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The medical assistance to die decriminalized

ministre-federale-sante-jane-philpott(Quebec) The deadline of 6 June imposed by the Supreme Court reached. Starting today, the terminally ill whose suffering is “persistent and intolerable” can claim medical help to die without doctors to help them end their days are prosecuted. Meanwhile, debate continues in the Senate, where it wants amendments to Bill C-14, considered too “restrictive”. In Quebec, the Act on end of life care applies. And it is even less permissive. Decryption.

C-14 and stop Carter

Bill C-14 to amend the Criminal Code and to make related amendments to other Acts (physician assisted dying) aims above all, as the title indicates, to amend the Criminal Code. It was written after the Supreme Court, in Carter, had struck down section 241 of the Code which criminalizes medical help to die and Article 14 which prohibits the consent to death. According to the highest court in the country, the ban on assisted suicide violates the rights of patients with health problems “serious and irreversible” causing their suffering “persistent and intolerable.” The Carter decision allows these patients to use medical help to die without necessarily the end of life. The federal government had the responsibility to establish clear rules specifying in particular the circumstances in which the medical staff is authorized to give death to a patient. This however is the provinces that are responsible for the implementation of the practice. They are thus free to decide how far they go inside C-14.

Who is entitled to medical assistance to die, according to C-14?

Anyone competent adult suffering from a disease, disorder or a severe disability who is in a state of advanced and irreversible decline and undergoing unbearable suffering is eligible for medical help to die. Death, however, must be “reasonably foreseeable”, that is to say, we must consider all the circumstances surrounding the health of the sufferer (age, frailty and interaction of several medical conditions can put his life in danger, for example). If the text was written and is “to allow all those who suffer while they are in a state of decline leading them towards the end of life to have the option to choose a medically assisted death” says the federal Department of Justice in its website.

And the Quebec law?

Quebec, which already has a law on end of life care, does not intend to go as far as permitted by federal legislation. According to the Minister of Health, Gaétan Barrette, the wording of death “reasonably foreseeable” is “medically impractical.” “I personally am not inclined to governmental and professional reasons, to take the road C-14 based on the element that is the worst of all C-14, which is reasonably foreseeable natural death,” said -he last week. According to him, “go in the direction of C-14 to physicians and staff who would be involved in that, I think you enter a field that is somewhat undermined my taste.” Overall, the Quebec law on end of life care provides that a person suffering from an incurable disease and of exceptional suffering may request medical help to die, provided it is the end of life. “Our intentions are to the effect of not changing our law initially [except perhaps some minor elements] and start thinking about how far we could go,” especially with respect to people disabilities, said last week the Minister Barrette, saying he would wait 6 June (the date that the Supreme Court has imposed in Ottawa to legislate) before determining how to proceed with regard to the harmonization of Quebec law with the new federal framework.

After June 6

Although Bill C-14 has not yet been adopted, the Carter applies after midnight June 6, allowing Canadians to avail medical help to die without that doctors do subject to criminal prosecution. Adopted after much wrangling Tuesday night, the bill is in the Senate since Thursday. Senators expect to need two weeks to complete their work and propose amendments. According to them, C-14 is too restrictive and discriminates against people who are in intolerable suffering but not in terminal phase of their illness. Several constitutional experts also believe that the notions of “advanced and irreversible decline of capacity” and “reasonably foreseeable death” are too strict and that they are contrary to the spirit of the Supreme Court. Still, once the amendments to the bill, it must return to the House of Commons, which will decide whether it retains or rejects the changes made by the Senate. If they are rejected, the Senate will have to decide whether it remains on its position or if it bends to the will of Parliament. The bill could also be transmitted directly to the Supreme Court for approval. Fearing the “legal vacuum”, the Trudeau government urged senators to act quickly to protect health workers and vulnerable people. On Monday, the Health Minister, Jane Philpott, was of the opinion that laws and provincial regulations on medical assistance to die did not provide sufficient clarity and protection to physicians subject to these requests. The Canadian Medical Association also feared that in the absence of federal legislative framework, doctors do not want to practice medical help to die. Also she advises physicians to counsel before asking the act. For senators, the importance of “legal vacuum” is relative insofar colleges of physicians protocols.

Quebec law applies

In Quebec, where the law on end of life care is already applied, the Minister of Health advises doctors to opt for caution and evaluate their actions according to Quebec law to avoid problems legal in nature. For its part, the College of Physicians invites its members to seek legal advice if they decide within the scope of provincial law.

Other debates to come to Ottawa …

For now, the federal bill closes the door for medical help to die to minors and those with psychiatric illnesses, nor does it allow the prior consent. Ottawa is nevertheless committed to address these issues 180 days after the adoption of the law. In Quebec, the Minister Barrette was of the opinion that Quebecers were not ready to open medical assistance to minors.

… And in Quebec

If Bill C-14 is expanded to include patients who experience persistent and unbearable suffering without suffering from a terminal illness, what do we do in Quebec, where the law limits medical help to die for end-of-life? For now, “the Quebec law applies regardless, and we will have a discussion in Quebec to whether we want to go as far” that the federal bill that will be adopted on Monday reiterated the Press Secretary Minister Barrette, Julie White.

Patients before a cruel choice?
At the precise day enter into force on the Carter decision aid in dying, some fear that patients with an incurable disease without being terminally ill are faced with a cruel choice.

Some patients might have to decide to die now – even if they do not feel ready yet – or risk not being able to do it later because of the adoption of C-14 and its very restrictive eligibility criteria .

During a press conference Monday in BC, family Kay Carter – this woman with spinal stenosis whose case went to the Supreme Court of Canada (SCC) – confided that she felt “betrayed” by the Justin Trudeau government.

With Bill C-14, the family believes that Ms. Carter could not get medical help to die because his illness, although qu’irrémédiable do not predict a natural death in the short term. But the “dead reasonably foreseeable” is one of the eligibility criteria of the Liberal bill.

C-14 was passed in the Commons and is currently before the Senate. Meanwhile, the deadline imposed by the CSC to the federal government to amend the Criminal Code was to expire Monday. Patients who wish to seek medical help to end their days can therefore, thanks to the decision of the highest court of the country, make a request to their doctor.

“Today we celebrate the fact that Canadian law now allow Canadians a death in dignity and peace. But I feel betrayed: the Liberal government drafted Bill C-14 so restrictively that my own mother would not have been right, “lamented Lee Carter, daughter of Kay, who brought the case to after arm for years.

Alongside relatives of Ms. Carter, Grace Pastine, litigation director of the Civil Liberties Association in British Columbia expressed concern that some patients are rushed in their decision wanting to seize this window of opportunity.

“A patient can now qualify under the SCC decision, but in a month or two, do not qualify under C-14,” she raised.

These patients have to wonder if they want assistance to die quickly – before the entry into force of C-14 – or wait at the risk of no longer be eligible later.

“Someone will ask:” Should I try medical help to die now, before it is ready to go, while life still has meaning for me, or should I wait and possibly be sentenced to die a cruel death? ‘ “she illustrated.

She said the stark choice is the direct result of the bill, more restrictive than the Carter judgment.

Call Senators

Million children myself Carter urging the Senate to pass amendments to the Liberal bill to broaden its scope.

“C-14 is not a good first step. This is a wrong, “insisted his son Price.

Several senators have already expressed their desire to see the bill amended. They continued their study Monday bill and heard different views of experts.

The Constitutionalist Peter Hogg argued that the SCC decision “does not restrict the class of persons entitled ‘to medical assistance to die and that the Liberal bill and against the spirit of the judgment.

Monday, the Prime Minister reiterated that he was open to suggestions from senators.

“We always said that we were open to all kinds of input from many Canadians. We did that in the House of Commons. It accepted amendments committees and other opposition parties, and we will look at what the Senate has to say, “assured Justin Trudeau. With The Canadian Press

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