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Protecting Choice and Safeguarding Inclusion

December 21, 2015 - - Disability Supports, Equality Rights

Following the Government of Canada’s recent request for a six-month extension to review the issue and develop new laws governing physician-assisted suicide/voluntary euthanasia, CACL is calling on governments and health professions to give much more attention to how vulnerable patients will be identified and cared for in the new system. To see our background papers on this issue click here.

CACL shares with all Canadians the value of a health care system that promotes patient autonomy and dignity in end-of-life care. However, recent proposals and recommendations fail to recognize the growing vulnerability in Canadian society.

Safeguards: What is needed to protect vulnerable Canadians?

  • Mandatory vulnerability assessments by a qualified professional other than the attending physician, for every person making the request:

o Screen for any vulnerability factors (if no, proceed to authorization);
o If yes, multi-disciplinary team inquires into risks;
o If risk is too high, arrange alternative courses of action.

  • Advance independent review to provide checks and balances, and an expedited process where needed. All persons requesting assisted suicide must be considered as potentially vulnerable.
  • Teams of clinical specialists who can guide the diagnosis of medical conditions and capacity for well-reasoned requests in the face of a person’s suffering. Most assisted suicide proposals rely on a physician to approve the request by a patient to terminate their life. This is not enough.

Risks: What are the risks of weak safeguards?

Evidence from other jurisdictions shows that some people request assisted suicide because their suffering is caused by factors other than a medical condition, such as:

  • the disability itself;
  • social stigma and isolation;
  • poverty;
  • domestic abuse;
  • family and caregiver stress; and,
  • coercion.

If strong safeguards are not in place, the root causes of suffering could go unidentified and unaddressed. Someone whose suffering has been caused by other factors such as stigma or disability will receive assisted suicide instead of other interventions that address the root causes. Without safeguards, disability-related suffering could become a primary motivation for assisted suicide. This will worsen the stigma surrounding disability. 

What the Supreme Court Said

  • Canadians have a right to assisted suicide. But “stringent limits that are scrupulously monitored and enforced” are needed to safeguard vulnerable people from:

o being induced to commit suicide in a time of weakness;
o taking their own lives; and
o abuse and error in the health care system.

  • It is up to Parliament’s to specify any needed safeguards.
  • Parliament can design and implement safeguards within the Criminal Code ban on assisted suicide to protect vulnerable people from being induced to commit suicide in a time of weakness.
  • It is up to Parliament to define a “grievous and irremediable medical condition.” The Supreme Court did not say it was by definition a terminal condition, nor did they say that it is not.