Some hopeful that more end-of-life options will become available, but others worry how government will interpret the ruling

On Feb. 6, the Supreme Court of Canada ruled that the country’s Criminal Code is in conflict with the right of a competent, consenting adult facing terminal illness, to ask doctors to assist in their planned death.

Section 14 of the Criminal Code states that a person cannot consent to have death inflicted upon him or her. Section 241(b) states that everyone who aids or abets a person to commit suicide is guilty of an indictable offense.

In 1993, the Supreme Court ruled that section 241(b) of the criminal code was constitutional, and denied Sue Rodriguez, who suffered from ALS, access to doctor-assisted death.

But the contradiction between the Criminal Code and section seven of the Canadian Charter of Rights and Freedoms, which guarantees a citizen’s right to life, liberty and security, has to be reconciled, the Justices’ ruled.

Doctor-assisted death was legalised in Quebec in 2014 when the province created legislation that bypassed the Criminal Code.

The Supreme Court has given the federal government 12 months to review, and then adapt, current laws governing end of life options. The ruling specifies that only a competent adult person, who clearly consents to the termination of life and has a grievous and untreatable medical condition that causes intolerable suffering, can have access to a doctor-assisted death. These medical conditions can include general illnesses, specific diseases or disabilities.

Family Members

Judy Hunt’s mother became incurably ill in 2010. She was mentally competent but physically frail.

“We all hope for a quick, easy, and gracious exit,” said Hunt. “But that seems to be the rarity, not the norm.”In New Mexico, in January 2014, the court ruled that patients have a constitutional right to access doctor-assisted death. However, there are no laws addressing the issue. Similarly, in Montana in 2009, the court ruled that doctors are protected if they assist in death, but there is no legislation addressing a patient’s right to access.

Infographic by Jocelyn Doll

Hunt’s mother did not want doctors to take measures to prolong her life. Patients have the right to deny medical procedures to extend their lives, but in the end, Hunt’s mother became immobile and totally dependent on others to look after her basic needs.

“Being a really independent woman all her life,” Hunt explained, “this just crushed her pride and spirit to the point where she begged for help to end her life.”

But, under current law in Alberta, it is illegal for a physician, or anyone, to assist in the death of a patient. Hunt said that because her mother felt like she didn’t have any other options, she refused to eat and drink for days on end, and ended up starving to death.

“Having watched a loved one resort to the option of starving herself to death,” Hunt said, “It is a choice that I wouldn’t wish on anyone.”

Hunt became involved with Dying with Dignity after her mother’s death. According to their website, Dying with Dignity’s mission is to “improve individuals’ quality of dying and expand Canadians’ end-of-life options.”

The health care system extends life without considering the self-esteem and emotional well-being of the individual, said Hunt.

“They just think about the body, the physical body. They don’t think about what goes on inside,” added Hunt.

Hunt said she believes that everyone should have the choice to have a more dignified end of life experience. She hopes the recent ruling on medically assisted death will take us one step closer to having this option.

“The system has to respect that individuals should have control over what happens with their bodies and their end of life experience,” Hunt said.

Patients

Idiopathic pulmonary fibrosis is a progressive terminal illness where scar tissue accumulates in the lungs. Peter Harvey was diagnosed in 2009. He believes that the Supreme Court ruling on doctor-assisted death is a step in the right direction.

“At the end of life I want the decision,” he said. “My family is aware of my views, not everyone agrees with me.”

“We all hope for a quick, easy, and gracious exit. But that seems to be the rarity, not the norm.”

-Judy Hunt, member of Dying with Dignity Not long after his diagnosis, Harvey got involved with Dying with Dignity.

“It’s just a matter of providing a legal framework for people that want to, when they reach the terminal end of life, diminish the risk and pain,” he explained.

Although he is supportive of doctor-assisted death, Harvey acknowledges the need for safeguards and choice on both sides. He said that he doesn’t want a law that forces doctors to do something they aren’t comfortable with.

“With the proper legislation, people that want it can get the assistance and go in peace,” he said.

Euthanasia Prevention Coalition

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, said he is worried about the language in the Supreme Court ruling, and the how the implications might affect people with mental illnesses or disabilities.

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Schadenberg said he believes that the ruling is unclear and lacking objective criteria, criteria that will be needed to protect the people that need protecting.

“People who are going through mental illness issues, people who might need excellent pain control, how do we protect them?” Scadenberg pointed out. “If your language is so wide, it becomes nearly impossible.”

Schadenberg said that if there were legislation created, it would have to be clear and specific. Personally, he said that he is hoping a politician will invoke section 33 of the Charter, the not-withstanding clause. This clause allows the government to overrule specific parts of the Charter.

College of Physicians and Surgeons

Not only will patients and their loved ones be affected by the legislation resulting from the ruling, medical practitioners will also need to look at their standards of practice.

Judy Hunt has been advocating for more end-of-life choices through Dying with Dignity since her mother died in 2010.

Photo courtesy of Judy HuntKelly Eby, director of communications for the College of Physicians and Surgeons of Alberta, said, in an email, that the College will be reviewing the ruling in detail. After the review, she said that the College would look at standards of practice to see if advice or direction needs to be adopted.

For the time being, she wrote that doctor-assisted death remains illegal and that the College recommends that doctors seek legal council if a patient asks for assistance dying.

The Politics

The Supreme Court gave a 12-month window for the government to review and change the law that applies to doctor-assisted suicide.

Jonathan Denis, Alberta Minister of Justice, said that the next step for the government is to review the ruling, consider if any laws need to be changed, and to see if it applies to any current cases in the province.

Euthanasia prevention advocate, Alex Schadenberg, doesn’t think that the Harper government will debate the doctor-assisted death law until after the election this fall.

Justin Trudeau, leader of the Liberal Party, appears to have similar concerns because he has started a petition as well as a Facebook campaign, which says “Parliament should debate the physician-assisted death law right now.”

jdoll@cjournal.ca