This column is an opinion by Ray Pennings, co-founder and executive vice-president of Ottawa faith-based think tank Cardus. He is involved in public policy discussions at all levels of government, appears often as a media commentator, and has led Cardus research on better end-of-life care. For more information about CBC’s Opinion section, please see the FAQ.
Look all ways before crossing the street – that’s the advice we give to children. Frankly, that’s also the best advice federal Justice Minister David Lametti could follow before responding to a Quebec court ruling that pushes the federal government to broaden access to medical assistance in dying (MAID).
The government, which plans to table amended MAID legislation in February, needs to be especially careful in its next steps, lest it take Canada right into oncoming traffic.
The need for care makes the rushed public consultation process very concerning, despite the large number of responses — nearly 300,000 — it received before the consultation period ended Jan. 27.
The government gave Canadians just 14 days to fill out a bare-bones online questionnaire on expanding MAID. Graduating high school students have more time to consider a university acceptance letter than Canadians were given to consider monumental social change fraught with moral complexity. The government needs to take its time.
On the positive side, it seems open to considering improved oversight for MAID.
Options under consideration include making sure patients are aware of all avenues available to relieve suffering without ending their lives, as well as retrospective committee review of MAID cases to ensure all eligibility criteria and safeguards were satisfied.
These are wise and sensible measures, especially considering the case of Alan Nichols in British Columbia last summer. Doctors gave Nichols, who had a history of depression and was arguably not facing imminent death, a lethal injection at his request. The MAID regime allowed this to happen despite protests from his family, who said he was mentally ill and not able to give consent.
If the government is going to liberalize MAID laws, it’s vital to ensure more effective oversight.
However, all the oversight in the world won’t help if Canadians are pressured into requesting death.
Consider Roger Foley, who deals with an incurable neurological disease. He publicly released audio recordings of London, Ont., hospital staff offering him assisted death and outlining how much it costs to keep him in hospital – a pressure tactic Foley says he endured instead of getting the home care he desired and needed.
His case caught the attention of the UN Special Rapporteur on the Rights of Persons with Disabilities. Following a visit to Canada last spring, the UN’s Catalina Devandas Aguilar issued a statement that she had “received worrisome claims about persons with disabilities in institutions being pressured to seek medical assistance in dying.” She also urged the federal government to investigate and prevent such cases.
As it amends the legislation, how seriously is the government taking the urgent need to protect vulnerable patients from pressure to request MAID?
It isn’t just patients who are vulnerable. So are conscientious objectors to MAID.
Conscience rights are Charter rights, yet health care workers who experience moral distress over MAID aren’t adequately protected. Last year, the courts upheld a College of Physicians and Surgeons of Ontario regulation requiring doctors who object to assisted death as immoral to provide an effective referral to another doctor to carry out the procedure.
This is problematic for at least three reasons.
First, coercing doctors to provide a referral implicates them in subsequent actions their patients take.
Second, it denies doctors the freedom to live according to deeply held personal beliefs, which no regulatory body has a right to dictate.
And third, it can put them in the unenviable position of giving up careers in order to avoid moral distress.
Yet the government has been ominously silent on conscience rights.
Finally, the justice minister needs to address the issue of continued respect for different views on MAID.
No side in this debate has a monopoly on compassion. MAID advocates are often moved by the experience or suffering of a loved one. MAID opponents are often at the forefront of alleviating suffering and improving palliative care. A government proves its commitment to pluralism by preserving respect for different views in the midst of controversy.
Yes, the courts in Quebec are pushing the entire country to cross the road to a new MAID regime. But the federal government needs to be very careful before it sets foot on the pavement.
Mistakes here are fatal.
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