Category: Euthanasia

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Private Member’s Bill C-390: Expanding Euthanasia For PROVINCIAL Frameworks

Just before Parliament took their summer recess, Private Member’s Bill C-390 was introduced in the House of Commons. It came from Sylvie Bérubé, MP with the Bloc Québécois. It aims to (once again) expands assisted suicide, a.k.a. medical assistance in dying, or MAiD.

It does this by amending the Criminal Code to add exemptions in for this “practice”, if it is carried out under an applicable provincial framework. If there are no criminal consequences, then logically, the Provinces and Territories could each write their own version.

Exemption for medical assistance in dying
227 (1) No medical practitioner or nurse practitioner commits culpable homicide if they provide a person with medical assistance in dying in accordance with section 241.‍2 or an applicable provincial framework..

Exemption for person aiding practitioner
(2) No person is a party to culpable homicide if they do anything for the purpose of aiding a medical practitioner or nurse practitioner to provide a person with medical assistance in dying in accordance with section 241.‍2 or an applicable provincial framework.

Non-application of section 14
(4) Section 14 does not apply with respect to a person who consents to have death inflicted on them by means of medical assistance in dying provided in accordance with section 241.‍2 tor an applicable provincial framework.

Exemption for person aiding practitioner
(3) No person is a party to an offence under paragraph (1)‍(b) if they do anything for the purpose of aiding a medical practitioner or nurse practitioner to provide a person with medical assistance in dying in accordance with section 241.‍2 tor an applicable provincial framework.

Exemption for pharmacist
(4) No pharmacist who dispenses a substance to a person other than a medical practitioner or nurse practitioner commits an offence under paragraph (1)‍(b) if the pharmacist dispenses the substance further to a prescription that is written by such a practitioner in providing medical assistance in dying in accordance with section 241.‍2 tor an applicable provincial framework.

Exemption for person aiding patient
(5) No person commits an offence under paragraph (1)‍(b) if they do anything, at another person’s explicit request, for the purpose of aiding that other person to self-administer a substance that has been prescribed for that other person as part of the provision of medical assistance in dying in accordance with section 241.‍2 or an applicable provincial framework.

Failure to comply with safeguards
241.‍3 A medical practitioner or nurse practitioner who, in providing medical assistance in dying, knowingly fails to comply, subject to subsection 241.‍2(3.‍2), with all the requirements set out in paragraphs 241.‍2(3)‍(b) to (h) or paragraphs 241.‍2(3.‍1)‍(b) to (k) or all the requirements of an applicable provincial framework, as the case may be, and with subsection 241.‍2(8) is guilty of

Now, why would Bérubé draft such a Bill?

According to the Federal Lobbying Registry, she met with a group called Dying With Dignity shortly after the Bill was introduced.

The group is also a registered charity, meaning that taxpayers are subsidizing any donations that come in. The amount of direct subsidies seem minimal.

According to the information available with the Canada Revenue Agency, this charity takes in roughly $2 million per year. The vast majority is from private donations.

Dying With Dignity advocates for euthanasia for people with mental disorders, which is pretty messed up. It seems to tiptoe around the issue of informed consent.

They also support the rights of “mature minors” to get MAiD. Interestingly, there doesn’t appear to be any minimum age specified on the site, nor any safeguards in place.

This group also supports the concept of “removing final consent“, or making requests in advance. This seems to line up with Bill S-248, introduced by Pamela Wallin.

So, where does the line get drawn? It doesn’t seem that there is one.

(1) https://www.parl.ca/legisinfo/en/bill/44-1/c-390
(2) https://www.parl.ca/DocumentViewer/en/44-1/bill/C-390/first-reading
(3) https://www.ourcommons.ca/Members/en/sylvie-berube(104622)
(4) https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/cmmLgPblcVw?comlogId=610243
(5) https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/vwRg?cno=366489&regId=951614#regStart
(6) https://apps.cra-arc.gc.ca/ebci/hacc/srch/pub/dsplyRprtngPrd?q.srchNmFltr=dying+with+dignity&q.stts=0007&selectedCharityBn=118890086RR0001&dsrdPg=1
(7) https://www.dyingwithdignity.ca/
(8) https://www.dyingwithdignity.ca/advocacy/allow-maid-for-mental-disorders/
(9) https://www.dyingwithdignity.ca/advocacy/mature-minors/
(10) https://www.dyingwithdignity.ca/advocacy/advance-requests/

Private Member Bills In Current Session:
(1) Bill C-206: Decriminalizing Self Maiming To Avoid Military Service
(2) Bill C-207: Creating The “Right” To Affordable Housing
(3) Bill C-219: Creating Environmental Bill Of Rights
(4) Bill C-226: Creating A Strategy For Environmental Racism/Justice
(5) Bill C-229: Banning Symbols Of Hate, Without Defining Them
(6) Bill C-235: Building Of A Green Economy In The Prairies
(7) Bill C-245: Entrenching Climate Change Into Canada Infrastructure Bank
(8) Bill C-250: Imposing Prison Time For Holocaust Denial
(9) Bill C-261: Red Flag Laws For “Hate Speech”
(10.1) Bill C-293: Domestic Implementation Of Int’l Pandemic Treaty
(10.2) Bill C-293: Concerns Raised In Hearings Over Food Supplies
(11) Bill C-312: Development Of National Renewable Energy Strategy
(12) Bill C-315: Amending CPPIB Act Over “Human, Labour, Environmental Rights”
(13) Bill C-367: Removing Religious Exemptions Protecting Against Antisemitism
(14) Bill C-373: Removing Religious Exemptions Protecting Against Antisemitism 2.0
(15) Bill C-388: Fast Tracking Weapons, Energy, Gas To Ukraine
(16) Bill S-215: Protecting Financial Stability Of Post-Secondary Institutions
(17) Bill S-243: Climate Related Finance Act, Banking Acts
(18) Bill S-248: Removing Final Consent For Euthanasia
(19) Bill S-257: Protecting Political Belief Or Activity As Human Rights
(20) Bill S-275: Adding “Sustainable And Equitable Prosperity” To Bank Of Canada Act

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2023 Report To Parliament: Extend Euthanasia To Children, Disabled; Booking “Advance” Dates

Back in February, the House of Commons released a report on the state of medical assistance in dying, or MAiD. This is also known as assisted suicide or euthanasia. (See archive).

To be clear, there’s no intention of stopping, or even slowing this down. Instead, the report recommends expanding and accelerating the accessibility of death.

Specifically, new recommendations include:
(a) Letting “mature minors” apply for MAiD
(b) Letting people “book in advance” a date to die
(c) Ensuring people with disabilities have options to get MAiD
(d) Consulting with First Nations on MAiD options and availabilities

There are also reports from 2019 and 2020 that are available to read.

Remember when MAiD was supposed to be limited to adults with fatal conditions, with no hope of recovery? Back in 2016 this was presented as a limited scope option. We’ve gone way past that now.

Recommendation 1
That the Government of Canada, in partnership with provinces and territories, continue to facilitate the collaboration of regulatory authorities, medical practitioners and nurse practitioners to establish standards for medical practitioners and nurse practitioners for the purpose of assessing MAID requests, with a view to harmonizing access to MAID across Canada.

Recommendation 2
That the Government of Canada, through relevant federal departments and in collaboration with relevant regulatory authorities, medical practitioners, and nurse practitioners, continue to address the quality and standardization of MAID assessment and delivery.

Recommendation 3
That, every six months, Health Canada provide updates to the House of Commons Standing Committee on Indigenous and Northern Affairs and the Standing Senate Committee on Indigenous Peoples on its engagement with First Nations, Inuit and Métis on the subject of MAID.

Recommendation 4
That the Government of Canada work with First Nations, Inuit and Métis partners, relevant organizations, such as the Canadian Association of MAID Assessors and Providers, regulatory authorities, and health professional associations to increase awareness of the importance of engaging with First Nations, Inuit and Métis on the subject of MAID.

Recommendation 5
That the Government of Canada, through Correctional Service Canada, support approved track one MAID recipients being able to die outside a prison setting only for the event itself and any immediate preparatory palliative care that is required.

Recommendation 6
That the Government of Canada, through relevant federal departments and respecting the jurisdiction of provinces and territories, consider increasing funding for the implementation of the Action Plan on Palliative Care: Building on the Framework on Palliative Care in Canada, and make targeted and sustained investments in innovative approaches and early-stage research aimed at improving health system performance and quality of care for people living with life-limiting illness and their caregivers.

Recommendation 8
That the Government of Canada, in collaboration with the provinces and territories, work to develop data systems to collect disaggregated data for Black, Indigenous, racialized, disabled, and 2SLGBTQ+ communities beyond the regulations that went into force January 1, 2023.

Recommendation 11
That the Government of Canada, through the Department of Justice, and in consultation with organizations representing persons with disabilities, explore potential amendments to the Criminal Code that would avoid stigmatizing persons with disabilities without restricting their access to MAID. Options considered should include replacing references to “disability” in section 241.2(2) of the Criminal Code, with attention to the potential legal ramifications of such an amendment across Canada.

Recommendation 12
That the Government of Canada convene an expert panel to study and report on the needs of persons with disabilities as they relate to MAID, similar to the Expert Panel on MAID and Mental Illness.

Recommendation 13
That, five months prior to the coming into force of eligibility for MAID where a mental disorder is the sole underlying medical condition, a Special Joint Committee on Medical Assistance in Dying be re-established by the House of Commons and the Senate in order to verify the degree of preparedness attained for a safe and adequate application of MAID (in MD-SUMC situations). Following this assessment, the Special Joint Committee will make its final recommendation to the House of Commons and the Senate

Recommendation 14
That the Government of Canada undertake consultations with minors on the topic of MAID, including minors with terminal illnesses, minors with disabilities, minors in the child welfare system and Indigenous minors, within five years of the tabling of this report.

Recommendation 15
That the Government of Canada provide funding through Health Canada and other relevant departments for research into the views and experiences of minors with respect to MAID, including minors with terminal illnesses, minors with disabilities, minors in the child welfare system and Indigenous minors, to be completed within five years of the tabling of this report.

Recommendation 16
That the Government of Canada amend the eligibility criteria for MAID set out in the Criminal Code to include minors deemed to have the requisite decision-making capacity upon assessment

Recommendation 17
That the Government of Canada restrict MAID for mature minors to those whose natural death is reasonably foreseeable.

Recommendation 18
That the Government of Canada work with provinces, territories and First Nations, Inuit and Métis communities and organizations to establish standards for assessing the capacity of mature minors seeking MAID.

Recommendation 19
That the Government of Canada establish a requirement that, where appropriate, the parents or guardians of a mature minor be consulted in the course of the assessment process for MAID, but that the will of a minor who is found to have the requisite decision-making capacity ultimately take priority.

Recommendation 20
That the Government of Canada appoint an independent expert panel to evaluate the Criminal Code provisions relating to MAID for mature minors within five years of the day on which those provisions receive Royal Assent, and that the panel report their findings to Parliament.

Recommendation 21
That the Government of Canada amend the Criminal Code to allow for advance requests following a diagnosis of a serious and incurable medical condition disease, or disorder leading to incapacity.

Recommendation 22
That the Government of Canada work with provinces and territories, regulatory authorities, provincial and territorial law societies and stakeholders to adopt the necessary safeguards for advance requests.

Recommendation 23
That the Government of Canada work with the provinces and territories and regulatory authorities to develop a framework for interprovincial recognition of advance requests.

Tough to add much to the report, as it’s pretty shocking to read.

Regarding #4, sure, the Federal Government can’t even provide clean drinking water or real health care. But Ottawa will make sure that people are aware they have the option to kill themselves. Or, to be more precise, they will be killed by government authorized medical representatives … a.k.a. medical doctors.

While lip service is paid to the idea of expanded health care access, the real goal is clear. The Government wants more people getting access to euthanasia. They are officially recommending it to “mature minors” (or children), and to people with disabilities.

Although parents should be consulted about their child possibly being euthanized, the report suggests that the final decision goes to the minor.

Even more creepy is the idea that it can be “booked ahead” upon finding out that a person has a serious condition.

It’s true that assisted suicide for people whose only issue being a mental illness was delayed. It was supposed to be implemented in March 2023, and has now been pushed back to March 2024.

On page 105 of the report, the Conservative Party “dissent” begins, and it’s mainly just partisan argument. Most of this revolves around details of study and implementation. In other words, the CPC doesn’t seem to have ideological issues with any of this. Our “Official Opposition” at work again.

At page 107, there is the line: “Conservatives do not support MAID for mature minors at this time.” This of course leaves open the possibility that they would be okay with euthanizing children at some point in the future.

The whole report is so disturbing that it’s difficult to believe it’s real.

(1) https://parl.ca/Content/Committee/441/AMAD/Reports/RP12234766/amadrp02/amadrp02-e.pdf
(2) MAiD Report To Parliament February 2023
(3) https://parl.ca/DocumentViewer/en/43-2/bill/C-7/royal-assent
(4) https://www.canada.ca/en/health-canada/services/medical-assistance-dying-annual-report-2019.html
(5) https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2020.html
(6) https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html

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Private Member’s Bill C-230 DEFEATED: Would Protect Health Care Workers From MAiD Compulsion

Anyone hear about Bill C-230? It would have protected health care workers from being compelled to participate in medical assistance in dying, or euthanasia. Perhaps it made the news at one point.

It had been introduced by Kelly Block, Member of Parliament for Carlton Trail—Eagle Creek, Saskatchewan, back in March 2022.

Turns out it was defeated in October 2022, along party lines. The vote was 115 in favour, and 208 against. Conservatives supported the Bill, while Liberals, NDP, Greens and Bloc Québécois voted it down.

SUMMARY
This enactment amends the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of medical assistance in dying.
.
It also makes it an offence to dismiss from employment or to refuse to employ a medical practitioner, nurse practitioner, pharmacist or other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of medical assistance in dying.

2 The Criminal Code is amended by adding the following after section 241.‍2:
Intimidation
241.‍21 (1) Every person who, for the purpose of compelling a medical practitioner, nurse practitioner, pharmacist or other health care professional to take part, directly or indirectly, in the provision of medical assistance in dying, uses coercion or any other form of intimidation is guilty of an offence punishable on summary conviction.

Employers
(2) Every person who refuses to employ, or dismisses from their employment, a medical practitioner, nurse practitioner, pharmacist or other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of medical assist­ance in dying is guilty of an offence punishable on summary conviction.

It’s hard to believe this is real, but it is. Parliament voted down a Bill that would have protected health care workers from being forced to participate in assisted suicide.

Don’t forget that we still have Bill S-248 in the Senate. That would remove the requirement for final consent for people wanting to end their lives.

In late 2021, Don Davies introduced Bill C-220, which would make it an aggravating factor in criminal sentencing to assault a health care worker. Are we to assume that people in the medical industry need to be protected from violence…. but at the same time, it’s okay to compel them to kill others?

People can be truly evil.

Sources:
(1) https://www.parl.ca/LegisInfo/en/bills?page=3
(2) https://www.parl.ca/LegisInfo/en/bill/44-1/c-230
(3) https://www.ourcommons.ca/Members/en/votes/44/1/186
(4) https://www.ourcommons.ca/Members/en/kelly-block(59156)
(5) https://www.parl.ca/DocumentViewer/en/44-1/bill/C-230/first-reading
(6) https://www.parl.ca/LegisInfo/en/bill/44-1/s-248
(7) https://www.parl.ca/LegisInfo/en/bill/44-1/c-220

Private Member Bills In Current Session:
(A) Bill C-207: Creating The “Right” To Affordable Housing
(B) Bill C-219: Creating Environmental Bill Of Rights
(C) Bill C-226: Creating A Strategy For Environmental Racism/Justice
(D) Bill C-229: Banning Symbols Of Hate, Without Defining Them
(E) Bill C-235: Building Of A Green Economy In The Prairies
(F) Bill C-250: Imposing Prison Time For Holocaust Denial
(G) Bill C-261: Red Flag Laws For “Hate Speech”
(H) Bill C-293: Domestic Implementation Of Int’l Pandemic Treaty
(I) Bill C-312: Development Of National Renewable Energy Strategy
(J) Bill C-315: Amending CPPIB Act Over “Human, Labour, Environmental Rights”
(K) Bill S-215: Protecting Financial Stability Of Post-Secondary Institutions
(L) Bill S-243: Climate Related Finance Act, Banking Acts
(M) Bill S-248: Removing Final Consent For Euthanasia
(N) Bill S-257: Protecting Political Belief Or Activity As Human Rights

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Canadian Parliament Has Hearings On Veteran Allegedly Offered Assisted Suicide

In August 2022, a scandal broke where it was claimed that Veterans Affairs Canada had offered medical assistance in dying (MAiD, or euthanasia), to a veteran that called in with PTSD. Understandably, this caused quite the uproar.

What makes this worse is that it apparently wasn’t just a one-time event. There are several cases that have now been reported.

Now, hearings are going on in Parliament about the issue. However, the response isn’t really one that would satisfy most people. It seems that the Government doesn’t ideologically object to members of the Canadian Forces taking their lives. Instead, it shouldn’t be offered.

If there are technical details about it (such as pensions and benefits), then that’s okay to address.

From the hearings and the transcripts provided, this doesn’t appear taken out of context.


(Time approx 16:01 in video). The hearing is interesting as the only issue seems to be with Veterans’ Affairs suggesting assisted suicide in the first place. If this topic is brought up, it’s to be referred to a supervisor.


(From 17:16 in the same video). While this may be well intentioned, it comes across as rather cold. “Talk to your doctor” seems to be a poor way to treat people (veterans) who are seriously considering this option.

It’s unclear when the Committee will eventually release their report, or even what would be contained in it. But these were all-party meetings.

With the expansion of assisted suicide in Canada, it shouldn’t come as a surprise that it would be offered to members of the armed forces. This was never intended to be limited to people suffering with terminal illnesses.

Members of the Committee:

  • Sean Casey (LPC)
  • Emmanuel Dubourg (LPC)
  • Wilson Miao (LPC)
  • Churence Rogers (LPC)
  • Darrell Samson (LPC)
  • Rechie Valdez (LPC)
  • Terry Dowdall (CPC)
  • Blake Richards (CPC)
  • Fraser Tolmie (CPC)
  • Cathay Wagantall (CPC)
  • Luc Desilets (BQ)
  • Rachel Blaney (NDP)

Is this okay as long as Veterans Affairs doesn’t bring it up? It’s explained that the department has no authority on this topic. Fine, but isn’t looking after vulnerable people (both physically and mentally vulnerable) a role that the organization is supposed to do?

How is this considered health care?
Or looking after veterans?

(1) https://americanmilitarynews.com/2022/08/canadas-veterans-affairs-offers-assisted-suicide-to-veteran-with-ptsd/
(2) https://www.cbc.ca/news/politics/veterans-maid-rcmp-investigation-1.6663885
(3) https://www.ourcommons.ca/Committees/en/ACVA/StudyActivity?studyActivityId=11850743
(4) https://www.ourcommons.ca/DocumentViewer/en/44-1/ACVA/meeting-22/minutes
(5) https://www.ourcommons.ca/DocumentViewer/en/44-1/ACVA/meeting-22/evidence
(6) https://parlvu.parl.gc.ca/Harmony/en/PowerBrowser/PowerBrowserV2/20221020/-1/37828?gefdesc=&startposition=20221020160031
(7) https://www.ourcommons.ca/DocumentViewer/en/44-1/ACVA/meeting-23/evidence

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Bill S-248: Removing Final Consent For Assisted Suicide Requests

Remember how people were warning that assisted suicide (medical assistance in dying or MAiD) wouldn’t be the limited measure that was initially laid out? Those alarmists worried that safeguards and conditions would be rolled back to further expand this “procedure”.

Well, here we go again. Senate Bill S-248 would allow people to enter into contracts that would permit the euthanasia, even if the person isn’t capable of giving that final consent.

Supporters of MAiD had always claimed that the patient would always have the option to change their mind, and to back out. This would allow for contemplation, and for cooler heads to prevail.

From the description of the Bill:

This enactment amends the Criminal Code to
.
(a) permit an individual whose death is not reasonably foreseeable to enter into a written arrangement to receive medical assistance in dying on a specified day if they lose the capacity to consent to receiving medical assistance in dying prior to that day; and
.
(b) permit an individual who has been diagnosed with a serious and incurable illness, disease or disability to make a written declaration to waive the requirement for final consent when receiving medical assistance in dying if they lose the capacity to consent to receive medical assistance in dying, are suffering from symptoms outlined in the written declaration and have met all other relevant safeguards outlined in the Criminal Code.

Of course, the usual questions will come up. Did the person fully understand and support this decision? Was their undue influence? Did they ever change their mind? How do we determine whether or not they are capable of giving that final go-ahead?

There is still a provision that the person can speak or gesture to indicate that they no longer wish to go through with this. However, if they are incapacitated, that obviously won’t help.

This Bill was brought by Pamela Wallin. A decade ago, she became infamous for playing fast and loose with her expenses and got suspended, along with Mike Duffy and Patrick Brazeau.

In her capacity as a Senator, Wallin has had some interesting visitors recently.

Wallin brought this Bill on June 2, 2022. The day before, the Alzheimer Society of Canada had paid a visit. Among the topics listed in their lobbying profiled was: “Parliamentary review of medical assistance in dying with respect to advance requests”. In other words, go ahead, even if final consent can’t be obtained.

Field Trip Psychedelics Inc. has also been in touch with Wallin. This was concering the: “regulation of psilocybin-assisted psychotherapy that would give Canadians access to medical, non-recreational, psilocybin therapy.”

The Canadian Palliative Hospice Care Assocation also has contacted Wallin. Although their profile does mention end of life care, it doesn’t specify assisted suicide.

In any event, these are probably just coincidences, right?

Shouldn’t be any surprise that Wallin brought this Bill. But seriously, how far back do we keep pushing the line, or is there a limit?

(1) https://www.parl.ca/legisinfo/en/bill/44-1/s-248
(2) https://www.parl.ca/DocumentViewer/en/44-1/bill/S-248/first-reading
(3) https://www.cbc.ca/news/politics/senate-moving-to-suspend-pamela-wallin-mike-duffy-1.2101305
(4) https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/cmmLgPblcVw?comlogId=533156
(5) https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/vwRg?cno=367664&regId=905218&blnk=1
(6) https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/cmmLgPblcVw?comlogId=533156
(7) https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/vwRg?cno=14475&regId=923718&blnk=1
(8) https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/cmmLgPblcVw?comlogId=523500
(9) https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/vwRg?cno=15059&regId=917004&blnk=1

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Parliament’s Guidelines On Euthanizing The Mentally Ill

Medical Assistance in Dying (MAiD), a.k.a. euthanasia or assisted suicide, had been touted as proponents as having an extremely limited scope. In other words, it would be available to people with terminal illnesses, who were otherwise living in extreme pain.

Bill C-14 was supposed to be limited to terminal cases. In the next session, Bill C-7 increased the eligibility options. Suddenly, even people with serious mental illnesses were able to obtain euthanasia, provided the mental problem wasn’t the sole reason.

And now, we reach the point where people whose SOLE problem is a mental illness can be put down with the help of so-called medical professionals. The people pushing the slippery slope argument have been proven correct once again.

An interim report was released in June 2022, and it’s widely expected that expanding the scope will become law very soon.

MAID PRACTICE STANDARDS

Recommendation 1: Development of MAiD practice standards
The federal, provincial and territorial governments should facilitate the collaboration of physician and nurse regulatory bodies in the development of Standards of Practice for physicians and nurse practitioners for the assessment of MAiD requests in situations that raise questions about incurability, irreversibility, capacity, suicidality, and the impact of structural vulnerabilities. These standards should elaborate upon the subject matter of recommendations 2–13.

INTERPRETING GRIEVOUS AND IRREMEDIABLE MEDICAL CONDITION

Recommendation 2: Establishing incurability
MAiD assessors should establish incurability with reference to treatment attempts made up to that point, outcomes of those treatments, and severity and duration of illness, disease or disability. It is not possible to provide fixed rules for how many treatment attempts, how many kinds of treatments, and over what period of time as this will vary according to the nature and severity of medical conditions the person has and their overall health status. This must be assessed on a case-by-case basis. The Panel is of the view that the requester and assessors must come to a shared understanding that the person has a serious and incurable illness, disease or disability. As with many chronic conditions, the incurability of a mental disorder cannot be established in the absence of multiple attempts at interventions with therapeutic aims.

Recommendation 3: Establishing irreversibility
MAiD assessors should establish irreversibility with reference to interventions tried that are designed to improve function, including: recognized rehabilitative and supportive measures that have been tried up to that point, outcomes of those interventions, and the duration of decline. It is not possible to provide fixed rules for how many attempts at interventions, how many types of interventions, and over how much time, as this will vary according to a requester’s baseline function as well as life goals. Therefore, this must be assessed on a case-by-case basis. The Panel is of the view that the requester and assessors must come to a shared understanding that the person is in an advanced state of irreversible decline in capability.

Recommendation 4: Understanding enduring and Intolerable suffering
MAiD assessors should come to an understanding with the requester that the illness, disease or disability or functional decline causes the requester enduring and intolerable physical or psychological suffering.

VULNERABILITIES

Recommendation 5: Comprehensive capacity assessments
MAiD assessors should undertake thorough and, where appropriate, serial assessments of a requester’s decision-making capacity in accordance with clinical standards and legal criteria. These assessments should be consistent with approaches laid out in standardized capacity evaluation tools.

Recommendation 6: Means available to relieve suffering
To ensure all requesters have access to the fullest possible range of social supports which could potentially contribute to reducing suffering, the Panel recommends that ’community services’ in Track 2 Safeguard 241.2(3.1)(g) should be interpreted as including housing and income supports as means available to relieve suffering and should be offered to MAiD requesters, where appropriate.

Recommendation 7: Interpretation of track 2 safeguard 241.2(3.1)(h) the person has given serious consideration to those means
Serious consideration should be interpreted to mean genuine openness to the means available to relieve suffering and how they could make a difference in the person’s life.

Recommendation 8: Consistency, durability, and well-considered nature of a maid request
Assessors should ensure that the requester’s wish for death is consistent with the person’s values and beliefs, unambiguous and rationally considered during a period of stability, not during a period of crisis.

Recommendation 9: Situations of involuntariness
Persons in situations of involuntariness for periods shorter than six months should be assessed following this period to minimize the potential contribution of the involuntariness on the request for MAiD. For those who are repeatedly or continuously in situations of involuntariness, (e.g., six months or longer, or repeated periods of less than six months), the institutions responsible for the person should ensure that assessments for MAiD are performed by assessors who do not work within or are associated with the institution.

ASSESSMENT PROCESS

Recommendation 10: Independent assessor with expertise
The requester should be assessed by at least one assessor with expertise in the condition(s). In cases involving MAiD MD-SUMC, the assessor with expertise in the condition should be a psychiatrist independent from the treating team/provider. Assessors with expertise in the person’s condition(s) should review the diagnosis, and ensure the requester is aware of all reasonable options for treatment and has given them serious consideration.

Recommendation 11: Involvement of other healthcare professionals
Assessors should involve medical subspecialists and other healthcare professionals for consultations and additional expertise where necessary.

Recommendation 12: Discussion with treating team and collateral information
• If the requester’s primary healthcare provider is not one of the assessors, assessors should obtain input from that person. When the requester’s clinical care is shared by members of a multidisciplinary healthcare team, assessors should solicit their input as well.
• With a requester’s consent, assessors and providers shall obtain collateral information relevant to eligibility and capacity assessment. This should include reviewing medical records, prior MAiD assessments, and discussions with family members or significant others. Care must be taken to determine that obtaining collateral information will not be harmful to the requester.

Recommendation 13: Challenging interpersonal dynamics
Assessors and providers should be self-reflective and examine their reactions to those they assess. If their reactions compromise their ability to carry out the assessment in accordance with professional norms, they should seek supervision from mentors and colleagues, and/or discontinue involvement in the assessment process. The practitioner should adhere to any local policies concerning withdrawal from a MAiD assessment and onward referral.

IMPLEMENTATION

Recommendation 14: Consultations with first nations, inuit and métis peoples
Consultation between health regulatory bodies in each province and territory with First Nations, Métis, and Inuit peoples must aim to create practice standards with respect to MAiD MD-SUMC, and MAiD more generally, that incorporate Indigenous perspectives and are relevant to their communities.

Recommendation 15: Training of assessors and providers in specialized topics
To support consistent application of the law and to ensure high quality and culturally sensitive care, assessors and providers should participate in training opportunities that address topics of particular salience to MAiD MD-SUMC. These include, but are not limited to: capacity assessment, trauma-informed care and cultural safety.

Recommendation 16: Prospective oversight
Given its concurrent jurisdiction in relation to MAiD, the federal government should play an active role in supporting the development of a model of prospective oversight for all or some Track 2 cases that could be adapted by provinces and territories.

Recommendation 17: Case-based quality assurance and education
The federal government should play an active role in supporting the development of provincial/territorial systems of MAiD case review for educational and quality improvement purposes.

Recommendation 18: Modifications to data collection under the federal maid monitoring system
Data related to specific topics (eligibility, supported decision-making, means available to relieve suffering, refusal of means available, and residence and legal status) should be collected in the MAiD monitoring system in addition to data already collected under the 2018 Regulations. These data can be used to assess whether key areas of concern raised about MAiD MD-SUMC and complex Track 2 cases discussed in this report are being addressed by the clinical practices recommended.

Recommendation 19: Periodic, federally funded research
The federal government should fund both targeted and investigator-initiated periodic research on questions relating to the practice of MAiD (including but not only MAiD MD-SUMC).

If nothing else, Recommendation #8 points out that this should only be an option during a period of stability, and not during a crisis.

Keep in mind, this is only an interim report. There’s nothing to suggest this won’t be expanded on at some later point.

Since its inception, the rates of people receiving assistance in suicide has increased year over year. This will surely raise those numbers even more.

(1) https://www.ourcommons.ca/Committees/en/Work
(2) https://parl.ca/DocumentViewer/en/44-1/AMAD/report-1/
(3) https://parl.ca/Content/Committee/441/AMAD/Reports/RP11896958/amadrp01/amadrp01-e.pdf
(4) https://canucklaw.ca/canadas-bill-c-14-assisted-suicide/
(5) https://canucklaw.ca/euthanasia-3-bill-c-7-to-expand-scope-of-assisted-suicide/
(6) https://canucklaw.ca/recent-statistics-on-euthanasia-assisted-suicide-in-canada/