Physician-assisted dying should be available for mature minors and mentally unwell, Parliamentary committee says

OTTAWA | A special committee appointed to guide lawmakers on physician-assisted dying has just released its long-awaited report which recommends that all publicly funded health institutions be required to offer PAD but only for Canadian medicare patients (to restrict so-called death tourism). The panel of MPs and Senators said that physicians should not be required to perform the service, but asked that those who conscientiously object be required to make an effective referral.The 21 recommendations, if accepted, also provide greater insight as to who will be eligible for PAD under law and the proper process for obtaining consent and carrying out the procedure. Dr. Jeff BlackmerIf made law, registered nurses and nurse practitioners will be allowed to administer the procedure under the supervision of a physician. At least two physicians will have to conclude that the person is eligible; meaning they would be in agreement that the patient suffers from a "grievous and irremediable" condition and is enduring "intolerable suffering."This would also apply to those suffering from psychiatric conditions.Controversial recommendationsThe report also contained a number of more contentious recommendations. For example, the committee suggested that "mature minors" be eligible for the procedure within the next three years, giving the government time to study the "moral, medical and legal issues" related to determining who exactly qualifies as "mature."The committee also suggested that patients be allowed to request assisted-dying before their suffering becomes intolerable. "(The) advance request may not, however, be made prior to being diagnosed with (a grievous and irremediable) condition," the report said. The committee also suggested that, whenever possible, such a request be made in writing and witnessed by two people without a conflict of interest (but, as our affiliate publication Advisor's Edge pointed out, the report doesn't actually say what constitutes a conflict of interest)."Our interpretation was that the Carter decision didn't seem to allow for advanced directives," said Dr. Jeff Blackmer, the Canadian Medical Association's vice-president of medical professionalism. "For physicians it really provides an extra layer of complexity that we will have to work out. It may seem very simple to say 'I'm going to set out what I want done in the future' and have those followed, but we know in real life you can never capture all the subtleties of a clinical condition or scenario."According to a Canadian Press report, several dissenting MPs issued a separate report criticizing a few of the recommendations. As the Globe and Mail's Andre Picard tweeted, they were particularly concerned about the recommendations surrounding minors and advanced directives. Dissenting members also said the recommendations didn't respect objecting physicians and that mentally ill patients weren't adequately protected."There is no group that is more vulnerable than people with underlying mental health challenges, on the question of capacity and on the question of consent,'' said Alberta MP Michael Cooper. He accused the committee of disregarding the top court's directions that there should be "stringent safeguards'' for such people.Support for reportDespite the dissent, the majority of Conservative senators were in favour of the report's recommendations. The Canadian Press reported that Dying with Dignity praised the report and NDP MPs also issued a report of their own, encouraging the recommendations to promote "culturally and spiritually appropriate care" for indigenous patients."I would say they've done a good job in a challenging situation with a wide variety of viewpoints," Dr. Blackmer said of the report. "We never anticipated that it was going to answer every question that was out there. They've provided good guidance on some of the complicated issues and there's more work to be done."

Physician-assisted dying should be available for mature minors and mentally unwell, Parliamentary committee says

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