Right-to-die debate ignites calls for better palliative care

Religious leaders from several faiths are calling on Canadian legislators to improve palliative care and respect human life as the contentious debate over doctor-assisted dying heats up.

The Canadian Conference of Catholic Bishops and the Evangelical Fellowship of Canada, along with other faith leaders, held a joint news conference on Parliament Hill to release a declaration on physician-assisted death.

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"We urge federal, provincial and territorial legislators to enact and uphold laws that enhance human solidarity by promoting the rights to life and security for all people; to make good-quality home care and palliative care accessible in all jurisdictions; and to implement regulations and policies that ensure respect for the freedom of conscience of all health-care workers and administrators who will not and can not attempt suicide or euthanasia as a medical solution to pain and suffering," the declaration reads.

The statement has been endorsed by more than 30 Christian denominations, as well as Jewish and Muslim leaders from across the country. 

In a unanimous landmark ruling on Feb. 6, 2015, the Supreme Court of Canada struck down the ban on physician-assisted dying, on the grounds that it violated Canadians' charter rights. Justices gave the federal and provincial governments 12 months to prepare for the decision to come into effect.

This week, CBC News reported the incoming Liberal government is considering asking the Supreme Court for a six-month extension to draft new laws.

Ottawa Rabbi Reuven Bulka said while the religious groups oppose assisted death, they do not want to impose their will on Canadians. Instead, they want to be heard in the process of enacting new policies, which he says should focus on universal access to palliative care and improved supports for the terminally ill and their caregivers.

"We are convinced that were this choice available to everyone, Canadians would overwhelmingly choose it," he said. "But without access, Canadians are unfairly deprived of this life choice."

Ottawa Catholic Archbishop Terrence Prendergast warned about the dangers of not having strong laws in place.

"The biggest fear is that we have the same situation as we have with abortion, which is no regulations, no controls, no safeguards, " he said. "We would have people, teenagers, deciding that they don't want to live and they'd ask the doctor to put them away."

Sister Nuala Kenny said as it stands now, without new laws Canada will have "the most liberal end-of-life policy in the world." She said the new regulatory framework must include strict definitions around competence and consent and what constitutes a "grievous" physical or psychological condition.

The Conservatives had set up an independent panel this summer to hear from Canadians. Work was suspended during the three-month election campaign.

Dr. Cindy Forbes, the new president of the Canadian Medical Association, hopes there will be a national approach to legislation instead of a patchwork of regulations that differ depending on where you live in Canada.

She said doctors were initially divided over whether they should be allowed to help a terminally ill patient end his or her life. Since the Supreme Court ruled, the conversation has changed to one about how physicians will be protected if they choose to participate or not.

"It's a very difficult issue. It requires a lot of soul-searching and physicians are struggling with this in many respects the same as the general public," Forbes said. "It's definitely not something that we learned about in medical school. It's a changing of the landscape completely when it comes to conversations about life and death."

Patients in 'cruel limbo'

Advocacy group Dying With Dignity issued a statement opposing the request for an extension by the incoming Liberal government.

"Right now, patients across this country are living in a cruel limbo, grappling with unimaginable suffering while they wait for their rights to be fully recognized," said the group's chief executive officer Wanda Morris. "Another six months may seem like nothing to politicians in Ottawa, but to Canadians facing horrible diagnoses, a delay of weeks or even days can mean the difference between a peaceful death and a torturous one." 

Defeated Conservative MP Steven Fletcher had his own private member's bill on the issue, and has long been an advocate for physician-assisted dying.

He would prefer the federal government let the provinces deal with the issue going forward.

"I'm not sure what kind of legislation the government could bring forward. What the Supreme Court did was, when they made their decision, they took the meat of my private member's bill and put it into their decision. So the framework, the boundaries are already in place," Fletcher said.

Politicians dodged issue

Fletcher said all political parties dodged this issue in any kind of detail in the election campaign.

"Politicians are terrible at making laws that deal with morality, particularly telling cognitive adults what they can or can not do," he said.

But, he added, he heard from many voters about their support for physician-assisted dying, and he believes the political tone will change going forward, not because it's a new government, but because of what Canadians are telling their politicians.

"The people who went door knocking in the last three months would have heard about this on their doorstep. And what people would say, in my experience was, the vast majority were in favour of physician-assisted death with the appropriate caveats," Fletcher said.