OTTAWA — The federal government unveiled its legislative response Thursday to last year's Supreme Court decision striking down the existing ban on medically assisted death.
While it is only 16 pages, Bill C-14 — "An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)" — makes landmark changes to provide people the ability to ask for medical help ending their lives.
Health Minister Jane Philpott speaks as Justice Minister Jody Wilson-Raybould looks on at a news conference in Ottawa on Thursday, April 14, 2016. (Photo: Adrian Wyld/CP)
Here are five things to know.
1. It sets out numerous conditions on who is eligible to access medical help to end their life. Among them, that a person has an incurable illness or disability, is in an advanced state of irreversible decline, that they are in intolerable suffering and that their natural death has become "reasonably foreseeable."
2. Kay Carter may not have been eligible. It was Carter's desire to end her life that led to the Supreme Court ruling. The British Columbia Civil Liberties Association, which was a plaintiff in the case, said under this bill, she still wouldn't have had legal access to that help. She suffered "excruciating physical and psychological distress" from spinal stenosis but she was not facing imminent death, the BCCLA said.
3. There are some issues the bill does not address. The question of whether people can declare in advance of any illness that they'd like to access medical assistance to die, whether so-called mature minors would be eligible and whether those with only mental illness could be eligible aren't dealt with in the bill. The justice minister says the government will study those issues if the bill is passed, but that there was not enough time to consider them fully enough to include them in the legislation.
4. The provinces still hold a lot of power. The bill is an amendment to the Criminal Code, but implementing its provisions will fall to the provinces as they have control over health care. That means there is no guarantee that the right to access medical support to die will be provided uniformly across the country. The federal government has promised to work closely with them in this regard.
5. The clock is ticking. The Supreme Court gave the government until June 6 to have a new law, meaning it has to pass both the House of Commons and the Senate in less than two months. It is likely the House of Commons will hold extended sittings in order to give MPs a chance to speak to the bill and the committees studying it are also expected to have extended and lengthy meetings in order to meet the deadline. The Senate is expected to study the bill at the same time the House does to help speed up the process.
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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.