Carolyn Bennett April 30th, 2015

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Necessary conversations for better end-of-life policies

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On Feb. 6 the unanimous Supreme Court of Canada ruling extended the “sanctity of life” provision in the Charter of Rights and Freedoms to the “passage into death.” The court maintained the Criminal Code’s prohibitions on assisted suicide, but decided that they no longer apply “to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

This is huge. As Sean Fine reported in the Globe and Mail, “the court decision puts Canada in the company of a small group of countries such as Belgium — and U.S. states Washington and Oregon — that permit doctor-assisted death. And it gives the Conservative government difficult choices as it heads toward an election expected in the fall.”

On Feb. 24 Liberal leader Justin Trudeau tabled a motion to create a special parliamentary committee “to consider the ruling of the Supreme Court; that the committee consult with experts and with Canadians, and make recommendations for a legislative framework that will respect the Constitution, the Charter of Rights and Freedoms, and the priorities of Canadians.”

He explained that “Canadians expect parliamentarians to take a leadership role on this issue and engage with it in an informed and respectful way.”

Unfortunately, the Conservative members voted against the motion. The committee wasn’t struck. With the certainty of an election this year, there is very limited time for parliamentarians to deliver on the ruling of the Supreme Court.

All across Canada I’ve heard huge concerns that the ruling is supposed to provide choice, but until Canada has a commitment to quality end-of-life and palliative care, and a serious pan-Canadian pain strategy, choice really isn’t there.

We certainly know that safeguards have to be in place. The Council of Canadians with Disabilities and the Canadian Association for Community Living expressed their concerns in a joint statement on the need to protect the vulnerable because they worry that the ruling could be interpreted that “all persons with a serious disability in Canada can access assisted suicide.”

We know there are power differentials. Many times as a family doctor I would have to argue with family members who had descended on a vulnerable senior and then tried to persuade me that the patient “has suffered enough.”

As MP Irwin Cotler has said so often, our society is judged by how we look after the most vulnerable in our society. We cannot let them down.

We need everybody to read Willie Molloy’s book Let Me Decide. We need to get on with recommendations of the Canadian Society of Palliative Care Physicians. There are some clear protective targets we could use. Ontario has an objective in which 70 percent of people over 70 would have an advance directive describing their end-of-life wishes.

There is no question that too many are suffering at the end. Too few die peacefully and with dignity. We will not get this right without listening to Canadians. This is about compassion, ethics and our values.

In St. Paul’s we will begin the conversation at 2 p.m. on Sunday, May 24 at Christie Gardens, 600 Melita Cres. Please join us. Expertise and lived experience matters.