POLICY PAPER POLS3300

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M. Reddon POLS3300 LEGISinfo Policy Paper Medical Assisted Suicide

2 1. Identifying Information I. Full Title of Bill: C-7: An Act to amend the Criminal Code (Medical assistance in dying) II. 43rd Parliament, 2nd Session III. Sponsor: The Honourable David Lametti, Minister of Justice, Liberal Party of Canada IV. Introduced: October 5th, 2020 V. Received Royal Assent: March 17th, 2021 2. Summary of The Bill The topic of medical assisted dying (MAID) has been an important and popular debate among Canadians in recent years both socially and legally. Bill C-7 is an act to ammend the previous criminal code (Medical Assistance in Dying,) and Quebec’s Act (respecting end - of - life care) to broaden the scope of the policy. It was argued that the previous provisions in the above mentioned acts were contrary to the Canadian Charter of Rights and Freedoms, especially section 7 (life, liberty and securiy of the person.) Further, bill C-7 is an amended version of bill C-14 from 2016, and it outlines a difference between patients whose deaths are “reasonably forseeable” and those whose are not (Crooks, 2009. ) Another major ammendment is that bill C-7 requires one independent signing witness (rather than two) to qualify someone for MAID. The purpose of bill C-7 is to amend the previous versions of MAID policies by establishing a set of protection for people who’s deaths are not “reasonably forseeable,” and making adjustments to safeguards for those in which natural death is forseeable (Parliament of Canada, n.d.) . The bill also distinguishes mental health as a factor in decisions regarding MAID and the rules governing medical assisted death for those suffering from things such as depression. This bill relates to, and expands upon, the case of Carter V. Canada (Attorney

3 General.) In this case, the supreme court declared that sections 241(b) and 14 of the Criminal Code , (which precluded people from seeking assistance in terminating their life) infringed upon the right to life, liberty and security of the person for those who seeked such help (Parliament of Canada, n.d.) 3. Opposition and Support for the bill The conservative party opposed this bill, stating it was a complex issue that did not benefit from a “rushed legislation (House of Commons, 2023.)” Conservatice speaker, Michael Cooper (St. Albert, Edmonton) spoke in opposition claiming that pre-existing bill C-14 was carefully reviewed, and protected both the sanctity of life and vulnerable persons. However, he believed the provisions of bill C-7, such as allowing for MAID in circumstances where a terminal illness is absent (reasonably foreseeable death) would put vulnerable people at risk. Mr. Garnett Genuis (Fort Saskatchewan, CPC) debated that medical professionals were obligated to provide ‘euthanasia,’ and that the ten day reflection period was necessary. This was refuted by David Lametti, stating the conservatives’ idea as a “mischaracterization (House of Commons, 2023.)” A primary concern was that people suffering from mental health issues and disabilities would not be protected under the law. Michael Cooper shared a letter from an advocacy group of disabled Canadians which stated “ the legislation could arguably contravene article 10 of the UN Convention on the Rights of Persons with Disabilities, which provides that persons with disabilities should be treated equally under the law (House of Commons, 2023.)” The conservative speaker, Mr. Cooper denied the claim that this opposition was consistent with many conservative members’ religious beliefs, after the Bloc Quebecois speaker submitted that both the BQ and NDP were in favour of the bill. While many conservative

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4 speakers opposed the bill in the debate due to a supposed lack of safeguards present within it, their speeches were not significant enough to hinder its enactment, and the bill was later passed. Interest Group and Individual Witness Participation One testimony that stood out was that of Alain Naud, a family physician in Quebec who was an expert in the Truchon case. Dr. Naud was understanding yet honest, and proved to have adequate experieince to speak on the issue. Dr. Naud has carried out medically assisted deaths, and is not opposed to them in the right context. However, he suggested changes, such as proper medical terminology, and framework for care and policy involving patients with dementia and other conditions not specified. Then there is the president of Dr. Georges L’esperance, speaking for Dying with Dignity Canada. He also testified that the bill needed more medically specific and accurate phrasing, but argues for the morality of the bill as well. He spoke about the reflection period, saying “ That so- called period of reflection is an insult to our patients' intelligence and suffering.” L’esperance asserted that patients with disabilities are aware of their conditions, and these decisions are not acted on upon impulse (House of Commons, 2023.) Finally, Dr. Ann Collins spoke for the Canadian Medical Association. In agreeance with the other witnesses, Dr. Collins suggested a re-work of language and terminology as well as the expansion of data collection to further understand MAID. She supports consent that can be given before a patient loses the mental capacity to decide, and suggests the existing language in the bill had the potential to be stigmatizing of mental illness. She stated that it is not common that mental illness is an isolated event that leads a person to seek MAID, but an effect of other conditions. For this reason, excluding mental illness from the bill entirely is a mistake. Collins finished her

5 initial speech by stating: “The pursuit of a painless and dignified end of life is a noble one. The assurance that the providers of this privilege are supported is an ethical imperative (House of Commons, 2023.)” Assessment and analysis One thing about asessing a bill that has been passed, is that there is actual data available to be used in analyzing whether the fears of the opposition have been realized or not. In Beyond Policy Analysis, it is suggested that true empirical evidence is found by looking at actual events of policies, not what “might be the likely effect (Beyond Policy Analysis, 2006.)” For example, one oppositional argument was that removing the ten day waiting period would be a grave mistake because people would change their minds about their wishes. Theoretically, if these people were granted their wishes during a “vulnerable point” as discussed in the parliamentary debate ( House of Commons, 2023) it would be too late. However, these statistics from 2019- 2021 can offer two things of value. Firstly, the percentage of people who died of natural causes less than ten days after submitting a request for MAID average at 56.1%. 23.9% died of other causes within 11-30 days of their request (Health Canada, 2021.) These figures show that a large number of people will only request MAID intervention if there is a high likelihood of their natural death. The only difference is, if MAID had been granted, their deaths could have potentially been more peaceful and dignified. The other survey that is helpful in rebuting the conservative argument that the bill would take advantage of those suffering with disabilities and mental illness, but the data show this is not the case. 65.8% of those who received MAID care suffered from cancer (In Dr. L’esperance’s testimony he suggested the number was 76% in Quebec that year), 18.7% with cardiovascular issues, and 12.4% with neurological issues (which does not necessarily mean mental illness, but includes it) (Health Canada, 2021.) 12.7% is still a

6 large number of people, but both Mr. Lametti’s speech and an article in a date science journal suggest the median is not the way to decide on public policy. There is no way to support every individual of the public, and so our justice policies need to focus on the mean averageI believe the oppositional government used the vulnerable population as a scapegoat to further their agenda in opposing the bill, when this population is the outlier and not the majority. In another analysis of the aforementioned article, the cruciality of acknowledging the fact that emotions and personal values lie within our perception of ‘facts’ is shown. In Hawkesworth (1988) it is suggested that critics “point out that facts are always constructed through values and perceptions.. Through deep theories that structure our cognition of reality.” (Hawkesworth, 1988.) The conservative opposition were offended that the liberal sponsor suggested a religious prerogative was in the way, but the truth is this is a complex moral dilemma, and it is important to accept that while policy can try to be impartial, values and beliefs will always be a factor. It is also imperative to acknowledge that people are almost always capable of ending their own lives. Similar to arguments about abortion, creating policy or allowing freedom in medical care allows for more safety for everyone, because rejecting bill C-7 would not stop suicide in people suffering from illness, but force them to do it on their own and without dignity. With great compassion for the arguments concerning mental illness and the sanctity of life, it is important to be mindful of the purpose of section 7 in the Charter and not take it as a suggestion that the value of citizens’ lives should be up to anyone but themselves. This is detailed in a CBC story about Jeanette Lodoen, a woman who received MAID. In the article, Jeanette says “I’ve had a long life. I’m 87 years old. I’ve had a wonderful family who support me and I love dearly forever,” she said. “It was such a release to know that I didn’t have to suffer anymore, and that it was OK

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7 to go. (CBC News, n.d.)” Because of this, I think a more liberal standpoint on law is always the best route to take, granted it does not infringe on another citizens right. Bill C-7 would not force anybody to get medically assisted death if they did not want it, and while the safeguards are minimal, they exist to a point where a reasonable person, with input from family and medical professionals, can make a rational decision. In answering the question, would I be in favour of passing this bill, the short answer is yes. However, I agree with witnesses like Dr. Naud, and a little bit with Mr. Cooper, that there is no need for this bill to have been passed so quickly. I believe is important that there be an interconnectedness between the goal of the law and the law itself- that is, a law concerning healthcare needs to have considered the scientific background of the case and not only the moral background. It seems like, although I am in support, the bill did miss a few key factors. With that being said, the fluidity of policy-making in Canada allows for evaluation and ammelioration, which is why I would have voted for the bill in support of individual autonomy, with the knowledge that remedy would be available in the ‘policy evaluation’ stage if proven necessary. Citations: Beyond policy analysis: public issue managementin turbulent times, Pal, Leslie Alexander, p. 11, 14-25, Thomson/Nelson, 2006. (Ares) Wrathall, M. Unit 2: Public Policy and the Policymaking Process, Courselink, 2023. CBC News - "A Good Death: The Right to Die with Dignity" https://www.cbc.ca/newsinteractives/features/a-good-death-maid Towards Data Science - "Mean or Median: Choose Based on the Decision, Not the Distribution"

8 https://towardsdatascience.com/mean-or-median-choose-based-on-the-decision-not-the- distribution-f951215c1376 Government of Canada - Health Canada - "Annual Report on Medical Assistance in Dying 2021" https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual- report-medical-assistance-dying-2021.html#a4.1 House of Commons - "Hansard of the 43rd Parliament, 2nd Session, Sitting 21" https://www.ourcommons.ca/DocumentViewer/en/43-2/house/sitting-21/hansard House of Commons - "Evidence from the 43rd Parliament, 2nd Session, Standing Committee on Justice and Human Rights, Meeting 5" https://www.ourcommons.ca/DocumentViewer/en/43- 2/JUST/meeting-5/evidence House of Commons - "Evidence from the 43rd Parliament, 2nd Session, Standing Committee on Justice and Human Rights, Meeting 4" https://www.ourcommons.ca/DocumentViewer/en/43- 2/JUST/meeting-4/evidence House of Commons - "Hansard of the 43rd Parliament, 2nd Session, Sitting 13" https://www.ourcommons.ca/DocumentViewer/en/43-2/house/sitting-13/hansard#10947272 Parliament of Canada - "British Columbia (Attorney General)" https://lop.parl.ca/sites/PublicWebsite/default/en_CA/ResearchPublications/201943E#:~:text=Bri tish%20Columbia%20(Attorney%20General). Parliament of Canada - "Charter of Rights and Freedoms" https://lop.parl.ca/sites/PublicWebsite/default/en_CA/ResearchPublications/LegislativeSummarie s/432C7E

9 BMC Health Services Research - "The Process and Impact of Developing a Local Palliative Care Data Infrastructure for Integrated Health Services: A Case Study in British Columbia, Canada" https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-07222-5

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