Assisted Dying - pub domainOn June 17, the Canadian Senate passed Bill C-14, “an act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying),” into law. The Bill legalizes medically assisted dying in Canada, which joins countries like Switzerland, Germany, Japan, the Netherlands, and Ireland in allowing certain patients to choose to end their lives.

In a joint statement, the Canadian Ministers of Justice and Health said the legislation “strikes the right balance between personal autonomy for those seeking access to medically assisted dying and protecting the vulnerable.”

Bill C-14 was drafted in response to Carter v Canada, a 2015 Supreme Court ruling which found that criminal laws prohibiting medical assistance in dying (MAID) limited patients’ rights to life, liberty and security of the person. The ruling declared void the section of Canada’s Criminal Code which prohibits medically assisted dying for competent adult persons who (1) clearly consent to the termination of life; and (2) have 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.

Based on Carter v Canada, Bill C-14 laid out stringent conditions to determine a patient’s eligibility for MAID. As outlined in the Supreme Court ruling, eligible patients must have an incurable illness or disability, must be in an advanced state of irreversible decline, and must be experiencing intolerable suffering. Additionally, Bill C-14 stipulates that the patient’s natural death must be “reasonably foreseeable.”

The Senate’s decision to pass Bill C-14 was well-received in parliament, with Health Minister Jane Philpott calling June 17 “a transformative day for Canadian social policy.” However, lingering questions remain around the new legislation. For instance, without clarification of the meaning of “reasonably foreseeable,” physicians may not be able to determine a patient’s eligibility and may, as Hospital News reports, “face indeterminate liability for opinions rendered regarding MAID.”

Per Hospital News: “Providing MAID where there is disagreement over whether the patient’s natural death was “reasonably foreseeable” … could result in (A) a civil claim for wrongful death brought by the patient’s estate, or (B) criminal charges for aiding suicide under section 241 of the Criminal Code.”

Other unresolved issues include MAID’s availability to mature minors and people with mental illnesses, and advance requests.

“Health Canada will continue to work with the provinces and territories as provisions of the legislation come into force, and further study will be done with respect to medical assistance in dying in the context of mature minors, people for whom mental illness is the sole underlying condition, and advance requests,” the Health and Justice Ministers said in their joint statement.

While questions around the legislation remain, the passing of Bill C-14 into law is a watermark moment in Canadian medical and legal history, and has prompted emotional responses from both sides of the debate over medically assisted dying’s legal and moral legitimacy.

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Greg Neinstein