A joint committee composed of members of Congress and Senators began to review the law on May 17. The task of the committee is to answer some heavy questions, such as whether mature minors should receive medical assistance for the dying (MAID), and whether patients should be allowed to request medical records in advance before their pain becomes intolerable.

Attorney General David Lametti’s office said in a statement: “Medical assistance for death is a complicated and deep personal matter for many Canadians and their families.”

“The five-year parliamentary review of the previous C-14 bill will be an appropriate forum to review many issues.”

These are some of the problems faced by the committee.

The history of MAID

After the Supreme Court ruled that certain parts of the Criminal Law that made assisted suicide illegal violated the Charter of Rights and Freedoms, the Trudeau government legalized MAID.

parliament Passed the law Deaths that allow adults to obtain medical assistance in the event of a “serious and irreparable” medical condition and “reasonably foreseeable” death. In other words, those who are diagnosed with an incurable disease, illness or disability that causes unbearable mental or physical pain are eligible-but only if they are dying.

Critics call the “foreseeable death” rule too strict.Quebec High Court Knocked down In 2019.

Watch | New law on medically assisted death passed:

The government responded with Bill C-7, Adopted in March 2021.

This new law gives Canadians who have suffered intolerable suffering, who have the right to seek MAID immediately when they approach the end of their natural life.

Those suffering solely from mental illness will receive MAID treatment in March 2023.

According to Canadian data, between 2016 and 2019, 13,946 people died in medical assistance Health Canada. Most of them suffer from cancer-related diseases (67%), 10.8% suffer from respiratory diseases, another 10.4% suffer from neurological diseases, and another 10.1% suffer from cardiovascular diseases.

mental illness

The expansion of MAID to people mainly suffering from depression, schizophrenia, post-traumatic stress disorder and other mental illnesses has left legislators facing many unresolved problems.

For example-how do doctors and practitioners who assess the suitability of a patient for MAID determine whether a mental illness can be cured?

Many mental illnesses can be treated with drugs or other therapies, or mental illness can be improved if the living conditions that lead to deterioration of mental health, such as poverty, loneliness, or lack of housing, are resolved.

The Toronto Center for Addiction and Mental Health stated in 2017: “In the field of mental health, there is not enough evidence… to determine whether someone has an irreparable mental illness.”

Watch: Ottawa prepares to expand MAID program to mental illness

The federal government hopes to expand medical assistance for dying programs to include those with incurable mental illness two years after the expanded legislation is passed, but some people believe that the government first needs to provide better mental health support. 1:59

Dr. Sonu Gaind, chair of the MAID group physician at Humber River Hospital, said he was worried that MAID would be provided to people who could otherwise recover.

Gay End, associate professor of psychiatry at the University of Toronto, said: “This is sacrificing marginalized people who have never had the autonomy to live a dignified life. Now they choose death as a potential means of resolving their suffering.

“The safeguards we take should be as strong as possible to minimize…the number of people seeking MAID for social poverty and other things, they can actually get relief through other communities or social support.”

The Liberal government is forming a team of experts to study mental health issues and propose safeguards to protect vulnerable groups. The team is expected to provide recommendations by March 2022.

Dalhousie University law professor Jocelyn Downie (Jocelyn Downie), who has been studying MAID for decades, said the team will need to determine the role of psychiatrists in conducting MAID assessments.

Downey said that another unresolved issue is whether patients with mental illness should have to prove that they have exhausted their treatment options before allowing them to obtain MAIDs.

Request in advance

The original law requires that patients who have been approved for assisted death must reconfirm their wishes before surgery.

Those who take powerful painkillers or suffer from degenerative diseases worry about losing the intelligence required for later consent, which forces them to consider assisted death as soon as possible.

This is the case of Audrey Parker, a woman from Nova Scotia, who has advanced breast cancer that has spread to her brain. In a video released a few days after the assisted death in 2018, Parker said that because of concerns about losing transparency, she chose an earlier death date than she wanted.

Bill C-7 includes what the advocates call the “Audrey Amendment”. It allows MAID recipients to be exempt from subsequent consent requirements.

Helen Long, chief executive of the advocacy group Dying With Dignity, said: “The prior consent means that people don’t have to choose to leave early.”

Listen | United Nations supervisory agency expresses concern about Canada’s medical dying law

However, the current law still requires MAID recipients to be in an irreversible decline and suffer unbearable pain. Many advocates hope to allow patients to request assisted death after diagnosis but in unbearable pain.

Long said, this will enable people to describe the future painful state, once this state is reached, the doctor will be able to continue the MAID procedure.

Lang said: “It is easy to think of a period when you may have a stroke, an aneurysm or even a catastrophic fall, and you will never be able to express your wishes again.”

Downey said: “When you are not in unbearable pain, you will make better decisions.” “Therefore, we want people to have a conversation and reach an agreement with their clinicians about the MAID they will provide in the future. ”

Mature minor

The age of consent is one of the most controversial issues in the death right debate.

Currently, only people over 18 years old can apply for MAID.

The Canadian Pediatrics Association has promoted the exclusion of minors from MAID, while others believe that the age limit is arbitrary.

Lang said that the concept of “minors” who can make medical decisions is already mature in Canadian healthcare.

“This is the same as the medical rescue procedure at the time of death, for example, ensuring that a child with life-long cancer can make the same choices that a 70-year-old man might make. Assuming they have the ability, maturity and ability to do so,” she says.

A kind Provincial Advisory Group It is recommended to obtain MAID based on age rather than age in 2015. The previous parliamentary committee also approved the entry of capable mature minors, but only after studying ethics, ethics, and legal issues.

Downey said that if adult minors have the legal right to refuse life treatment, they should have the right to choose assisted death.

She said: “Clinicians can assess the ability of these serious consequences.” “And they will take exactly the same way as they refuse life-sustaining treatment.”