Audrey Parker, who chose to receive an assisted death on Nov. 1, 2018, feared that her advanced breast cancer, which had already spread to her brain, would soon make her incapable of providing 'late-stage consent' on the day of her death.Chris Donovan/The Globe and Mail
Allowing Canadians to request a medically assisted death weeks or even years ahead of time would be less ethically fraught if limited to patients who have already been approved to receive the procedure imminently, according to an early draft of a report prepared for the federal government.
Permitting advance requests for patients with dementia − especially in cases where years elapse between the formal application and the lethal injection − would be much more complicated and would require extensive safeguards, says the draft, obtained by The Globe and Mail.
The Council of Canadian Academies, an independent not-for-profit organization, was asked by Ottawa nearly two years ago to produce reports on three types of patients who don’t qualify for an assisted death under the law, including those who want a doctor to end their lives after they’ve lost the capacity to say yes at the moment of death.
The Globe and Mail obtained a confidential draft of the advance requests portion of the report on the same day that Audrey Parker, a 57-year-old Halifax woman, chose to receive an assisted death earlier than she would have liked.
Read more: Audrey Parker is bent on changing Canada’s late-stage consent rule – if only posthumously
Ms. Parker feared that her advanced breast cancer, which had already spread to her brain, would soon make her incapable of providing “late-stage consent” on the day of her death – in which case, she wouldn’t have qualified for a legal assisted death. Ms. Parker had already been assessed by two physicians who concluded that she was suffering intolerably and her death was “reasonably foreseeable,” as required by the law.
In her final sign-off on Facebook, Ms. Parker called the late-stage consent rule, which was written into the law as a safeguard, “a cowardly act that completely ruined the [assisted-dying] process for people like me who are dying.”
“I wanted to make it to Christmas and New Year’s Eve … but I lost that opportunity because of a poorly thought-out federal law,” she wrote in her final post.
Asked during Question Period on Thursday whether the government would amend the legislation, federal Health Minister Ginette Petitpas Taylor expressed sympathy for Ms. Parker’s plight.
“If I could have given authorization for her advanced request, I would have absolutely done so,” Ms. Petitpas Taylor said. “But as parliamentarians, the laws we make are for all Canadians. That’s why we put in place a group of experts to look at three sensitive areas, as we want to protect our vulnerable Canadians.”
Ms. Petitpas Taylor added that she was looking forward to receiving the expert panel’s report, which is scheduled to be released in December.
The confidential draft The Globe obtained forms part of that coming report.
However, the 188-page draft – dated Aug. 3, 2018 and marked as “working draft 5.0” – is not the finished version and “does not reflect the final deliberations of the Working Group,” according to Eric Meslin, the president and chief executive of the Council of Canadian Academies.
The final version won’t include any specific recommendations: When Prime Minister Justin Trudeau’s government gave the council directions, it asked the experts to stick to summarizing the evidence. The government isn’t obligated to act on the findings of the expert panel.
The draft of the partial report analyzes three scenarios for advance requests: Cases such as Ms. Parker’s, where patients have already been assessed by two doctors and approved; cases where patients have been diagnosed with dementia; and cases where people have not received a diagnosis but want to make an advance request for medical assistance in dying (MAID), just in case.
“The complexity of each individual [advance request] for MAID would be influenced by the timing of a request in relation to its implementation. [Advance requests] prepared shortly before MAID was to be provided (e.g., when a patient already met eligibility requirements) would involve much less uncertainty than [advance requests] for MAID written well in advance of the point at which they might be implemented,” the draft says.
The bulk of the draft is dedicated to the practical and moral challenges of allowing people with dementia to request an assisted death in advance. There is scant international evidence to rely on: Only four countries permit advance requests in dementia cases and two of them, Belgium and Luxembourg, allow the lethal injections to go ahead only once a patient is irreversibly unconscious.
In the Netherlands, there are only seven “reported cases of people registered as incompetent, who received euthanasia based on their advance directive." Dutch physicians are extremely reluctant to hasten the death of patients who have lost the capacity to consent, the draft says.