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Canadian Governement presents new Bill on medical assistance in dying

On April 14, 2016 Prime minister Justin Trudeau of Canada presented the long awaited bill (C-14 An Act to amend the Criminal Code and to make related amendments to other Acts [medical assistance in dying]) in Ottawa in the House of Commons for a first reading. The bill limits the medical assistance in dying to citizens and residents who are eligible to participate in the national health care system, an effort to prevent a surge in medical tourism among the dying from other countries. Under Canada’s proposed law, people who have a serious medical condition and want to die will be able to commit suicide with medication provided by their doctors or have a doctor or nurse practitioner administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process. The bill would allow consenting adults “capable of making decisions with respect to their health” to choose to end their own lives or seek assistance in doing so from their doctors. A physician must decide that “natural death has become reasonably foreseeable, taking into account all of their medical circumstances.”

From New York Times:

Officials said that a patient does not have to have a terminal condition, citing the example of someone with an immune system deficiency which leaves them vulnerable to lethal infections. Two independent physicians must agree and the patient must wait 15 days before moving to end his or her life, though the bill would allow for that waiting period to be shortened under certain circumstances. Doctors will not be required to help people die, but they must refer patients to another physician if they have an objection to participating.

The legislation is the latest step in a decades-long and frequently emotional debate in Canada about the rights and protections of patients with serious medical conditions who might seek to end their lives

The legislation is expected to pass, given the Liberal Party’s strong majority in the House of Commons. However, the government has promised to further study the issue after the law’s passage and may make changes to the system. “For some, medical assistance in dying will be troubling,” Jody Wilson-Raybould, the justice minister, said at a news conference on Thursday. “For others, this legislation will not go far enough.” “I’ve seen people die well and I’ve seen people die in misery,” Dr. Jane Philpott, the health minister who is also a family physician, told reporters on Thursday after the bill was introduced. “I want Canadians to have access to the best care possible.”

The government’s proposal is more restrictive than some proponents of legal assisted suicide had sought. It does not include provisions for minors who may be capable of making decisions about their own medical care to choose to end their lives, nor does it allow for people in the early stages of illnesses like dementia to request an assisted death while they are still competent. “This law actually pits me against medical ethics,” said Dr. Brett Belchetz, a physician with Dying With Dignity Canada, an advocacy group. “There are a number of shortfalls and I do think the legislation requires an urgent rethink.” Critics of the legislation, including some religious groups, have long opposed any form of assisted death.

“It changes our approach to human life, it changes our approach to human society,” Cardinal Thomas Collins, the Roman Catholic Archbishop of Toronto, said in an interview Thursday after the new bill was introduced. He added that he was “deeply troubled” by the pressure the legislation might put on health care workers who object to assisted suicide.

Mr. Trudeau, who came to power in the fall, moved to introduce the bill to fill the legal void left in February 2015 when the Supreme Court of Canada overturned a criminal ban on assisted suicide. The court had unanimously concluded that it was unconstitutional to deny the option of assisted death to consenting adults with severe medical conditions. At that time, the previous government, led by Stephen Harper, had one year to introduce a new law. But Mr. Harper’s Conservative Party was divided on the issue and did little to introduce legislation before last October’s election. When it became apparent that the Conservative government was not going to act on the court’s ruling, the province of Quebec used its powers over health care to introduce a system for assisted dying late last year. Judges in other parts of Canada have also given individual patients permission to hasten their own deaths. The previous government, backed by some religious leaders, vigorously challenged any attempts to legalize assisted suicide through the courts. Mr. Trudeau, before he became prime minister, had supported a law that would allow for doctor-aided deaths, a position he said was informed by the final days before the death of his father, former Prime Minister Pierre Elliott Trudeau. He died in 2000 after declining aggressive treatments for prostate cancer and Parkinson’s disease. A few Liberal members of Parliament in Mr. Trudeau’s party have said that the new law conflicts with their religious beliefs, and they will not support the legislation.

Still, the bill is expected to pass but maybe not by June 6, the date on which the current criminal prohibition expires Michael Cooper, a Conservative member of Parliament, said his party will work with the government to make sure that the deadline is met. Mr. Cooper said that he was pleased that the legislation proposes a narrower system than the one put forward this year by a parliamentary committee, though he added that he is still opposed to using nurse practitioners to aid assisted deaths. Dominic LeBlanc, the Liberal Party leader in the House of Commons, told reporters Thursday that he would propose extended parliamentary sessions to pass the legislation in time. He also reminded opponents of the bill that “this question of whether Canadians should have access or not was decided by a unanimous Supreme Court.” Defeating or delaying the legislation beyond the June deadline, he said, would leave “a complete vacuum.”