Balancing Love, Vulnerability and the Right to a Doctor Assisted Death

In the United States, news is dominated by the pre-election primaries.  But in Canada, headlines are about how my country should operationalise a Supreme Court ruling on physician-assisted suicide.  The Supreme Court's 'Carter Decision' found that: 

Section 241 (b) and s. 14  of the Criminal Code  unjustifiably infringe s. 7  of the Charter  and are of no force or effect to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

The court gave the government 12 months to create a legislative framework for the new law and then a further four month extension when the new federal Liberal government was elected.  Last week, Parliament released a Select Committee Report, 'Medical Assistance in Dying: A Patient Centred Approach'.   This report is Parliament's response to the requirement to create a legislative framework for doctor assisted dying.  To date, public opinion has been mixed in its reaction to the latest Parliamentary report. But my reading is that most pundits are saying the report has gone too far.  I agree with that assessment and here's why: the Supreme Court cites conditions for assisted dying as "people who are grievously and irremediably ill... who cannot seek physician's assistance in dying."  The Parliamentary report recommended expanding the criteria for accessing physician assisted dying to include psychiatric patients who are not terminally ill, 'mature minors' and those who have written advance directives.  In my youth, I suffered from clinical depression. Our son has severe disabilities and when he was a mature minor, he was deemed palliative (but not at end of life).  At that time, he suffered from uncontrolled pain. Given this background, I believe that my personal life experience gives me a unique perspective on this debate.  I agree with the physicians who testified to the Parliamentary Select Committee that all psychiatric illness is potentially remediable (mine was and many people I know have suffered terribly, but with medication and therapy, they have recovered). In our country, children do not have the right to vote, drink alcohol or fight in a war. That is because they lack the maturity to make life altering decisions that require the maturity of adulthood. For that reason, I believe physician assisted dying is not appropriate for children. The pre-requisite for requesting physician assisted dying is capacity - that much is agreed. An advance directive to end a patient's life after they have lost capacity due to Alzheimer's or other cognitive impairment no longer meets that pre-requisite. Furthermore, an advance directive would be carried out after a patient does not have the specific capacity to determine coercion or differentiate the social determinants of health from irremediable suffering. But my real fear about the Select Committee Report is that it does not offer anything in the way of a legislative framework that protects vulnerable patients from seeking physician assisted dying on the basis of coercion or suffering resulting from psycho-social determinants of health (poverty, unemployment, loneliness, etc.)  The availability (or lack of it) of home care, especially palliative care is an obvious reason patients might well assess their own suffering as intolerable. Equal access to physician assisted dying without equal access to community-based services and palliative care places the right to die above the right to live. And that's wrong in my view. Luckily, the Canadian Association for Community Living has just released a new tool to assess the potential vulnerability of persons asking to receive physician assisted death. It's called The Vulnerable Persons Standard and I am proud to be an advisor on it.  Here are the Standard's Five Guidelines. If you agree with the principles of this Standard, you can sign to support it HERE. I hope the Parliament of Canada will take notice of the Standard and incorporate its compelling safeguards into the legislative framework guiding access to physician assisted dying. I want to ensure that our son is protected from coercion; that my mother will not choose to end her life because she feels that she is a burden (she isn't!); and that I am allowed to live my life to its fullest and natural end, according to my wishes so long as I am able to choose my fate. "The federal government needs to exercise wisdom in striking a balance between equitable access and appropriate safeguards for people whose physical, emotional, cognitive or social vulnerability may make them more susceptible to suicide." — Dr. Harvey Max Chochinov, Canada Research Chair in Palliative Care and Former Chair of the ‘Federal External Panel’ on Options for a Legislative Response to Carter v Canada, and an advisor to the Standard As my friend and colleague, Al Etmanski said in his excellent blog post today, "I accept the right to choose active euthanasia for the small minority of people who will ultimately avail themselves of that option. But rights don’t exist in isolation. They carry obligations to ensure that we have sufficient safeguards to address the concerns of a much larger minority of vulnerable Canadians." I urge Members of Canada's Parliament to incorporate the Vulnerable Persons Standard into the new legislative framework governing physician assisted dying in our country.