I do not support Bill C-14 in its present state because I do not think that the final version of the bill reflects the intent of the Supreme Court of Canada's ruling on physician-assisted death (Carter case) nor do I think that it serves the patient's best interests.
I did not come to this decision easily.
I agonized over my decision from the day the legislation was first tabled in the House of Commons. I listened intently to House debates, to committee hearings, and to explanations regarding the acceptance and rejection of final amendments. I consulted with my constituents and medical colleagues.
I believe that this bill was written with sincere intent and consideration, for the best interest of Canadians, by the ministers involved. It was not an easy task given the deeply personal effect it will have on all of our lives, and I applaud their commitment to national strategies for full palliative care.
I looked at this bill through the eyes of a family physician who had practised medicine for over 20 years. Over those years, I walked with my patients through their painful experiences of dying, their tortured fight with chronic irremediable diseases, disabilities, and mental illness.
I learned that each patient's experience was deeply personal and the level of suffering and endurance was unique to that individual. The eventual decision was driven by religious faith, personal ethics, family relationships, and a sense of dignity in suffering and death.
I do not think the current bill addresses this. I do not think the current bill recognizes the individual desire of a patient to choose whether to live or not in a body that has betrayed them.
The bill also does not give clarity to health-care professionals who struggle, daily, to provide the best possible physical, mental, and spiritual care and to fulfill the best interest of each patient.
The criteria in Bill C-14, requiring that "natural death is reasonably foreseeable” in order to allow medically assisted dying (MAID), is an ambiguous directive to physicians.
Does it mean that only those who are dying can access MAID?
Where does that leave those who endure "grievous and irremediable suffering"? That could escalate but not cause death? This definition was specific in the Supreme Court of Canada's ruling on Carter. Yet the definition has been limited in the bill to "serious, incurable illness disease and disability."
What does that mean for a patient who does not wish to take a “cure” for personal and other reasons?
I am also concerned that this bill does not allow for acceptance of clear, written, and witnessed "advance directives" of the patient's intent regarding MAID—where the patient is of sound mind but concerned that he or she may not have the mental or physical capacity to do so later in the illness or disability. As a physician, I have seen patients’ specific directives ignored, contravened, and debated by families who, out of love, seek to disregard them. I have seen families torn apart by these debates.
I recognize that the authors of the bill fear that patients may change their minds later and be unable to give voice to that change. But it is possible to have a team of neurologists, geriatricians, or psychiatrists make assessments in such cases. The standing committee recommended a study be done on the issue of "advance directives" within 180 days. I hope this is done in consultation with medical professionals whose expertise will be essential.
I understand and support the principle that those who are mentally incapable of making decisions with regard to life and death should have the protection of the law. This could be accomplished by safeguards in the bill that allow for second opinions and that prohibit coercion.
With the passage of Bill C-14 in the House and its referral to the Senate, I hope that the issues of concern are addressed by amendments there. If so my support of the bill will be assured.