Recent Developments
Council of Canadian Academies Expert Panel on Medical Assistance in Dying
Through the Canadian MAiD legislation, Parliament tasked the Ministers of Health and Justice to “initiate one or more independent reviews of issues relating to requests by mature minors for medical assistance in dying, to advance requests and to requests where mental illness is the sole underlying medical condition.” In December 2016, the Government asked the Council of Canadian Academies to conduct an independent review on these issues. The Council of Canadian Academies in turn appointed an Expert Panel to conduct the review. The Expert Panel will conduct an assessment of the evidence available on the three issues and will release the results of its independent review in the Fall 2018. It will not make recommendations on the policy issues that lie behind the statutory mandate to initiate the review. The Government is required to report back to Parliament by December 2018.
Mature minors – access to MAiD is restricted to individuals over the age of 18. The policy issue here is whether mature minors should also have access and, if so, under what conditions. Mature minors are individuals under the age of majority (18 or 19 depending on the province or territory) who have the capacity to understand and appreciate the consequences of the specific decision in front of them.
Advance requests – access to MAiD is restricted to individuals who have the capacity to give express consent immediately prior to the provision of MAiD. The policy issue here is whether access to MAiD should be available through requests made by competent individuals in advance of loss of capacity and, if so, under what conditions.
Mental illness is the sole underlying medical condition – individuals whose sole underlying medical condition are not expressly excluded from access to MAiD. If they meet the eligibility criteria, access is permitted under the legislation. However, as a consequence of the specific definition of the general eligibility criterion “grievous and irremediable medical condition,” many people with mental illness as the sole underlying medical condition will not be deemed eligible. Most commonly, they will found to not meet the requirement that their “natural death has become reasonably foreseeable”. The policy issue here is whether access to MAiD for individuals whose sole underlying medical condition is a mental illness should be more restrictive (change the law to explicitly exclude them), retain the status quo (leave the law as it is such that they qualify if they meet the current eligibility criteria), or more permissive (change the law so as to allow greater access) and, if becoming more permissive, under what conditions to allow access.
College of Physicians and Surgeons of British Columbia Complaint against Dr. Ellen Wiebe
On February 13, 2018, the CPSBC Inquiry Committee issued a “Final Disposition Report” on a complaint submitted by the Chief Medical Officer and Coroner, BC Coroners Service against Dr. Ellen Wiebe asking the College to “review this matter [medical assistance in dying for Ms. S] to ensure that the eligibility criteria for medical assistance in dying were met.” The Inquiry Committee concluded that “a patient cannot be forced to take treatment they do not consider acceptable, i.e., patients seeking medical assistance in dying retain, as do all competent patients, right of refusal. It was determined that Ms. S met the requisite criteria and was indeed eligible for medical assistance in dying, despite the fact that her refusal of medical treatment, food, and water, undoubtedly hastened her death and contributed to its ‘reasonable foreseeability’. Given the above, the Committee agreed that Dr. Wiebe acted in compliance with the College’s standard in all respects.”
