Neil Godbout: Bill C-14 is overly cautious, but a good start

Disappointment from all sides greeted the introduction of Bill C-14 in the House of Commons last week, which means Canada’s proposed new law on medical suicide is right about where it should be.

Anything other than an outright ban would not have satisfied most social conservatives opposed to anything resembling euthanasia on ethical and religious grounds. Anything other than a European-style free-for-all is a restriction on personal freedoms for the most strident advocates of medical suicide.

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Like abortion, there isn’t even agreement on the language. Like abortion, the proposed law offers adult Canadians the right to take their own lives with the assistance of a health professional but under certain criteria.

Doctor-assisted death. Assisted dying. Physician-assisted suicide. The Liberals call it “medical assistance in dying.” They also changed the language from a “terminal” diagnosis to “reasonably foreseeable” death.

Abortion is the proper word to use to describe the termination of a pregnancy. Suicide is the proper word to use to describe someone taking their own life. Medical suicide is the accurate phrase to describe someone taking their own life for medical reasons.

Physician-assisted dying already occurs in palliative care when doctors prescribe large doses of morphine and other painkillers in a terminal patient’s painful last days, putting the individual into something much like a drug-induced coma to reduce their suffering. These prescriptions usually don’t hasten death but they effectively end the active life of their patients, who spend their last hours mostly unconscious, before their heart finally stops.

A physician or other health care professional who, upon request, provides access to drugs or other methods that will make a patient die sooner than they otherwise would have is an active participant in a suicide. Softening the language takes away the honesty and clarity needed for a serious debate on this difficult subject.

Bill C-14 allows nurse practitioners, as well as doctors, to work with patients to provide this level of care. This is essential for Canadians living in isolated rural communities with limited access to doctors, as University of Northern B.C. professor Catharine Schiller rightly points out.

Yet Schiller remains critical of Bill C-14, pointing out that the requirement for two practitioners to approve the procedure is a barrier in communities lucky to have one health-care professional. That issue becomes further complicated if the only health-care professional in the community is a conscientious objector who refuses to endorse the procedure, she added. With no requirement for that doctor or nurse practitioner to refer their patient to another health-care professional, mandatory under Quebec law, it is up to the individual to find someone else to assist in their medical suicide.

She’s right that the federal law should match the Quebec law. Like abortion, doctors are free to not do the procedure themselves, but they are required to refer their patient to a doctor who will safely terminate the pregnancy. She’s also right to complain about Bill C-14 not allowing advanced directives. Living wills, power of attorney and “do not resuscitate” orders are routine and should be applied to medical suicide, as well.

Where Schiller is wrong is the level of access to care rural residents can rightfully expect to receive. It should never be up to just one health-care provider to sign off on a medical-suicide prescription. The involvement of multiple doctors is already common practice when patients have to travel to urban centres to receive specialized care to treat cancer and many other complex health conditions. That is an added hardship, but not an onerous one.

Schiller’s discomfort with the age requirement is also off-base. Bill C-14 sets the age limit at 18 but she is open to allowing “mature minors” to undergo medical suicide. Strict age limits that parents cannot override are common practice, both legally and medically, across Canada to cover everything from serving in the military and voting to non-essential cosmetic surgery and prescribing puberty blockers for transgender kids.

Medical suicide should be restricted to adults only, although that will certainly be just one of numerous legal challenges (what is “reasonably foreseeable” death?) that will make its way to the Supreme Court. That’s fine. In the meantime, however, the overly cautious Bill C-14 is a good place to start.

 

Neil Godbout is managing editor of the Prince George Citizen.

ngodbout@pgcitizen.ca

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