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Toronto, ON – Health care in Canada is about to undergo a major transformation as patients obtain the right to request and receive physician-assisted suicide and voluntary euthanasia in order to die. As we proceed down this path, the Canadian Association for Community Living (CACL) calls on health professions and governments to urgently give much more attention to how vulnerable patients will be identified and cared for in the system.
CACL shares with all Canadians the value of a health care system that promotes patient autonomy and dignity in end-of-life care. However, the recommendations proposed in the Final Report of the Provincial-Territorial Advisory Group, released December 14th, fail to recognize the growing vulnerability in Canadian society. “There is compelling evidence from other jurisdictions that some people will be motivated to request physician-assisted suicide and voluntary euthanasia (PAS/VE) because of suffering caused or compounded by factors other than their medical condition,” states CACL President Joy Bacon. “These include: the experience of disability itself; related social and economic disadvantage; victimization and domestic abuse; family and caregiver stress, inducement and coercion; social isolation and stigma; and barriers to health care access. Relying on existing mechanisms to make these distinctions, as proposed by the P-T Advisory Group, is completely inadequate to address the concerns the Supreme Court of Canada clearlyidentified.”
As a starting point for access to a PAS/VE system, CACL believes all persons coming forward to make this request must be considered as potentially vulnerable to being induced to commit suicide. “Only with a robust vulnerability assessment process, advance independent review, and clinical specialists who can guide the diagnosis of medical conditions and capacity for well-reasoned requests in the face of a person’s suffering, can we trust that the needed distinctions can be made to safeguard vulnerable persons,” says CACL Executive Vice President Dr. Michael Bach.
CACL is calling for governments to abide by the Supreme Court’s imperative that any safeguard system must balance the competing values of protecting the autonomy and dignity of a person’s right to choose on the one hand, and the need to protect vulnerable persons on the other. To do anything less would be to prioritize the value of autonomy over protecting the vulnerable, and the Supreme Court provided no such avenue in its decision.“A weak safeguards system for vulnerable people – like that proposed by the P-T Advisory Group - risks disability-related psychological suffering becoming a primary motivation and justification for physician-assisted suicide and voluntary euthanasia,” states Bach. “This will contribute to a disability stigma and a vicious cycle can ensue, where living with a disability is used to justify terminating life.”
Given the very real risk to vulnerable persons that could result from a system for physician-assisted suicide and voluntary euthanasia, it is of the utmost urgency and importance to develop robust, transparent and consistent safeguards in which Canadians can build trust. Canada must make certain that in every case of physician-assisted suicide, real autonomy is being exercised by individuals, in a context of assured dignity, access to needed supports for palliative care or for continuing to live in the community, information about alternative courses of action, and informed consent. CACL urges the federal and provincial-territorial governments not to move quickly on the recommendations of the Provincial-Territorial Advisory Group, and to ensure adequate process where other perspectives can be heard.
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