A doctor who works with home care patients is warning legislators that the Liberals’ new assisted dying bill—which includes the possibility to receive death on the same day a person requests it—will put vulnerable patients like hers at risk due to “transient suicidal ideation.”
Dr. Ramona Coelho, a family doctor in London, Ont., who works primarily with vulnerable patients who are home-bound due to illness or disability, made the comments in her testimony to the Justice Committee on Nov. 3.
She said if Bill C-7 goes through without amendments, she “won't be able to protect” her patients from their temporary suicidal ideation because though many of them have fleeting thoughts of suicide, those thoughts are often resolved with proper investigation of the root cause combined with high-quality medical care—processes that take time.
“The existential crises and hardships of these people are real, but their death wishes are often transient, and we need time to apply good medicine,” she said.
“Suicide prevention must remain a priority and standard of medical care be given to Canadians.”
Coelho referred to one of her patients—a woman in her 70s who expressed the wish to die for months as her health deteriorated. As Coelho ran tests and tried to diagnose the root of the illness, she found another cause: the woman’s son had recently moved in with her and was stealing her money while neglecting to feed her.
The proposed bill’s minimum 90-day assessment period to determine a person’s eligibility for medical assistance in dying (MAID) would not have been enough time to save the woman, Coelho said.
“I know that if I had a 90-day framework to try to outrun her death wishes, I would have facilitated a death driven by elder abuse and financial abuse,” she said.
Bill C-7 Debated
Dozens of Conservative MPs protested the new assisted dying bill as they debated it at the Justice Committee meeting on Nov. 3.
The Conservative caucus was split on the bill, with 78 of their 121 MPs voting against it on its second reading, including Conservative leader Erin O’Toole. All other MPs voted in favour of the legislation, making it likely to pass the House of Commons.
In a statement after the first vote on Oct. 29, O'Toole had said he may support the bill if it's amended to include “reasonable safeguards to protect the vulnerable.''
“My vote on this bill is informed by my own personal experience with my mother in palliative care and my legal examinations of safeguards to protect the vulnerable,'' he said.
During the Conservative leadership campaign, O'Toole promised to protect "the conscience rights of all health-care professionals whose beliefs, religious or otherwise, prevent them from carrying out or referring patients for services that violate their conscience.''
Conservative MP Garnett Genuis sponsored a petition last month protesting the bill in its current form, saying some of the safeguards of the original legislation introduced in 2016 have been removed.
This includes dropping the wait time between approval and death from 10 days to “same-day death,” reducing the number of independent witnesses required from two to one, and dropping the requirement that a person must be able to give consent a second time immediately prior to receiving the procedure.
“Lacking adequate palliative care, Canadians do not currently have a meaningful choice insofar as there is a lack of access to life-supporting options. The government needs to do more for assisted living, instead of removing vital safeguards that protect people around the assisted dying regime,” the petition reads.
The Liberals created the assisted dying regime in June 2016 in response to a landmark Supreme Court of Canada decision, Carter v. Canada, where the prohibition of assisted suicide was challenged as contrary to the Canadian Charter of Rights and Freedoms by several parties, including the family of Kay Carter, a woman suffering from degenerative spinal stenosis.
The new legislation, Bill C-7, responds to a different Quebec Superior Court ruling last fall, which found it was unconstitutional to allow only those whose natural death is “reasonably foreseeable'' to be able to get medical help to end their suffering.
The Official Opposition has questioned why the Liberal government decided not to appeal the Quebec decision, instead creating Bill C-7 to expand the availability of assisted death to comply with it. The government reintroduced the legislation on Oct. 5, which allowed just two months to get the controversial bill through both the Commons and the Senate before the court-ordered deadline.
At the committee meeting on Nov. 3, Justice Minister David Lametti said his department consulted with “various voices” in their decision to accept the court ruling.
“We did hear various voices, including voices from the disability community,” Lametti said. “We took the decision, put quite simply, to reduce suffering. It was hard to see cases like Nicole Gladu and Jean Truchon, and Julia Lamb out west, and not see the suffering that they were going through with no recourse to medical assistance in dying that other Canadians had.”
If approved, the new legislation would set out easier eligibility rules for those who are near death and more stringent rules for those who aren't.
People not near death would face a minimum 90-day period for assessments of their requests for an assisted death. One of the two medical practitioners who assesses a request would have to have expertise in the person's particular medical condition. And the person would have to be able to give final consent immediately prior to the assisted death.
The bill also explicitly prohibited assisted dying in cases where mental illness is the sole underlying medical condition.