In recent blog posts, we examined the current state and future of medical assistance in dying in Canada. Please see our earlier posts for further background and resources on this topic: Medically-Assisted Dying – Where are we, and where are we going? and Medical Assistance in Dying – The Deadline has Passed, Now What?.
Since our last post, the proposed federal legislation on this topic, Bill C-14 (An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)) has received Royal Assent and is now largely in force. A final version of Bill C-14 that received Royal Assent can be viewed here. As such, the majority of Bill C-14’s amendments to the Criminal Code are now law and govern the medical assistance in dying process.
Some of the key highlights of the new law for medical assistance in dying in Canada include:
- Criminal Code Exemptions for Medical Assistance in Dying: Certain medical professionals, including physicians and nurse practitioners, those who assist them (including pharmacists), and other persons or professionals who assist or provide information regarding medical assistance in dying are exempt from relevant Criminal Code offences provided that all of the prescribed conditions are met.
- Types of Medical Assistance in Dying: There are two types of medical assistance in dying available in Canada, including where a physician or nurse practitioner directly administers a substance to a person, at their request, that causes their death (voluntary euthanasia), or gives or prescribes a drug to a person, at their request, that they may self-administer to cause their own death (medically-assisted suicide).
- Eligibility Criteria: In order to be eligible for medical assistance in dying, the applicable individual must:
- be eligible for government-funded health services in Canada;
- be at least 18 years of age and have capacity to make health-related decisions;
- have a grievous and irremediable medical condition;
- make a voluntary request for medical assistance in dying that was not the result of external pressure; and
- give informed consent to receive such assistance after receiving information of the means that are available to relieve their suffering, including palliative care.
- Grievous and Irremediable Medical Condition: Individuals are considered to have a grievous and irremediable medical condition only if:
- they have a serious and incurable illness, disease or disability;
- they are in an advanced state of irreversible decline in capability;
- they are caused enduring physical or psychological suffering that is intolerable and which cannot be relieved under conditions that they consider acceptable; and
- their natural death has become reasonably foreseeable taking into account all of their medical circumstances.
- Safeguards: Before a physician or nurse practitioner can provide medical assistance in dying they must:
- be of the opinion that all eligibility criteria are met;
- ensure that the individual’s request for medical assistance in dying was written, signed, dated and independently witnessed after the individual was informed that he or she has a grievous and irremediable medical condition;
- ensure that a second, independent physician and/or nurse practitioner has provided a written opinion confirming that all eligibility criteria are met;
- subject to limited exceptions, ensure that there is a minimum of 10 clear days between the date of the request and the date on which medical assistance in dying is provided;
- ensure that the individual has been informed of their ability to withdraw their request at any time;
- give the individual the opportunity to withdraw their request and ensure the individual gives express consent to receive medical assistance in dying, immediately prior to providing the medical assistance in dying; and
- take all necessary measures, if the person has difficulty communicating, to ensure the person understands the information provided to them and can communicate their decision.
- Criminal offences: Criminal offences exist for failing to comply with the required safeguards, forging or destroying documents, or interfering with the rights and obligations created by Bill C-14.
- Information Requirements: Medical professionals involved in medical assistance in dying are required to provide prescribed information to designated recipients. Bill C-14 contemplates that the requirements for such monitoring and reporting on the use of medical assistance in dying will be outlined in regulations enacted pursuant to the Criminal Code. Bill C-14 also contemplates that there will be criminal offences for failing to comply with these requirements. As of the date of this post, the provisions of Bill C-14 pertaining to these information requirements and related regulations and offences are not yet in force.
- Further Examinations and Review: The federal government is required to initiate independent review(s) of certain issues not addressed by Bill C-14 within 6 months of Bill C-14 becoming law, including questions relating to requests by mature minors, individuals who suffer from mental illness only, and advance requests for medical assistance in dying (which issues may be considered in future reviews of the legislation). The federal government will have 2 years from the date the review(s) are initiated to report on their findings and recommendations. Further, a parliamentary review of Bill C-14 is required to be initiated within five years of Bill C-14 becoming law.
You can find more detailed information about medical assistance in dying, including the request process, the eligibility criteria, information for health professionals, as well as various other helpful resources at the Government of Canada’s website on the topic here.
In closing, we note that since Bill C-14 became law earlier this month, there have already been reports of at least one legal challenge to the constitutionality of Bill C-14. We will continue to watch with interest as this new area of law develops.