The Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying released their pro-euthanasia report, one-day before the release of the report from the Federal Panel on Assisted Dying. Link to the report.
The Provincial-Territorial Expert Advisory Group featured a stacked deck of pro-euthanasia activists. Maureen Taylor, who describes herself, on Twitter, as an advocate of assisted death, was a co-chair, while Jocelyn Downie, Canada’s leading promoter of assisted death, and Arthur Schaefer is a long-time advocate of euthanasia and assisted suicide were also members.
There are 43 recommendations in the report. Many of the recommendations are similar to the euthanasia laws in Belgium and the Netherlands and a few are particularly concerning.
The 43 recommendations focus on the provision of death, not the protection of patients. I will focus on the following recommendations:
Recommendation 3: All provinces and territories should ensure access to physician-assisted dying, including both physician-administered and self-administered physician assisted dying. The recommendations set out in Appendix 3 should be implemented through provincial/territorial legislation.
Recommendation 4: Provinces and territories should require all regional health authorities to have an effective publicly funded care coordination system in place to ensure patient access to physician-assisted dying.
Recommendation 5: Provincial/territorial governments should publicly fund physician-assisted dying.
Recommendation 8: Provinces and territories should request that the federal government amend the Criminal Code to allow the provision of physician-assisted dying by a regulated health care professional (registered nurse or, if applicable, physician assistant) acting under the direction of a physician, or a nurse practitioner. Provinces and territories should in turn ensure that no regulatory barriers exist that would prevent these health care professionals from providing physician-assisted dying.
Recommendation 9: Provinces and territories should ensure that health professionals are protected from liability for acts or omissions done in good faith and without negligence in providing or intending to provide physician-assisted dying.
Recommendation 13: Within one year, provinces and territories, in collaboration with the federal government, should study whether patient declaration forms completed prior to the diagnosis of a grievous and irremediable medical condition might also be considered valid.
Recommendation 14: Substitute decision makers should not be given the legal authority to consent to/authorize physician-assisted dying on behalf of an incompetent patient.
Recommendation 17: Access to physician-assisted dying should not be impeded by the imposition of arbitrary age limits. Provinces and territories should recommend that the federal government make it clear in its changes to the Criminal Code that eligibility for physician-assisted dying is to be based on competence rather than age.
Recommendation 18: “Grievous and irremediable medical condition” should be defined as a very severe or serious illness, disease or disability that cannot be alleviated by any means acceptable to the patient. Specific medical conditions that qualify as “grievous and irremediable” should not be delineated in legislation or regulation.
Recommendation 22: Two physicians must assess the patient to ensure that all criteria are met.
Recommendation 26: We do not recommend a prescribed waiting/reflection period. Rather, the time between initial request and declaration will vary according to the time it takes for the attending and reviewing physician to be confident that the declaration is free and informed and made by a competent individual.
Recommendation 28: There should be no requirement that a physician be present at a self-administered assisted death.
Recommendation 29: Following the provision of physician assisted dying, physicians should file a report with a Review Committee to support the review of each individual case. This review will ensure transparency and confirm compliance with existing policies and procedures.
Recommendation 30: Physician-assisted dying should be listed as the manner of death on medical certificates of death across all provinces and territories and the name of the medical condition that qualified the patient for physician assisted dying should be listed as the cause of death.
Recommendation 33: Conscientiously objecting health care providers should be required to either provide a referral or a direct transfer of care to another health care provider or to contact a third party and transfer the patient’s records through the system described in Recommendation 4.
Recommendation 38: Faith-based institutions must either allow physician-assisted dying within the institution or make arrangements for the safe and timely transfer of the patient to a non-objecting institution for assessment and potentially, provision of physician-assisted dying. The duty of care must be continuous and non-discriminatory.
Recommendation 39: Provincial and territorial governments should establish a Review Committee systems to review all cases of physician-assisted dying after the provision of the service to ensure compliance with relevant federal/provincial/territorial legislation and health professional regulatory standards, transparency and accountability.
Recommendation 42: Professional organizations, regulatory authorities and universities should collaborate with each other and with patient groups to develop appropriate curricula and continuing education programs and training for students, physicians and health professionals that are related to the provision of physician-assisted dying.
Recommendation 43: Provinces and territories should provide public education about physician-assisted dying and apply best practices for public engagement to inform the continued development of end-of-life care law, policies, and practices.