Bill C-7 is an act to amend our law on euthanasia, euphemistically referred to as medical assistance in dying or MAID. The federal government proposes Bill C-7 as its response to the September 2019 Quebec Superior Court decision striking down the requirement in Bill C-14 that natural death be reasonably foreseeable in order to be eligible for euthanasia. The government could have exercised its option to appeal the decision but chose not to. While Bill C-7 removes the clause that natural death be reasonably foreseeable, it goes much further than the Quebec Superior Court decision mandates.
This bill will greatly expand access to euthanasia. It would allow physicians and nurse practitioners to euthanize a patient even if the patient were no longer able to consent as long as the patient had requested, been approved for euthanasia and given advance consent. In Bill C-14 which was passed in 2016, the ability to consent prior to receiving a lethal injection was presented as a safeguard to protect vulnerable persons from involuntary euthanasia:
Immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying
The 2015 Supreme Court decision in Carter explicitly stated that euthanasia would be allowed “ for a competent adult person who clearly consents to the termination of life”.
Section 3.2 of Bill C-7 would now permit euthanasia of a patient who is no longer competent if the patient had previously given consent as long as “the person does not demonstrate by words, sounds or gestures, refusal to have the substance administered or resistance to its administration.”
However, section 3.3 which follows says: For greater certainty, involuntary words, sounds or gestures, made in response to contact do not constitute a demonstration of refusal or resistance for the purpose of paragraph 3.2c.
According to these two sections of the bill, it seems that the decision depends entirely on how the physician interprets the words, sounds or gestures of the incompetent patient. Clause 3.3 provides protection to the physician not the patient.
Consider the following report from Holland. An elderly woman with dementia had given her consent to euthanasia in an advance directive. A physician at the facility where she lived decided later that the time had come for euthanasia. Prior to administering the lethal injection, the physician had placed a sedative in the elderly woman’s coffee. The patient struggled when the physician began the injection at which point, the physician asked the woman’s family to hold her down so she could finish the injection. The family agreed to do so.
Changing the law to allow euthanasia without final consent was not required by the Truchon decision of the Quebec Superior Court. With advance requests there is always a risk that a person may receive euthanasia against their wishes.
Secondly, the existing law requires two independent witnesses to a patient’s request for euthanasia. Bill C-7 requires only one witness and that person can be a paid caregiver or a medical professional responsible for your care. It cannot be however, the physician or nurse practitioner who will deliver the lethal injection.
It also eliminates the 10 day waiting period between the time of the request and the provision of the lethal injection for those whose natural death is reasonably foreseeable. It means that it would be possible for someone to request and receive euthanasia on the same day. For those whose natural death is not reasonably foreseeable but meet other criteria, a 90 day reflection period is required.
Persons with chronic illnesses or disabilities are at risk with this change in the law. Support services are still lacking for persons with disabilities. Under Bill C-14, cases of coercion towards euthanasia were reported in Canadian media. CTV featured the story of Roger Foley and CBC, the story of Candice Lewis.
Finally this bill lacks specific conscience rights protection for health care professionals and institutions who object to participation in euthanasia. Prior to the 2015 Supreme Court decision in Carter, euthanasia was considered homicide. Now, we are told that giving lethal injections is health care. Patients need care not killing.
In December 2020, Justice Minister Lametti asked and obtained from the Quebec Superior Court, an extension to give more time for the federal government to pass Bill C-7. The government was then told it had until February 26, 2021. It has now been granted another extension for passage of the bill.