Assisted dying has been legal in Canada for more than a year, with the assent of Bill C-14.
“These are conversations you folks will be having with your clients,” says Dr. Jeff Blackmer, vice-president of medical professionalism at the Canadian Medical Association, referring to end-of-life care and assisted dying. He spoke earlier this month at the Society of Trust and Estate Practitioners (STEP) National Conference. “It’s important for you to understand what’s available and what the clinical context is here in Canada.”
Requirements for approval
Blackmer explained that, to be approved for assisted dying, clients must:
- be Canadian residents;
- be at least age 18;
- be capable of making decisions both at the time of the request and at the time of intervention (Read: Request to die shouldn’t come from substitute decision maker);
- make a voluntary request;
- give informed, express consent; and
- have a grievous and irremediable condition.
“Grievous and irremediable” means that:
- the client has a serious and incurable illness, disease or disability in an advanced state of irreversible decline;
- the client experiences physical or psychological suffering; and
- natural death is reasonably foreseeable.
The last condition is most controversial, says Blackmer, and in some instances, physicians might disagree. That could be crucial, because clients are also required to have two assessments from two different physicians.
Further, requests must be made in writing and witnessed, and clients must wait 10 days between the request and intervention, unless “suffering terribly,” says Blackmer.
If clients change their minds, they can withdraw their requests.
Blackmer notes that the bill doesn’t address faith-based facilities. Many have opted out of assisted dying, he says, and no provinces have addressed these facilities through legislation.
In Quebec, every institution must offer end-of-life care, including assisted dying.
Statistics and what’s next
An interim report on the first six months of assisted dying in Canada (a few months longer in Quebec) reveals there have been 970 assisted deaths. The report finds the average age at assisted death is 72, and both men and women are equally represented by the numbers. About 60% of cases involve cancer, and 23% involve neurodegenerative diseases like Alzheimer’s. Overall, these deaths account for 0.6% of all deaths in Canada.
Only three deaths have been self-administered. “That’s not very surprising,” says Blackmer, “because people want the certainty of having a medical practitioner involved.”
Blackmer says federal data collection on assisted dying is in the works, which will help reveal things like who’s requesting assisted dying, who’s being denied and how disabled communities are being affected.
A federal study is underway to further assess three things not currently approved as part of assisted dying: advance directives, mental illness and mature minors. The report should be released at the end of next year, says Blackmer.