Is choosing medically assisted death too easy in Canada?

CALGARY, Alberta – The first time Cheryl Romaire attempted to take her own life under Canada’s assisted suicide law, her application was denied. But after the law was relaxed, she received approval to end her life – and now she only intends to do so.

Recently, Ms. Romaire said: “It felt like there was some weight on my chest, as one of her cats and a dog jostled for her attention at her apartment in Calgary, Alberta.

Last year, Canada changed its assisted dying law, allowing people with chronic illnesses, “grievous and irreparable” illnesses and physical disabilities to commit suicide, even if they don’t terminally ill. And so this allows Ms Romaire – who has undergone 41 medical procedures in 10 years for a painful and worsening spinal condition but has been told she has died from the condition, “nothing”. reasonably foreseeable” – qualified to die on his own. condition.

“You can have a good death, you can have your family there with you,” she said. “They are still in pain. But it’s not like the suicidal shock that people do when they’re at a level of pain where there’s no hope. “

Canada is among 12 countries and several US states that allow assisted dying in certain circumstances. Since last year, there has been one of at least three cases – including Belgium and the Netherlands – that allows assisted dying if the person is suffering from a chronic painful condition, even if it is not. is the final stage.

Although Canadian law has hot debate in 2016, when it was originally issued, it has won widespread public acceptance ever since, with polls showing strong support. As of December 2021, 31,664 Canadians have been assisted dying. Of those, the 224 who died last year were not terminally ill, taking advantage of last year’s amendment.

But the change in the law has sparked debate about the system. In March, the law will be expanded again, to apply to people with certain mental disorders. A Parliamentary committee of legislators is studying what standards should govern those cases; Its report is expected in the fall.

However, critics say Canada has now gone too far.

Among those critics were three United Nations disability and human rights experts, who said, in a letter to the Canadian government, that in legalizing assisted suicide for disabled people without terminal illnesses, the law, as it was written, devalued their lives by suggesting “That substantial disability could be worse than death.”

Some say that with the law’s expansion, Canada is making assisted suicide a near-common medical option, rather than treating it as a special measure taken in limited situations. .

“Canada has the fewest protections of any country that allow it,” said Trudo Lemmens, chair of health law and policy in the faculty of law at the University of Toronto, referring to assisted suicide legislation in general. ,” and it has the most open-ended system. “

He continued: “It is a state-funded, state-organized health system that provides end-of-life services. “What I find particularly troubling is that no other authority considers the termination of a physician’s life as standard medical practice.”

Under current law, terminally ill persons applying for assisted death must be assessed by a physician or nurse practitioner. Applicants with non-life-threatening illnesses and disabilities must undergo evaluation by two separate clinicians. They also have to go through a 90-day waiting period.

While patients have the choice to swallow their prescribed medication to end their lives, most choose to have a doctor or nurse administer a lethal injection. Clinicians are the final arbiter of whether the person qualifies for assisted dying. But all death assistance claims and the deaths themselves must be reported to the federal health department, which oversees them.

Helen Long, chief executive officer of Dying With Dignity Canada, a patient support group that considers assisted dying, said any doctor who doesn’t follow the rules will face serious consequences. “I think the system is working pretty well,” she said. “The reality is that they risk losing their medical license, if not criminal charges, if they don’t follow the rules.”

Jocelyn Downie, a professor of law and medicine at Dalhousie University in Halifax, Nova Scotia, said, “There is no solid evidence that the Canadian system is not working properly and we have systems in place to develop show when it’s not working well. . “

She added, “Regarding the rest of the world, I really think we have a great system.”

But a series of committee hearings, including the current congressional hearings, have provided a public forum for the rekindling debate both about the legislation and the country’s experience. in assisting the dead.

The committees have heard from people frustrated by their exclusion from the process that resulted in the death of family members; Deciding to die is, by law, a decision in which family members have no say. Many describe the revised law as a dangerous attack on people with disabilities and raises the possibility that those facing economic or housing challenges can now simply give up and choose the right one. died.

Others worry that including mental disorders will undermine suicide prevention efforts, or that death is inappropriately given as an alternative to more treatment or support.

Experts say there are often disagreements within families when someone chooses assisted suicide. But the government says there is no documented abuse of the system yet.

In a statement, Health Canada said the new law introduced additional safeguards to protect people with disabilities and mental disorders and enhanced the government’s ability to track applicants. please die and their motives. The government also says that the new law provides more oversight for doctors.

The committee, which is studying how to apply the changes to the law, has heard hours of testimonies and reviewed piles of submissions.

Committee members have grappled with questions such as whether minors should be allowed to choose assisted death and, if so, how and whether healthy Canadians can choose one. assisted death before they developed dementia or any other condition that would make it impossible for them to confirm. the request.

One submit from Christopher Lyon, whose father sought an assisted death under the revised law. Mr. Lyon said the father, who lives in western Canada, had a history of depression, had suicidal thoughts and threatened suicide. When he fell and stopped eating, doctors ruled him terminally ill, and granted him an assisted death at the age of 77. The son, who recently moved to England, said the process was rushed. withdraw and cause difficulties for his family.

“We have not received the records yet but what we do raises more questions than answers about the circumstances of his death and to me that is quite alarming,” Mr Lyon said. “Current legislation in Canada and the level of rigor that goes into the assessment do not appear to be strong.”

Canada’s move towards assisted suicide has been driven by the courts. The original 2016 law was a response to the 2015 decision by the Supreme Court of Canada that federal criminal law prohibits assisted dying. violate the Charter of Rights and Freedoms of the country. The revised law is a response to a 2019 ruling by a Quebec court that parts of the system are unconstitutional by being too restrictive.

In Calgary, Romaire, 46, and a divorced mother of two adult children, said the debate over the new law sometimes angers her but also worries her that the approval she’s getting being given an assisted death may be forfeited.

Despite wearing a fentanyl patch, Ms. Romaire said she was in constant pain. Once a walking and yoga enthusiast, she can no longer go to the Co-Op supermarket a block from her home.

Ms. Romaire said she had no immediate plans for her death, in part because she wanted to settle things first with two family members who were struggling with her decision.

Ms. Romaire said she has a message for those who want to add additional protections or restore system coverage by deeming it a threat to people with disabilities.

“I wish they didn’t speak for me,” she said. Assisted death is not something someone can be pushed into, she said. “It’s a very difficult process to go through, it’s not as easy as people think.”

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