The recommendations are contained in a document titled the “Vulnerable Persons’ Standard,” released March 1 in Ottawa. It contests a parliamentary committee report that recommended a “permissive” regime in which assisted suicide be made widely available to not only terminally ill patients, but to anyone, including minors under 18 and psychiatric patients, who meet a broad criteria.
The parliamentary report was “dismaying,” said Michael Bach, executive vice-president of the Canadian Association for Community Living. It expressed concern about vulnerable people but that concern “appears to be rhetorical,” he said, because rather than talk about treatment the parliamentary report focussed on a procedure that “will bring about someone’s death.”
Bach said a prior judicial or legal panel review is essential, because “this is a state authorized exception to the ban on assisted suicide.”
Bach’s organization is just one member of a large alliance that includes L’Arche Canada, the Catholic Health Alliance of Canada, the Catholic Organization for Life and Family (COLF), Living with Dignity, the Physicians’ Alliance Against Euthanasia, the Euthanasia Prevention Coalition and many other groups that promote life and care of the mentally and physically disabled.
The alliance wants physician-assisted death restricted to “end-of-life conditions for adults in a state of advanced weakening capacities with no chance of improvement and who have enduring and intolerable suffering as a result of a grievous and irremediable medical condition.”
Even then, every case should be subject to an “arm’s-length authorization” that includes “an expedited prior review and authorization by a judge or independent body with expertise in the fields of health care, ethics and law.”
Among more than 40 advisors, the alliance includes two representative from the three-member panel created last summer by the Stephen Harper government, chairman and palliative care expert Dr. Harvey Chochinov, and disability rights expert Catherine Frazee. Alliance advisors also include Sr. Nuala Kenny, who served on the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, McGill University bio-ethicist Margaret Somerville and the so-called “Father of palliative care in Canada,” Dr. Balfour Mount of Montreal.
The federal panel under Chochinov “did by far the most extensive research” on assisted death, Bach said. It heard from far more witnesses and conducted a survey of nearly 15,000 Canadians which showed majority support for strong safeguards.
“There’s a health side and a legal side,” Bach said. One of the criteria for a physician-assisted death is “not being vulnerable.”
The alliance is calling for “equal protection for vulnerable persons” to ensure that Criminal Code amendments on physician-assisted death do not “perpetuate disadvantage or contribute to social vulnerability.” It called for careful regulation and public reporting so any adverse impacts “will be identified and addressed without delay,” as well as insisting on “voluntary and capable consent” and encouragement for patients to pursue alternatives such as palliative care. It would prohibit advanced directives.
The alliance also believes every suicidal patient should have a suffering and vulnerability assessment. It would include a “careful exploration of the causes of a patient’s suffering as well as any inducements that may arise from psychosocial or non-medical conditions and circumstance.”
Michael Shea, president and CEO of the Catholic Health Alliance of Canada, said his group supported the Vulnerable Persons’ Standard because legalizing assisted suicide poses potential harm for vulnerable people. The federal government has until June 6 to enact legislation in order to meet a Supreme Court deadline.
“We are concerned about a number of the recommendations of the parliamentary committee on this matter,” Shea said. “The potential impact on vulnerable persons is clearly a concern.”
John O’Donnell, director of outreach and communications for L’Arche Canada, said his organization is morally opposed to assisted suicide but supports the goals contained in the Standard.
“We signed on because we believe it’s the best we’re able to do under the circumstances,” he said. “We still have to be in on the conversation and signing the Standard is one way to do that.”