.'' Imposing a duty to live, said the court, "would call into question the legality of any consent to the withdrawal or refusal of lifesaving or life-sustaining treatment.''
The nine Supreme Court justices also noted that when their court struck down the country's prostitution laws in 2013, it recognized that the legal conception of "gross disproportionality'' has changed since the Rodriguez decision.
The court agreed with the trial judge ``that a permissive regime with properly designed and administered safeguards was capable of protecting vulnerable people from abuse and error.
"While there are risks, to be sure, a carefully designed and managed system is capable of adequately addressing them.''
That is now Parliament's task, while Canadians watch and prepare to go to the polls within the next eight months.
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A look at some jurisdictions where right-to-die laws are in place. (Information courtesy of The Canadian Press)
A right-to-die bill was adopted last year, the first legislation of its kind in Canada. The law, scheduled to go into effect in December, stipulates that patients would have to repeatedly ask a doctor to end their lives on the basis of unbearable physical or psychological suffering. They would have to be deemed mentally sound at the time of the requests. The law, however, is being challenged in court by two Quebec-based groups on the grounds that it undercuts sections of the Criminal Code that outlaw assisted suicide and euthanasia. The federal government has expressed its opposition to the legislation but is named as a defendant in the court challenge because it is responsible for the Criminal Code.
The results of a referendum made Oregon the first U.S. state to make it legal for a doctor to prescribe a life-ending drug to a terminally ill patient of sound mind who makes the request. However, doctors cannot administer the life-ending drugs and the patient must swallow them without help. Patients must state three times -- once in writing -- that they wish to die, and those statements must be made at least 15 days apart. They must also obtain a concurring opinion from a second doctor that they have less than six months to live and are of sound mind. The law took effect in late 1997, and through June, 2014, just over 800 people had used the law.
The state became the first in the U.S. to allow a person's right to die through legislation rather than through a court decision or a referendum result. Vermont's law, which took effect in May 2013, is closely modelled on the system in Oregon and uses the same safeguards. Patients must state three times, including once in writing -- that they wish to die. They must also obtain a concurring opinion from a second doctor that they have less than six months to live and are of sound mind.
In January 2014, a judge ruled that competent, terminally ill patients have the right to seek their doctors' help in getting prescription medication if they want to end their lives on their own terms. The state's attorney general is appealing the ruling, and a decision on whether it will be upheld is expected later this year.
A referendum saw the state enact right to die legislation in 2008. As in Oregon, patients with less than six months to live must administer the doctor-prescribed lethal medication on their own. According to a government report, 549 people applied for the right to die between 2009 and 2013. Of those, 525 actually took their own lives.
In 2009, the state's Supreme Court ruled that Montana's public policy supports mentally competent, terminally ill patients being able to choose aid in dying. Physicians are allowed to prescribe medication that patients must administer themselves. More detailed legislative bills have been introduced in the state but have not passed. The court ruling still stands today, but data about its usage is not available.
A law passed in 1942 forbade anyone from helping someone kill themselves for selfish reasons. As a result, people arguing that they are assisting with a suicide for unselfish motives are not considered to be committing a crime. Suicides can be assisted by people other than doctors and no medical condition needs to be established. Switzerland is the only country that allows foreigners to travel there for the purpose of ending their own lives.
In the Netherlands, euthanasia is legal under specific circumstances and for children over the age of 12 with parental consent. In Europe, patients don't have to prove that they have a terminal illness -- establishing unbearable suffering is usually sufficient. Dutch doctors are allowed to perform euthanasia if a patient whose unbearable suffering has no hope of improvement asks to die with a full understanding of the situation. A second doctor must agree with the decision to help the patient die.