Chairman's Desk

What the Liberals got right — and wrong — in long overdue reforms to assisted dying

It has been a long, winding and unnecessarily tortuous journey, but finally, the federal government is about to recognize all Canadians’ right to a peaceful death.

Back in 2016, when the Trudeau government first introduced legislation that legalized medical assistance in dying (MAID), the government described it as “the responsible first step.”

It would have been more honest to describe it as “hiding behind the skirt of the court,” as Parliament only acted after being pushed by those in the ermine robes.  

But despite being mandated by the Supreme Court, legal challenges to the law’s many restrictions would begin within weeks. After all the twists and turns of the various cases and rulings were settled, these challenges would oblige the government to, once again, revisit the matter. All very predictable, I suppose.

And so now, after four delays, a bill is back before the House, having undergone surprisingly expansive amendment by the Senate. And once again, a deadline is staring the government in the face. It must now pass by the end of the month, unless it asks again for a fifth extension.

Eliminating the requirement that a patient’s death be “reasonably foreseeable” is the most significant change in this bill. But of course, that was also the basis for the Charter challenge that prompted the reforms in the first place.

The current disagreement has been reduced to the time at which those suffering solely from mental illness could become eligible for MAID. The House wants a period of two years; the Senate a year and a half.

But this petty dispute overshadows a far more egregious reversion. The version of the bill sent back to the House by the Senate included an amendment, which would have allowed those who fear dementia or Alzheimer’s eroding their future competence, to make advance requests for MAID. The government has, regrettably, stripped this amendment from the version of the legislation that is now poised to pass later this month. (The current regime requires informed consent right up until the scheduled date of death, making it an option that’s out of grasp for dementia patients.)

The Senate amendments were well supported: in a poll commissioned by Dying with Dignity Canada, 78 per cent of Canadians agreed a “waiver of final consent” should be available in cases where the individual was assessed, approved for MAID, but lost capacity before the scheduled date. Even more (83 per cent) supported allowing those with dementia to make advance requests for MAID. (Full disclosure: my consulting firm has previously worked with Dying with Dignity in an advisory capacity.)

From a policy perspective, the mechanism required to make this work is not especially complex. Those diagnosed with dementia, Alzheimer’s disease or other neurologically degenerative diseases could be empowered by law to create a checklist, the conditions of which, once met, would constitute their advanced consent to receiving medical assistance in dying.

This checklist would not be evaluated by family members or those with a vested interest in the outcome, but remain the exclusive responsibility of medical professionals.

Too many of us have seen what these diseases can do to our quality of life and basic dignity as humans.

I count myself among them. One of my most painful experiences has been bearing witness to my own mother’s slow decline. Having held my mother at the bedside of her husband as my father died, and of my sister as she died, I know the choices my mother would make now if she could.

Medical assistance in dying remains one of the most ethically complex and difficult issues to legislate, even if public opinion is clearly agreed on outcomes. Were it not for COVID, the government’s proposed legislation and the back-and-forth with the Senate would likely be the leading story out of Ottawa. Instead, it seems that the legislation is unfortunately destined to pass quietly in its much-diminished form.

In recognizing the 2016 legislation as merely a first step, the Trudeau government showed a rare streak of modesty. The reforms they are proposing now are important. And long overdue. And, once again, court mandated. But this time, they are disappointingly modest.

The government’s failure to go further and address the expectations of Canadians when it comes to medical assistance in dying is more than unfortunate. It represents a cowardice unbecoming of caring government.

This article first appeared in the Toronto Star on March 7, 2021.

Read More