Angry in the Great White North

C-407 is a private member's bill, introduced by Bloc MP Francine Lalonde, La Pointe-de-l'Île. In this piece, I'd like to point out a number of flaws in this bill that makes me wonder how it passed First Reading. Unless that's the way the bill is supposed to be...

The person who is looking to die must be 18 or older, must be suffering severe physical or mental pain without prospect of relief after having tried appropriate treatments or refusing treatments that have not been tried, or is suffering from a terminal illness. He must appear to be lucid to a medical practitioner when making the request. Alternatively, someone else can ask on his behalf when he does not appear to be lucid, that other person having been designated by the ill person in writing at some earlier date in front of witnesses.

The person aiding in the death must be a medical practitioner, or must be assisted by one, must act in the manner indicated by the ill person, and must provide a confirmation of the diagnosis to the coroner.

Consider these oversights:

• There are no residency requirements, either provincial or federal. I don't relish the idea of Canada becoming a mecca for Americans and other foreigners looking to die. Not only is that repellant, it leaves open the possibility of a "death industry" developing, marketing Canada to the terminally ill with money living in other countries.


• There are two independent medical conditions, either of which are required. Dealing with the second one first, terminal illness, the bill does not put any limits on this. We all suffer from the terminal illness called "aging". In Oregon's Death with Dignity Act, the illness must be deemed by competent physicians to be terminal within 6 months. According to Canada's bill, the moment you are diagnosed with a terminal illness you can pursue a dignified death. The potential here of course is misdiagnosis in the early stages of an illness. The Oregon statute opens the window for assisted death near the end, presumably when no doubt is left.


• Dealing with the condition of severe pain, the problem here is that pain is subjective. The Oregon statute does not recognize pain as a sufficient criteria for an assisted suicide. Mental pain is doubly difficult to prove. Why does this matter? The potential exists for abuse, perhaps even murder, since there is no objective means after death to determine if the patient was really in pain, while a terminal illness in the last 6 months would almost certainly be detectable in a post-mortem.


• The person seeking death on the grounds of painful suffering can do so after having tried appropriate treatments. For how long? Who makes the determination that the treatments attempted were appropriate? Most doctors would not classify Vitamin E megadoses as appropriate for a malignant tumour, but the bill makes no mention that a doctor is the authority to answer this question.


• The person seeking death on the grounds of painful suffering can do so after refusing the treatments that have not been tried. This leaves the door open for a person, not necessarily of sound mind, or under the influence of someone without his best interests in mind, to opt for suicide immediately.


• Speaking of sound mind, who determines if a person appears to be lucid? Again the bill makes no mention of a qualified psychiatrist being consulted in case of concern, or otherwise provides a legal definition of lucidity.


• The use of a stand-in is troubling, and has the potential for major abuse, as well as terrible conflicts as was seen during the Schiavo case. The Oregon law does not allow for stand-ins. Only the patient himself can make the request.


• The term "medical practitioner" is used over and over again in different parts of the bill, defined only as a person entitled to practise medicine in the province. Perhaps a stricter definition is required, such as requiring the physician to be a specialist in the illness in question (an oncologist for a person dying of cancer, for example). I'd hate to see a chiropractor starting a "death doctor" sideline in order to boost his income.


• Acting in the manner indicated by the person who wishes to die means...what? What if the ill person wants to die the old Druid way, set aflame in the Wicker Man? Or skydiving without a parachute? The bill puts no limits on the means by which a person is assisted in dying, leaving the door open for all sorts of potential problems.


• The bill makes no mention of who does the killing. The Oregon statute is clear -- the ill person must hold the lethal dose of oral barbituates and take it himself, without any aid whatsoever. Likewise, in any other selected means of suicide, the ill person must be the person who causes death to happen. In C-407, the person might be aided by the medical practitioner. The bill does not even require the ill person to be conscious at the time.


• A confirmation from two medical practitioners of the diagnosis is required. How do you confirm a diagnosis of mental pain?


• Can a medical practitioner charge for his service, or is it covered under the provincial health plan? In the case of both, are we looking a "two-tier death system"? Will the Prime Minister promise that all Canadians, regardless of their financial means, can die, and that no one will be allowed to jump the queue? Will he spend billions to shorten waiting lists for the dying? At the expense of the living?


• Can a medical practitioner refuse to participate on moral grounds? If there is only one such practitioner in a remote community, can he be sued for not providing a medical service? What protections does he have?


• Does a medical institution, such as a Catholic hospital, have the right to obligate its staff not to provide these services? Can a physician be fired from such an institution if he breaks that rule? Or will the institution be sued by the physician for trying to limit his practise, especially in the case where fees for assisted deaths are paid for privately?


• There is no obligation in the bill for the provinces to compile statistics on assisted deaths that might reveal things such as the percentage of out-of-province or out-of-country patients, whether there are specific doctors who are signing off on assisted deaths in unusually large numbers, and the means by which assisted deaths are occuring.


• If assisted deaths are privately paid for, where do the doctors get the drugs, assuming that's the most popular means for hastening death? In Canada, pharmaceuticals are purchased by the government. Will these drugs be made available in single doses for each case, or sold in bulk for use by "death doctors"? Do unused doses need to be returned and audits performed?

[A personal story of someone's dignified end, without hastening it.]