Assisted Suicide & Euthanasia

What is Euthanasia?

Euthanasia is the act of intentionally, knowingly and directly causing the death of a patient. If someone other than the person who dies performs the last act, euthanasia has occurred. For example, if a person administers a lethal injection or puts a plastic bag over a patient’s head to suffocate him/her, euthanasia has taken place. Euthanasia is sometimes called aid-in-dying, mercy killing, death with dignity, etc.

What is Assisted Suicide?

Assisted suicide is the act of intentionally, knowingly and directly providing the means of death to another person so that the person can use that means to commit suicide. If the person who dies performs the last act, assisted suicide has occurred.

For example, if a doctor writes a prescription for an intentional overdose of drugs for a patient to use to commit suicide and if the patient who dies performs the last act (the act of swallowing), assisted suicide has taken place.
Assisted-suicide is sometimes called “aid-in-dying,” “death with dignity,” “physician-assisted death,” etc.

We believe that neither consent nor motive changes the reality that both assisted suicide and euthanasia involve killing another human being. Killing the patient should never be the treatment for suffering.

Dr. Paul V. Adams of Manitoba Physicians for Life, describes what many view as the fundamental moral or ethical difference between acts of withholding and withdrawing and acts of euthanasia:

There is an essential difference between causing one to die, which is euthanasia, helping one to die, which would be assisted suicide, and allowing natural death to occur, which I referred to as withholding or withdrawing treatment. Frequently, there is confusion regarding the third category,  that is, allowing natural death to occur when death is inevitable, and there is no clinical or ethical reason to intervene. This is not euthanasia. It is both morally and ethically acceptable and it should continue to be legally acceptable.

Dr. Paul V. Adams of Manitoba Physicians for Life, Witness to the Special Senate Committee, 1995

Advance Directives

An advance directive is a document by which a person makes provisions for health care decisions in the event that, in the future, he/she becomes unable to make those decisions. There are two main types of advance directive – the “Living Will” and the “Durable Power of Attorney for Health Care.” There are also combination advance directives which are hybrid documents that combine elements of the Living Will with those of the Durable Power of Attorney. To be valid, an advance directive must comply with the law of the province in which it was signed.

Living Wills

A Living Will is the oldest type of health care advance directive. It is a signed, witnessed (or notarized) document. Most Living Wills instruct an attending physician to withhold or withdraw medical interventions from its signer if he/she is in a terminal or irreversible condition and is unable to make decisions about medical treatment.

Since an attending physician who may be unfamiliar with the signer’s wishes and values has the power and authority to carry out the signer’s directive, certain terms contained in the document may be interpreted by the physician in a manner that was not intended by the signer. Family members and others who are familiar with the signer’s values and wishes have no legal standing to interpret the meaning of the Living Will.

A Living Will may also be called a “Directive,” “Declaration,” “Individual Health Care Instruction,” etc.

Alliance for Life Ontario has made available the resource, Advance Directives and Living Wills, What are the Pitfalls, An Ontario, Canada Perspective and The LyfePRESERVER, a Protective Advance Directive and Power of Attorney for Personal Care. To order, select the item and click on the Buy Now Button. You do not need a Pay Pal account. Simply use your credit card.

Donation

What is the law in Canada concerning euthanasia and assisted suicide?

The Canadian Criminal Code did not address euthanasia prior to Bill C-14 or Bill C-7. Killing a person was addressed under Homicide Section 222, Murder Section 229, Manslaughter Section 224, Punishment for Murder, Section 235, and Punishment for Manslaughter Section 236.  Assisted Suicide was directly addressed under Counselling or Aiding Suicide, Section 241 and Administering Noxious Thing, Section 245.

Click here for Relevant Provisions of the Criminal Code and the Civil Code: regarding Euthanasia, Assisted Suicide, Withholding and Withdrawing Treatment and Pain Control and Sedation Practices.
Click here for Chronology of Major Canadian Developments and Events, 1972-1995 (Please note that update for 1996- present will be forthcoming.)
** The following links provide a comprehensive overview of the events and opinions surrounding the issue of euthanasia and assisted suicide, withdrawal and withholding of treatment, pain management and sedation. Alliance for Life Ontario does not necessarily agree with everything presented in these reports. We provide them for your research.
Click here for the Senate Committee Report, 1995 The Special Senate Committee on Euthanasia and Assisted Suicide Of Life and Death – Final Report, June 1995
Click here  for the Final Senate Committee Report, 2000, Quality End-of-Life Care: The Right of Every Canadian Subcommittee to update “Of Life and Death.”
There currently is a bill before the house to legalize assisted suicide and euthanasia. Click here to see the Bill C-384, An act to amend the Criminal Code(right to die with dignity). Click here (pdf) for analysis of Bill C-384.
Click here for a summary of Bill C-384

Dignity in old age. Disability, unconsciousness and suffering is enhanced above all, in knowing that you are respected and loved. Surely, we can find more constructive ways of demonstrating love and respect than by Killing.”

Where are we now in Canada?

  • Canada has the most permissive euthanasia and assisted-suicide laws in the world.
  • Adults may seek physician-assisted suicide or euthanasia for many forms of suffering, not just terminal illness
  • Euthanasia for solely mental health reasons goes into effect March 2023
  • Consideration is being given for “mature” minors to acquire access
  • Majority of Canadians support “mercy-killing or MAiD

Is this the kind of society we want?

How on Earth did we get here?

Palliative Care /End of Life Care

Joint Statement Canadian Hospice Palliative Care Association Canadians Society of Palliative Care https://www.cspcp.ca/joint-statement-from-chpca-and-cspcp-regarding-palliative-care-and-maid/

Fact Sheet on Palliative Care in Canada https://www.chpca.ca/wp-content/uploads/2019/12/new_fact_sheet_hpc_in_canada-summer2017-final-en.pdf and https://www.chpca.ca/wp-content/uploads/2020/03/CHPCA-FactSheet-D.pdf

 

June 2000 Quality End of Life Care: The Right of every Canadian https://www.chpca.ca/projects/the-quality-end-of-life-care-coalition-of-canada/

June 2010 Raising the Bar – A roadmap for the future of Palliative Care in Canada https://www.virtualhospice.ca/Assets/Raising%20the%20Bar%20June%202010_Senator%20Sharon%20Carstairs_20100608160433.pdf

November 2011 Not to be Forgotten  – Care of Vulnerable Canadians  https://www.mcgill.ca/palliativecare/files/palliativecare/parliamentary_report_eng_dec_2011.pdf

 

Financial cost of killing patients

 

The Rodriguez Case (1993)

  • In the early 1990s, Sue Rodriguez submitted to the courts that section 241(b) of the Criminal Code, which prohibited assisted suicide, was constitutionally invalid. (See also Assisted Suicide in Canada.) Rodriguez suffered from amyotrophic lateral sclerosis (ALS) and wanted the legal right to have a physician’s help in ending her own life.
  • On 30 September 1993, a 5–4 majority of the Supreme Court of Canada upheld section 241(b), declaring that it was constitutional and did not violate the Canadian Charter of Rights and Freedoms.
  • Nonetheless, Rodriguez committed suicide in February 1994, assisted by an anonymous doctor and in the presence of NDP MP Svend Robinson, who had championed her cause.
  • In 2015, the Supreme Court decided unanimously to strike down the prohibition and allow medically assisted suicide, which was officially legalized with the passing of the Medical Assistance in Dying (MAID) Act on 17 June 2016. In March 2021, new legislation was passed that expanded eligibility for MAID.

This article contains sensitive material that may not be suitable for all audiences.

Sue Rodriguez Case

In 1991, Sue Rodriguez was diagnosed with amyotrophic lateral sclerosis (ALS) — also known as Lou Gehrig’s disease — a quickly progressing neurological disease that attacks the nerve cells controlling voluntary muscle movement. Facing a rapid decline into paralysis, Rodriguez wanted the legal right to have a qualified physician’s help in ending her life at a time of her own choosing.

  • However, assisted suicide was illegal in Canada (as it was everywhere else in the world except Switzerland) and punishable by up to 14 years in prison.
  • A resident of Victoria, British Columbia, Rodriguez applied to the Supreme Court of British Columbia in December 1992 to have section 241(b) of the Criminal Code, which prohibited assisted suicide, declared constitutionally invalid on the grounds that it violated sections 7, 12 and 15 of the Charter.
  • After losing her case on 29 December 1992, as well as a subsequent appeal on 8 March 1993, Rodriguez applied to the Supreme Court of Canada.

Supreme Court Decision (1993)

On 30 September 1993, a majority (5–4) of Supreme Court judges ruled that section 241(b) was constitutionally valid and did not violate the Canadian Charter of Rights and Freedoms. They held that the most important issue was whether section 241(b) of the Criminal Code violated section 7 of the Charter, which states that, “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.” https://decisions.scc-csc.ca/scc-csc/scc-csc/en/item/1054/index.do

  • The majority recognized that Sue Rodriguez’s right to security of the person was denied by section 241(b) because it deprived her of personal autonomy in decisions concerning her body and that it caused her both physical pain and psychological distress.
  • Nevertheless, they believed that the prohibition against assisted suicide upheld principles of fundamental justice and, therefore, did not violate section 7 of the Charter. Their decision was based on the idea of the sanctity of life and the state’s interest in protecting human life.
  • They argued that assisted suicide was widely considered to be morally and legally wrong and that lifting the prohibition could potentially lead to abuses, particularly among the vulnerable. The majority also rejected the claim that section 241(b) violated sections 12 (protection from cruel and unusual punishments) and 15 (guarantee of equal rights) of the Charter.

The minority judges argued that the prohibition of assisted suicide was arbitrary.

  • In effect, a physically able person can commit suicide (which is not a criminal act), while a physically disabled person commits a crime when she asks for assistance to perform the same act. In their opinion, this distinction was contrary to the principles of fundamental justice.

Assisted Suicide in Canada

  • When Sue Rodriguez brought her case to the courts, assisted suicide was illegal in Canada. However, while she lost her appeal to the Supreme Court, the fact that the judges were divided 5–4 on the decision suggested that there was considerable support for decriminalizing medically assisted suicide.
  • In June 2014, just over 20 years after the Rodriguez decision, Quebec passed legislation legalizing physician-assisted suicide for consenting adult patients who suffer from a “serious and incurable illness,” are in “an advanced state of irreversible decline in capability” and “experience constant and unbearable physical or psychological suffering which cannot be relieved in a manner the patient deems tolerable.”

At the same time, the Supreme Court of Canada found itself once again debating the issue.

In 2011, the BC Civil Liberties Association had filed a lawsuit challenging the law against assisted suicide. The case was brought to court on behalf of the families of Kay Carter and Gloria Taylor, both of whom suffered from debilitating conditions (Carter died in 2010; Taylor, in 2012).

  • In 2014, the case came before the Supreme Court. On 6 February 2015, the court voted unanimously (9–0) to allow medically assisted suicide for
  • “a competent adult person who (1) clearly consents to the termination of life;
  • and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

The court reasoned that the Criminal Code prohibition was unconstitutional because it breached the rights to life, liberty and security of the person, as enshrined in section 7 of the Charter. SPECIFIC TO THIS CASE ONLY

Medical Assistance in Dying Act, 2016 (C-14) and 2021 (C-7)

On 17 June 2016, over a year after the Supreme Court decision, new federal legislation  (Bill C-14) was passed establishing the eligibility criteria and procedural safeguards for medically assisted suicide.

According to the Medical Assistance in Dying (MAID) Act, (C-14)   https://www.justice.gc.ca/eng/rp-pr/other-autre/addend/index.html  those eligible have to be (SEE eligibility)

  • at least 18 years of age,
  • with a “grievous and irremediable medical condition”
  • that causes “enduring physical or psychological suffering that is intolerable” to them.
  • Moreover, they must be in an “advanced state of irreversible decline,” in which their “natural death has become reasonably foreseeable.”

Critics pointed out that the legislation was more restrictive than the Supreme Court decision and that it might be vulnerable to constitutional appeal.

“The appeal is allowed.  We would issue the following declaration, which is suspended for 12 months:

  • Section 241(b) and s. 14 of the Criminal Code unjustifiably infringe s. 7 of the Charter and are of no force or effect to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition

[148]  Special costs on a full indemnity basis are awarded against Canada throughout.  The Attorney General of British Columbia will bear responsibility for 10 percent of the costs at trial on a full indemnity basis and will pay the costs associated with its presence at the appellate levels on a party-and-party basis

  • April 2019 Fourth Interim Report on MaiD was released
  • In September 2019, a Superior Court of Quebec justice ruled that the statutory provision — that natural death was “reasonably foreseeable” — was unconstitutional.

Canada MAiD Reports  Https://publications.gc.ca/site/eng/9.889100/publication.html

https://publications.gc.ca/collections/collection_2020/sc-hc/H22-1-6-2019-eng.pdf 2019

https://publications.gc.ca/collections/collection_2021/sc-hc/H22-1-6-2020-eng.pdf 2020

https://publications.gc.ca/collections/collection_2022/sc-hc/H22-1-6-2021-eng.pdf    2021

https://publications.gc.ca/collections/collection_2023/sc-hc/H22-1-6-2022-eng.pdf     June 2022

https://publications.gc.ca/collections/collection_2025/sc-hc/H22-1-6-2023-eng.pdf  2023

In February 2020, the Liberal government introduced Bill C-7,   https://www.justice.gc.ca/eng/csj-sjc/pl/charter-charte/c7.html  which proposed to allow MAID for those whose natural death was “not reasonably foreseeable.”

  • Discussion of the bill was stalled by the COVID-19 pandemic, which disrupted parliamentary proceedings.
  • It was reintroduced in October 2020. After extended debate, consultation and revision, Bill C-7 was passed by the House of Commons and approved by the Senate.
  • It became law on 17 March 2021.

The 2021 MAID legislation (SEE eligibility)