Françoise Hébert, Ph.D. Board of Directors. Woody Allen said “I’m not afraid of dying. I just...

Françoise Hébert, Ph.D.Board of Directors

Woody Allen said

“I’m not afraid of dying. I just don’t want to be there when it happens…”

Canadians Die• About 260,000 Canadians die every year• Most deaths for men at age 85, women age 89• Cancer, heart, complex chronic conditions• Process of dying can be long• 90% want to die at home, not alone• 70% die in hospital, often in ICU• 50% in long-term care die there

A Good Death

• Adequate pain and symptom control• No unnecessary prolongation of dying• A sense of individual control• Wishes of patient and family respected • No untoward burden on others

Personal Rights Now

• Advance care directive recognized • Substitute decision maker recognized• Pain and symptoms management• Can refuse or discontinue treatment• Can refuse food and drink (VSED)• Can commit suicide ( 1972 )

Palliative Care• Team approach to enhance quality

of dying, for patients and families• No life-prolonging interventions• Allows natural death• Access varies widely across Canada

• Palliative sedation allowed

Assisted DyingA small number (?) suffering greatly beg for help to die gently, not alone, at a time of their choosing.

Assisted suicide Voluntary euthanasia

Canadian Law Today[ until February 6, 2016 ]

Criminal Code Section 241

“Everyone who counsels, aids or abets a person to commit suicide is guilty of an indictable offence and liable to imprisonment for a term not exceeding 14 years.”

CARTER CASESUPREME COURT OF CANADA

October 2014

Allow assisted death because

1. Current law causes some to suffer needlessly

2. Current law causes some to end their life sooner than they wish

Canadian Government Opposed

• Allowing assisted death for a small number suffering intolerably devalues all respect for life

• There may be unwarranted deaths of vulnerable people (including women, seniors and disabled people)

Opponents Say

• Palliative care is sufficient• Slippery slope → vulnerable individuals may

feel pressured to die• Mental health problems / depression• Selfish modern society → devalues life• Religious or moral objections

Carter Decision - February 6, 2015

• Current law infringes the right to life, liberty and security of the person (Charter s. 7), so current law is unconstitutional

• New constitutional right created: Physician-assisted dying (PAD)

Physician-Assisted Dying (PAD)Constitutional Parameters

Competent adult who clearly consents to termination of life and has a grievous irremediable medical condition (illness, disease or disability) that causes enduring suffering intolerable to the individual in the circumstances of his or her condition.Right to object must be accommodated.

Timing of PAD• One-year suspension for Parliament

and provincial legislatures to enact legislation consistent with The Court’s constitutional parameters, if they wish

• If no legislation by February 6, 2016, PAD is a constitutional right anyway

Jurisdictions That Allow PAD

Switzerland 1937 (self-administered)Netherlands, Belgium 2002 Luxembourg 2009USA (self-administered)

Oregon 1997Washington State 2008Vermont 2013

Québec → Dec 2015? Canada Feb 2016?

Québec End-of-Life Care Act

• Passed June 2014, implementation proceeding• Medical aid to die reframed as a health issue,

provincial jurisdiction• Strong continuum of end-of-life care, including

right to palliative care & medical aid to die• Québec will not prosecute those who meet

conditions laid out in this act

Québec - All criteria must be met

Covered by Québec Health Insurance Act

Full age (18), capable of giving informed consent

At the end of life – terminal (undefined in the Act)

Suffering from a serious incurable illness

In an advanced state of irreversible decline in capability Constant unbearable physical or psychological pain which

cannot be relieved in a manner the patient deems tolerableCon’t …

Québec – Physician Responsibility

• Ensure patient meets all criteria• Ensure request is informed and options known• Discuss request with care team and family• Ensure patient can discuss with family• Verification by a second independent physician• Physician must administer medical aid to die• Physician must stay with patient until death

ensues• Physician must file required paperwork

Challenges for Rest of Canada

1. Who will regulate? When?

2. Patients must not be abandoned: Safeguards must not create barriers Doctors who object must refer Institutions must allow PAD on site

We Believe…• Palliative care should be accessible to all• Competent adults should have the right to

make their own end-of-life decisions• PAD, with clear access criteria and appropriate

safeguards, should be available across Canada on Feb 6, 2016