It’s not often one can say the world’s eyes should be riveted on Canada. But on February 26 our sensible neighbor is poised to dramatically expand medical suicide when it enacts a law allowing people with disabilities to kill themselves with the help of a doctor or nurse practitioner. Canada will join the ranks of Belgium and the Netherlands as a leader in death on demand.
Canada’s Parliament, because of a court decision, is now debating a law to broaden medical-aid-in dying rights beyond the terminally ill. The proposed law, called Bill C-7, will also permit euthanasia; that means a lethal injection to unconscious patients who agree ahead of time. Parliament is even considering circling back in 18 months to consider whether mental illness alone is sufficient cause for assisted suicide.
While the expansion of such laws has been well known in Europe, this new example North America hits closer to home as similar advocacy groups promote assisted suicide in the United States.
Bill C-7 bears watching by Americans because laws permitting physician-assisted suicide, or PAS are already on the books. While our laws are limited to patients with a terminal illness, that’s how Canada started out too, and not very long ago. PAS supporters tend to scoff at the “slippery slope” argument. Trends here as well as Canada show that the right-to-die movement is accelerating in North America.
Early on, U.S. advocates struggled through referenda and lawsuits, gaining three PAS laws in the years between 1994 to 2008. Recently the movement’s had rapid success, gaining laws in six jurisdictions over a three-year period. Death with Dignity, an Oregon nonprofit based in Oregon with many other state chapters that promote such laws, was part of the efforts that helped to shape the legislation. A group with a similar purpose, Dying with Dignity, is now a presence in Canada.
Doctors and disability rights activists have raised a hue and cry against the new law. Psychiatrist John Maher, for example, testified before Canadian Parliament, that the law hasn’t been enacted yet but is already impacting his practice. Aware that a medical suicide law is coming, his patients say: “Why try to recover?”
The U.N. is also concerned and rattled by the proposed law. Gerard Quinn, U.N. Special Rapporteur on the Rights of Persons with Disabilities, testified before the Canadian senate of his concern that Bill C-7 will send a message to society that disabled life is unworthy and will result in pressure on disabled people to choose death rather than burden the healthcare system.
How did Canada’s slippery slope get so slick? In 1993 Sue Rodriguez, a 42-year old woman with Lou Gehrig’s disease sued to have part of the criminal code struck down to clear the way for assisted suicide, but the courts ruled against her case. But, in 2015 the Supreme Court of Canada held in Carter v Canada that Canadians whose deaths were “reasonably foreseeable” had a right to assisted suicide, overturning the Rodriguez decision. Parliament and the provinces in response to Carter then enacted PAS laws a year later with safeguards similar to those of other countries.
The ink had barely dried on Canada’s federal PAS law when Jean Truchon, who had cerebral palsy, sued to expand the law to include disabled people who are not dying. Truchon’s case was decided by a Quebec provincial court in September 2019. The Attorneys General of Canada and Quebec chose not to appeal the decision even though it declared a federal law unconstitutional. Speaking from the campaign trail, Liberal leader Justin Trudeau pledged to “improve Canada’s medical assistance in dying legislation.” Parliament now has to pick up the pieces with a court deadline to amend the national law by February 26.
Like many disabled people in Canada, Mr. Truchon lived in a nursing home. He had an active life during the court case, according to a statement he made before he died in April. Mr. Truchon, then 51, made the decision to end his life because of the sudden isolation engendered by the coronavirus pandemic.
“Before this pandemic, I had all the difficulties in the world, keeping my head above water with all my activities,” Truchon said the statement. “The coronavirus has literally stolen my time with those I love. Therefore, I made the decision to leave now and this was well thought-out,” he said. Truchon killed himself with medical help because he was lonely. No one in Canada should be proud of that.
There are many more like Mr. Truchon facing long-term stays in nursing homes for whom Bill C-7 will make suicide available. According to the Ministry of Health and Long Term Care, six percent of the 90,000 people in Ontario’s nursing homes last year were under the age of 65. Many were younger. Trudo Lemmens, Scholl Chair in Health Law and Policy at the University of Toronto, Faculty of Law, expressed concern on CBC radio that Bill C-7 “is transforming a procedure that is intended to facilitate the dying process into some form of therapy for suffering, but only for people with chronic illness, people with disability.” By applying the law to the disabled in manner, Professor Lemmens cautions, we set them apart as “less worthy of living.”
As Bill C-7 broadens who may die, it also will quicken the pace by weakening safeguards. The bill gets rid of the reflection time between request and death, and reduces witnesses from two to one and allows a weaker 90-day assessment period, which may be shortened. Professor Lemmens says even ninety days is “too short for people with complex disabilities” to be thoroughly evaluated. While the law says patients are to be advised of “the means” to relieve their suffering such as palliative care and support services, the law doesn’t mandate or fund them. The bill under consideration would also allow persons diagnosed with dementia to request “advance consent” to participate in the assisted suicide protocols in the future, even after they cease to be mentally competent. This, in effect, is euthanasia. Mental competence has long been a litmus test to qualify for assisted suicide.
Very sick patients are often depressed, as are the disabled who are isolated. Consider Mr. Truchon’s final days. Therapy could help, but wait time to see a psychiatrist can take years in rural Canada, according to Dr. Ramona Coelho. She is the co-lead author and supporting signatory to the statement of Physicians Together With Vulnerable Canadians, which has been signed by 1,267 Canadian doctors opposing Bill C-7. Coelho, whose practice focuses on poor and refugee populations, is concerned that disabled persons lacking resources and agency will be pressured by their own caregivers to do medical suicide.
Bill C-7 shocks not only by its content, but the alacrity of its arrival just four years after assisted suicide was introduced into Canadian culture. For those watching this acceleration of radical judicial creep in real-time, it’s a spectacle that augers ill not only for our northern neighbor but the U.S., where the assisted suicide movement shows no signs of slowing down.
Update: Last night, the Trudeau government agreed with the Canadian Senate proposal to permit people suffering solely from mental illness to access assisted suicide, a policy that will begin in two years.