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Urgent Need for Safeguards in Physician-Assisted Suicide to Respect and Protect Vulnerable Persons with Disabilities

Summary: 
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.

Following the Government of Canada’s recent request for a six-month extension to study the issue and come up with new laws governing physician-assisted suicide, Inclusion BC is calling on governments and health professions to give much more attention to how vulnerable patients will be identified and cared for in the system. Inclusion BC is concerned that recommendations proposed in the Final Report of the Provincial-Territorial Advisory Group, released December 14th, fail to recognize the growing vulnerability in Canadian society.

Read the CACL news release here.

Safeguards: What is needed to protect vulnerable Canadians

  • Require mandatory vulnerability assessments by a qualified professional other than the attending physician, for every person making the request for physician-assisted suicide designed as a stepped process:
  1. screen for any vulnerability factors (if no, proceed to authorization);
  2. if yes, multi-disciplinary team inquires into risks;
  3. if risk is too high, arrange alternative courses of action. 
    Most assisted suicide proposals rely on a physician to approve the request by a patient to terminate their life. This is not enough.
  • Require all requests to undergo advance review and authorization by an independent body – to provide checks and balances, and an expedited process where needed. All persons requesting assisted suicide must be considered as potentially vulnerable and undergo this review.
  • Ensure annual reporting on requests, outcomes and vulnerability assessments to provincial/territorial legislatures and to Parliament.
  • Mandate safeguards in the Criminal Codewhile respecting provincial/territorial jurisdiction for delivering and regulating physician-assisted suicide and mandated safeguards.
  • Assure federal and provincial/territorial governments investment in palliative care and needed disability-related supports.

What are the risks of weak safeguards?

Evidence from other jurisdictions shows that some people request assisted suicide because their suffering is caused by things 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, people at risk will receive assisted suicide instead of other interventions that address the root causes.
We need our government to invest in disability supports that defeat stigma and foster inclusion. We need palliative care. Without these, a person’s experience of disability could become a reason to die. That would harm us all.  

RISKS: What might happen if safeguards are not in place or if they are weak?

  • The root causes of suffering could go unidentified and unaddressed. Someone who’s suffering has been caused by other factors such as stigma or disability, receive assisted death instead of help.
  • Disability-related suffering will become a primary motivation for assisted suicide. This will worsen the stigma surrounding disability.

What the Supreme Court Said

  1. Canadians have a right to assisted suicide. But “stringent limits that are scrupulously monitored and enforced” are needed to safeguard vulnerable people from:
  2. being induced to commit suicide in a time of weakness;
  3. taking their own lives; and
  4. abuse and error in the health care system.
  5. It is Parliament’s duty to specify the needed safeguards.
  6. 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.                   
  7. 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.