OTTAWA — The Trudeau government is insisting that medical assistance in dying should only be available to Canadians near death, showing no inclination to accept a Senate amendment to expand the right to those suffering from non-terminal conditions.
Justice Minister Jody Wilson-Raybould says the Senate amendment upsets the delicate balance the government has struck in Bill C-14 between respecting personal autonomy and protecting the vulnerable.
The amendment, passed late Wednesday, knocks out the central pillar underpinning the government's proposed new law as assisted dying.
Justice Minister Jody Wilson-Raybould speaks during question period in the House of Commons in Ottawa on Thursday, June 9, 2016. (Photo: Adrian Wyld/CP)
It deletes the requirement that only those whose natural death is "reasonably foreseeable" should be eligible to seek medical help to end their lives. And it replaces the bill's restrictive eligibility standard with the more permissive criteria set out in last year's landmark Supreme Court ruling, which struck down the ban on medically assisted dying.
"The amendment that was passed last night is a significant one," Wilson-Raybould said Thursday.
"It will broaden the regime of medical assistance in dying in this country and we have sought to ensure that we, at every step, find the right balance that is required for such a turn in direction."
Health Minister Jane Philpott said she's personally concerned that the amendment would mean people suffering strictly from mental illnesses would be eligible for assisted dying.
"We stand by the cohesiveness, the integrity of the piece of legislation that we put forward, that strikes that balance that we believe is necessary, that has had broad public support, that has been supported in a vote in the House of Commons."
— Health Minister Jane Philpott
"We stand by the cohesiveness, the integrity of the piece of legislation that we put forward, that strikes that balance that we believe is necessary, that has had broad public support, that has been supported in a vote in the House of Commons," Philpott said.
The ministers did not specifically say that the government will formally reject the amendment, which is just the first of many the Senate is expected to pass. It's up to the House of Commons to determine whether to accept or reject amendments from the upper house.
But their continued defence of the bill and their dismissal of any substantive changes sets up the potential for a deadlock between the two houses of Parliament.
'Unelected Senate' making rules
Interim Conservative Leader Rona Ambrose said the apparent collision course between the two chambers is a sign of a bigger problem.
"We have the courts making laws in this country and now we have an unelected Senate changing the laws of an elected House," Ambrose told a news conference Thursday.
"There's even a larger debate here, which I think is upsetting a lot of my constituents and a lot of people across the country."
Ambrose agreed with Wilson-Raybould that the bill strikes the right balance, although she actually voted against it.
The Senate is expected to continue debating the bill and voting on other amendments into next week.
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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.