OTTAWA — Not all Liberal backbenchers are happy with the Trudeau government's restrictive approach to medical assistance in dying.
Some fear the proposed new law does not comply with the charter of rights and falls short of what the Supreme Court ordered in last year's so-called Carter decision, when it struck down the ban on doctor-assisted death.
And at least one, after getting an earful over the weekend, says it is much more restrictive than what her constituents want.
Liberal MP Yasmin Ratansi delivers a speech prior to the vote for the election of a new Speaker to preside over the House of Commons on Parliament Hill in Ottawa on Thursday, Dec. 3, 2015. (Photo: Sean Kilpatrick/CP)
"Bottom line is I'd like to see some changes to suit my constituents' needs and to respect the Carter (decision) as a benchmark," Toronto MP Yasmin Ratansi said in an interview.
"At the moment, they feel ... that the bill has not met the benchmark. I don't want people who are suffering to go to court and to (have to) challenge to get their rights."
Ratansi, who represents Don Valley East, held a town hall meeting last weekend on the issue of assisted dying, conducted jointly with neighbouring Liberal MP Rob Oliphant, who co-chaired a special parliamentary committee that recommended a much more permissive approach than was adopted by the government in its new bill.
"I don't want people who are suffering to go to court and to (have to) challenge to get their rights."
The Saturday meeting had been scheduled before the bill was introduced on Thursday but Ratansi was amazed to find that the roughly 200 people who attended, predominantly well-to-do seniors, had already dissected the bill and had passionate views on it. Some 80 to 85 per cent found it wanting, she said.
One, a non-verbal disabled woman in a wheelchair, used a computerized board to express "how annoyed she was with the bill" because it wouldn't allow her to make an advance request for an assisted death, Ratansi said.
"She said, 'I want advance directive because I am competent at the moment ... What happens if I am no longer able to communicate? What happens then?'"
'Who are you to decide what my pain level is?'
Those who fear they may become incapacitated with dementia expressed similar concerns, Ratansi said. Others wanted the right to decide for themselves when a medical condition makes their lives intolerable.
"I guess people were saying, 'Who are you to decide what my pain level is and whether it's mental or physical?' I think we need to have thoughtful discussions on this."
In Carter, the court ruled that the ban on assisted dying violated the charter guarantee of the right to life, liberty and security of the person. It said medical help in dying should be available to clearly consenting adults with "grievous and irremediable" medical conditions who are enduring physical or mental suffering that they find intolerable.
Consenting adults only
The government's more restrictive bill would require a person to be a consenting adult, at least 18 years of age, in "an advanced stage of irreversible decline" from a serious and incurable disease, illness or disability and for whom a natural death is "reasonably foreseeable."
It does not extend the right to assisted dying to those suffering only from mental illnesses or to mature minors. Nor does it allow advance directives.
Advocates of medically assisted dying believe the bill disregards the court ruling and have accused the Liberals, who profess to be the party of the charter, of authoring the kind of restrictive law they would have expected from the previous Conservative government.
Even PM's parliamentary secretary is unsure
"I would agree with them if the bill doesn't change and it's a whipped vote," said Toronto Liberal MP Adam Vaughan, parliamentary secretary to Prime Minister Justin Trudeau.
However, he argued that the government is open to having a freewheeling debate on the bill and to making some changes and it has vowed to let MPs vote freely.
"I think now you're looking at a process where Canadians, through their members of Parliament, can effect the changes they want to see ... That's the way government's supposed to work," Vaughan said.
Among other things, Vaughan said he's hearing concerns from some groups about the failure to include advance directives for people diagnosed with competence-impairing conditions like dementia, "insofar as fate doesn't always afford you the chance to be able to speak when you need to be heard."
Government House Leader Dominic LeBlanc speaks to reporters on Parliament Hill. (Photo: The Canadian Press)
Dominic LeBlanc, the government House leader, said the feasibility of amendments depends in part on how quickly the bill moves through the legislative process in both the Commons and Senate, given the push to enact the law before the June 6 deadline set by the Supreme Court.
Some senators have vowed to propose amendments and LeBlanc said he hopes that will occur early so that "workable" changes can be incorporated into the bill before it's passed by the Commons. If the Senate were to vote for amendments after the bill is passed by the Commons, it would trigger a lengthy process of "ping pong," where the bill would bounce back and forth between the two houses of Parliament.
Other MPs see a good balance
Other Liberal MPs expressed satisfaction with the balance struck by the bill between a dying person's right to end their suffering, the need to protect the vulnerable and the right of medical practitioners to refuse to provide assistance in dying.
While he wants to hear what legal experts and Canadians have to say, Quebec MP Steve MacKinnon said: "Right now, I think the government's struck a pretty good balance."
Toronto Liberal MP Judy Sgro said most people she's heard from are "appreciative of the fact that we're going about it in a very careful, methodical way."
"I was a bit concerned it might go farther," Sgro added. "I think it will satisfy a lot of Canadians that we haven't gone too far and we are trying to be as considered as possible."
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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.