Dying with dignity – the new law on End-of-Life care

The right to die with dignity has provoked debates around the world. In Canada, there have been several unsuccessful attempts to have amendments made to articles 14 and 241 of the Criminal Code prohibiting assisted suicide and consent to death, including the 1993 Rodriguez decision, until the Carter judgment was rendered in February 2015.

This judgment recognizes that the right to life under section 7 of the Canadian Charter of Rights and Freedoms is not an absolute right and it is now possible to renounce to the right to life. Quebec, meanwhile, is the first province in Canada to adopt legislation with regards to end-of-life care, including a particular section on medical aid in dying. The Act Respecting End-of-Life Care brought forth many changes when it came into force, not without controversy, on December 10th, 2015.

Before the modifications introduced by the new legislation, a person of full age and who is capable to give consent could, at any time, refuse to receive a treatment or withdraw consent to receive care necessary to keep them alive. The new law brings a new option; i.e. the right to end-of-life care.

End-of-life care includes the right to palliative care (which includes continuous palliative sedation) and the right to medical aid in dying. These new rights essentially allow a person to end their life with the assistance of a healthcare professional. The law provides strict conditions limiting access to this option. Among other things, a person must be at the end of life, be of full age and capable of giving consent to care, suffer from a serious and incurable illness, be in a medical condition characterized by an advanced state of irreversible decline in capability, and experience constant and unbearable physical or psychological suffering which cannot be relieved in a manner that the patient deems tolerable.

The Act Respecting End-of-Life Care also recognizes the primacy of freely and clearly expressed wishes with respect to care, in particular by establishing an advance medical directives regime. This gives a more binding nature to advance medical directives then existed before.

In short, the main purpose of this law is to ensure care to those in end-of-life that is respectful of their dignity and of their autonomy. However one wonders if consent can truly be free and informed if a person is in unbearable pain? Also, the federal government still has not ruled on the follow-up to the Carter decision, it will therefore be interesting to see how the federal and provincial laws will interact and how they will be applied on a practical basis.