Standardizing a Bad Approach to Euthanasia
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When we talk about euthanasia and politics, we often focus on any new or proposed legislation to expand or reduce access to it. But there are other areas we keep an eye on which also affect Canada’s euthanasia regime, particularly regulatory change. These are changes made not by elected legislators but by government bureaucrats or cabinet ministers. And these regulatory changes impact the way euthanasia is provided on a practical, day-to-day basis. While these adjustments may technically fit within the law, regulations can have an outsized impact on the current system.
While the law around euthanasia is under federal jurisdiction, the provinces are the ones who carry it out in practice. For example, the Criminal Code lists the requirements a person must meet to be eligible for euthanasia. But medical professionals are given guidance on what those requirements look like from their provincial College of Physicians and Surgeons, which regulates the conduct of medical professionals within the province. Each province has published guidelines to help medical professionals deal with questions around euthanasia.
Over the past couple of years, some have argued that the concerns with Canada’s euthanasia regime will be alleviated by having clear, standardized guidelines for medical professionals to guide their response to a request for euthanasia. An Expert Panel Report published in 2022 recommended that “federal, provincial and territorial governments should facilitate the collaboration of physician and nurse regulatory bodies in the development of Standards of Practice for physicians and nurse practitioners for the assessment of MAiD requests in situations that raise questions about incurability, irreversibility, capacity, suicidality, and the impact of structural vulnerabilities.”
Based on this recommendation, the federal government tasked six people to create standards that provincial regulators can adopt. If enough provinces adopt these standards, there will be a consistent approach to providing euthanasia in Canada. The recommendations are explained in a new document titled “Model Practice Standard for Medical Assistance in Dying.” We want to point out a few particularly concerning recommendations where standardization would make a bad approach commonplace in Canada.
The group recommends that medical professionals who have a conscientious objection to providing euthanasia “must complete an effective [referral/transfer of care] for any person seeking to make a request, requesting, or eligible to receive MAID.” Currently, only Ontario and Nova Scotia explicitly require an effective referral, which means that a doctor must connect their patient to a doctor who will provide euthanasia. Other provinces currently have systems in place that more appropriately protect freedom of conscience for medical professionals. Expanding effective referral policies across the country will have detrimental effects on the healthcare system and on doctors’ consciences. You can read more about effective referral and ARPA Canada’s campaign to protect freedom of conscience in Ontario here.
A second concerning element of these guidelines is a recommendation that, if a medical professional believes a person may be eligible for euthanasia and has reason to believe that “MAID is consistent with the person’s values and goals of care,” they must advise the patient of the option of MAID even if it is not requested. Counselling a person to commit suicide is (and ought to be!) a crime in all circumstances and should extend to suggesting euthanasia as an option. Instead, the authors of the guideline document clarify that “Advising persons of potential eligibility for MAID is distinct from counselling persons to consider MAID.”
Whether or not euthanasia is consistent with a person’s values, no doctor (or anyone else for that matter) should ever suggest it to a patient. We have seen various stories in the media over the past couple of years where this did happen, such as when an employee of the Ministry of Veterans Affairs suggested euthanasia to four veterans. Proactive suggestions for MAiD devalue a person’s life and make them question whether it is worth living or if they are too much of a burden to their family or the healthcare system. At the same time, the guidelines recommend that medical professionals must not tell others (including the patient’s family and friends) about the request for or provision of euthanasia unless the patient gives consent to do so or if the doctor needs to clarify the patient’s values and goals of care. If implemented, these recommendations will contribute to dividing families and deteriorating existing safeguards.
Finally, the document does not recommend any additional regulations to protect those with mental illness. It simply states that the existing regulations will apply to those with mental illness when MAiD for mental illness becomes legal in 2024.
The guidelines do not adequately address the question of whether patients who request euthanasia are suicidal. The authors recommend ensuring that the euthanasia request is “rationally considered during a period of stability, and not during a period of crisis.” They also note that a medical professional must consider making a referral for suicide prevention supports if the patient is deemed ineligible for euthanasia and if the ineligibility increases the risk of suicide. But this is absurd. The request for euthanasia is a suicidal one. The guidelines are trying to strike a balance between suicide prevention and suicide assistance, but instead remind us that it is impossible to have both. It seems inevitable that a patient who is denied access to euthanasia will be at increased risk of suicide because they have already requested death. As one psychiatry professor states, “On the face of it, even if you look at what the word means, when somebody wants to die and they’re not dying, of course that means that they’re suicidal.” Euthanasia should never be an option for these patients in a country that claims to care about suicide prevention for the mentally ill.
What can you do?
These recommendations from Health Canada are not binding on individual provinces, but they do create some pressure for provinces to adopt a consistent approach with other Canadian jurisdictions. But what can you do when regulatory changes are introduced, since it is not elected law makers who are making these particular changes?
First, In the area of freedom of conscience, if you live in Ontario we ask you to participate in our campaign to protect conscience and improve healthcare in Ontario. If you live in another province, encourage your MLA or MNA to protect the freedom of conscience for doctors. Many of the talking points used in our Ontario campaign can also help you explain why you value freedom of conscience for your doctor.
Second, in relation to euthanasia and mental illness, continue to be involved in the Care Not Kill campaign. This is an important area where we can continue to push to protect vulnerable Canadians. While some politicians will talk about the need for safeguards, it is increasingly evident that safeguards will not protect the vulnerable. We need a full stop to expansion.