UNBC professor says legislation on medically assisted dying leaves a lot to be desired

The Liberal government has introduced what it hopes will become legislation regarding medically assisted dying in Canada.

And it seems to that nobody is happy with Bill C-14 in its current form. The BC Civil Liberties Association, who brought the case that triggered the legislation to the Supreme Court, has slammed the bill as a disappointment.

Catharine Schiller is a lawyer and nurse who teaches at UNBC’s School of Nursing. She says the bill certainly isn’t what it could have been.

“A lawyer who read it said that his impression was that, in big, bold, red letter on the front of this draft bill, it should say ‘Incomplete.’ And I think that that really captures my feeling about it too. There’s a lot that we were hoping would be in there that is absolutely missing.”

The government is restricting medical assistance in dying to Canadians over the age of 18 who are “suffering intolerably” and whose death is “reasonably foreseeable.” But what does that mean?

Schiller says the definition is a legal one and is not very helpful in a medical setting.

“I think that the government owed it to practitioners and to patients to be clear on what the criteria were. And I think that reasonably foreseeable is one of the furthest things from clear and precise that I’ve seen in draft legislation in a while.”

The bill will also require those wishing for medical assistance to end their lives to undergo a mandatory 15-day waiting period to avoid rash decisions. Canadians with mental illnesses will not have access to the service. Another aspect of the bill that has received a lot of criticism is its lack of an option for Canadians with degenerative diseases, such as Alzheimer’s, to provide advance directives about the end of their lives while still of sound mind. Schiller says advance directives are mentioned in the preamble of the bill but says, without a constitutional challenge, it will be five years before any provisions for advance directives are added to the law.

The government is under a time crunch to get the legislation passed. The Supreme Court has given them until June to pass legislation regarding medical assistance in dying. Schiller says that’s no excuse for sloppy legislation.

“Time pressure is one thing but I don’t think that’s an excuse to not get it as right as you can. And I think there was that opportunity to get it right. At least get the language more precise and as clear as possible so that people actually [know] what the criteria [are].”

But Schiller does see some bright spots in the bill. In particular, she says she appreciates the inclusion of nurse practitioners as professionals capable and qualified to help patients at the end of their lives.

“The very name change from physician-assisted in dying to medical assistance in dying indicate a broader acceptance of the role of other practitioners,” says Schiller. “And that’s especially important in rural and remote communities where the healthcare delivery framework is not led by a physician, it’s led by a nurse practitioner.”

Schiller is also in favour of the requirement that two medical professionals evaluate a person before they receive assistance in dying. She’s particularly supportive of an omission in that portion of the bill.

“It doesn’t say that the assessment has to be conducted in person so it leaves a bit more room in that potential framework to work in a rural, remote area and that’s awesome,” Schiller says. “But there were a couple of pieces that were much more concerning for me in this bill.”

One of those pieces allows medical practitioners to opt out of providing assistance in dying due to conscientious objections. But, unlike the law already in effect Quebec, Bill C-14 doesn’t provide for patients whose doctors say no.

“The new bill doesn’t address what has to be done in the case of conscientious objection,” says Schiller. “The Quebec law requires that, if you exercise that right to conscientious objection, then you gave to refer the patient to another practitioner who is willing to deal with the request.”

Schiller says a lack of referral requirement could have a significant impact on patients in rural communities.

“I really wonder how that’s going to work in a rural and remote setting. Many of these communities feel very fortunate to have one practitioner who leads the healthcare delivery framework,” she says. “So does that mean that the individuals who are requesting medically assisted dying will have to travel to find the second one?”

Schiller worries that terminally ill patients with “intolerable suffering” could be forced to travel great distances to end their lives, placing a huge burden on them and their families.