Wednesday, September 23, 2015

The Issue That Canada's Politicians Are Avoiding

Back on February 6, 2015, the Supreme Court of Canada announced its ruling on Carter v. Canada as shown on this document:

The Supreme Court unanimously ruled that people with both grievous and irremediable medical conditions should have the right to ask a doctor to help them die as shown in these key paragraphs:

"Insofar as they prohibit physician-assisted dying for competent adults who seek such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering, ss. 241 (b) and 14  of the Criminal Code  deprive these adults of their right to life, liberty and security of the person under s. 7  of the Charter . The right to life is engaged where the law or state action imposes death or an increased risk of death on a person, either directly or indirectly. Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable. The rights to liberty and security of the person, which deal with concerns about autonomy and quality of life, are also engaged. An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.

The prohibition on physician-assisted dying infringes the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice. The object of the prohibition is not, broadly, to preserve life whatever the circumstances, but more specifically to protect vulnerable persons from being induced to commit suicide at a time of weakness. Since a total ban on assisted suicide clearly helps achieve this object, individuals’ rights are not deprived arbitrarily. However, the prohibition catches people outside the class of protected persons. It follows that the limitation on their rights is in at least some cases not connected to the objective and that the prohibition is thus overbroad. It is unnecessary to decide whether the prohibition also violates the principle against gross disproportionality." (my bold)

While I realize that this subject is as divisive as abortion, it is a subject that is of great interest to me, particularly since, in recent years, I have lost both of my parents, one who endured extreme pain from untreatable multiple cancers and another who lost all dignity as a result of dementia.

At the time of the decision, the Supreme Court gave provincial and federal governments 12 months to craft new legislation to deal with their ruling; since then, nearly eight months have passed and there has been a notable lack of progress from Ottawa on this issue.  The Harper government finds itself between a rock and a hard place because the religious base of the Conservative Party of Canada has a very clear opinion on the issue.

Back in 2012, the Quebec National Assembly's Select Committee on Dying with Dignity released a report that examined in great detail what society's answer is to the suffering that some people experience at the end of life or during a degenerative disease.  Quebec was willing to admit that the debate on euthanasia and assisted suicide was something that could no longer be avoided and that the National Assembly and its elected Members had a duty to deal with this issue as stated here:

"It is also clear that the National Assembly must also turn its attention to this issue. MNAs have a responsibility to focus on major societal debates that are ongoing in the population. It is in fact one of their crucial functions as elected representatives. We must also ensure that these discussions are conducted responsibly and under ideal conditions in order to foster calm, respectful debate."

Sadly, this does not appear to be the case with the federal government.  Leadership on this issue is sadly missing.

After having gone through the issue of dying with dignity with my own parents, here is a key paragraph in the report: 

"Getting society to accept that death, like birth, is a natural phase of life is no small task. However, only when we succeed in this regard will palliative care become a genuine part of the continuum of care."

From my personal and very recent experience, a significant part of palliative care is the use of sedation to induce sleep and continuously relieve the patient's awareness that they are suffering, a process that some regard as euthanasia in disguise.  This is particularly important where the use of pain medications like morphine no longer reduce pain and discomfort.  One of the problems occurring from palliative sedation is the cessation of nutrition and hydration.  In my own case, I can recall having feelings that my loved one was being starved to death, however, many physicians feel that the combination of palliative sedation and withdrawal of nutrition hasten death for the sufferer.

Interestingly, in January 2015, Canada Revenue Agency annulled the charitable status of Dying With Dignity Canada effective on February 15, 2015.  Dying With Dignity Canada was  founded in 1982 to promote choice and dignity at the end of life, educating Canadians about patient rights, advance care planning, providing one-on-one support to individuals who are dying and want to do so on their own terms.  CRA determined that "DWD Canada does not conduct any activities that advance education in the charitable sense" and that they are primarily "political".  In case you missed it, Dying with Dignity was an intervener on the Carter v. Canada case.  Why did CRA annul Dying With Dignity Canada's charitable status?  They claimed that the organization was registered in error as a charity way back in 1982.  It just took CRA 23 years to figure that out and annul their status.  I think that this gives us a sense of where the Harper government stood on the issue.

From this, I think that we have some idea of why the Harper government has pretty much chosen to ignore this rather discomforting subject, preferring to deal with it after the October 2015 federal election, just in case their stance on this issue alienates their base.  As well, any response to the Supreme Court decision will require co-operation between the federal government and the provincial governments who each have their own provincial colleges of physicians, a prospect that must make Mr. Harper rather uncomfortable since he has shown little interest in federal - provincial policy discussions of any type and around any issue.  In response to this very important and looming issue which is of particular importance as Canada's population ages, voters need to ensure that they hold candidates from all political parties accountable for at least taking a firm stand on the issue, particularly since there will be less than four months to craft legislation after the October election date.

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