Submission to the Standing Committee on Justice and Human Rights, Parliament of Canada: Amendment to Bill C-7: An Act to Amend the Criminal Code (Medical Assistance in Dying)

2020 ◽  
Author(s):  
Sean T. Murphy
Keyword(s):  
Human Rights ◽  
Criminal Code ◽  
Medical Assistance ◽  
Standing Committee ◽  
Medical Assistance In Dying

scholarly journals P.117 The opinion of Canadian spine surgeons on medical assistance in dying (MAID); a cross-sectional survey of Canadian spine society (CSS) members

2019 ◽  
Vol 46 (s1) ◽  
pp. S44
Author(s):  
E Leck ◽  
S Barry ◽  
S Christie
Keyword(s):  
Cervical Spinal Cord ◽  
Criminal Code ◽  
Supreme Court Of Canada ◽  
Medical Assistance ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical Assistance In Dying ◽  
Cord Injury ◽  
The Right ◽  
Spine Tumour

Background: On February 6, 2015, the Supreme Court of Canada struck down the Criminal Code absolute prohibition on assisted dying, and in June 2016 the new law, Bill C-14, came into effect allowing for medical assistance in dying. We sought to determine the attitudes and opinions of Canadian neurosurgeons and orthopedic spine surgeons regarding MAID. Methods: A cross-sectional survey was sent out to members of the Canadian Spine Society (CSS), which included 21 questions pertaining to opinions regarding MAID. Responses were collected between May-June 2016. Results: A total of 51 surgeons responded to the survey, comprised of a mix of spine surgeons from across the country. The majority of surgeons supported MAID (62.8%), and right of physicians to participate (82.4%). Most surgeons supported the right to conscientious objection (90.1%), but also mandatory duty to refer (49.0%). The conditions most frequently felt to be appropriate for MAID included metastatic spine tumour (76.5%), malignant intramedullary tumour (64.7%), primary malignant spine tumour (54.9%), cervical spinal cord injury with tetraplegia (49.0%) and multiple myeloma (33.3%). Conclusions: This study highlights the complex landscape that exists when discussing MAID, but also the overall support of physicians, and need for ongoing conversations, particularly with issues not addressed by the current legislation.

scholarly journals Analysis of the Medical Assistance in Dying Cases in Ontario: Understanding the Patient Demographics of Case Uptake in Ontario since the Royal Assent and Amendments of Bill C-14 in Canada

2017 ◽  
Vol 7 (2) ◽  
pp. 263-287 ◽  
Author(s):  
Alexandra E. Rosso ◽  
Dirk Huyer ◽  
Alfredo Walker
Keyword(s):  
Nurse Practitioners ◽  
Medical Condition ◽  
Medical Personnel ◽  
Drug Regimen ◽  
Criminal Code ◽  
Medical Assistance ◽  
Eligibility Criteria ◽  
Medical Assistance In Dying ◽  
Patient Demographics ◽  
The Individual

On June 17, 2016, the Canadian government legalized medical assistance in dying (MAID) across the country by giving Royal Assent to Bill C-14. This Act made amendments to the Criminal Code and other Acts relating to MAID, allowing physicians and nurse practitioners to offer clinician-administered and self-administered MAID in conjunction with pharmacists being able to dispense the necessary medications. The eligibility criteria for MAID indicates that the individual 1) must be a recipient of publicly funded health services in Canada, 2) be at least 18 years of age, 3) be capable of health-related decision-making, and 4) has a grievous and irremediable medical condition. Because this is a new practice in Canadian health care, there are no published Canadian statistics on MAID cases to date, and this paper constitutes the first analysis of MAID cases in both the province of Ontario and Canada. Internationally, there are only a few jurisdictions with similar legislation already in place (US, the Netherlands, Belgium, Luxembourg, Switzerland, Columbia, Japan, and the United Kingdom). The published statistics on MAID cases from these jurisdictions were reviewed and used to establish the current global practices and demographics of MAID and will provide useful comparisons for Canada. This analysis will 1) outline the Canadian legislative approach to MAID, 2) provide an understanding of which patient populations in Ontario are using MAID and under what circumstances, and 3) determine if patterns exist between the internationally published MAID patient demographics and the Canadian MAID data. Selected patient demographics of the first 100 MAID cases in Ontario were reviewed and analyzed using anonymized data obtained from the Office of the Chief Coroner for Ontario so that an insight into the provision of MAID in Ontario could be obtained. Demographic factors such as age, sex, the primary medical diagnosis that prompted the request for MAID, the patient rationale for making a MAID request, the place where MAID was administered, the nature of MAID drug regimen used, and the status/specialty of medical personnel who administered the MAID drug regimen were analyzed. The analysis revealed that the majority of the first 100 MAID recipients were older adults (only 5.2% of patients were aged 35-54 years, with no younger adults between ages 18-34 years) who were afflicted with cancer (64%) and had opted for clinician-administered MAID (99%) that had been delivered in either a hospital (38.8%) or private residence (44.9%). Although the cohort was small, these Ontario MAID demographics reflect similar observations as those published internationally, but further analysis of both larger and annual case uptake in both Ontario and Canada will be conducted as the number of cases increases.

scholarly journals Free to Die: A Lutheran-Relational Approach to Medical Assistance in Dying

Religions ◽  
2020 ◽  
Vol 11 (4) ◽  
pp. 213
Author(s):  
Kayko Driedger Hesslein
Keyword(s):  
Medical Diagnosis ◽  
Medical Staff ◽  
Criminal Code ◽  
Medical Assistance ◽  
Power Of Attorney ◽  
Christian Church ◽  
Historical Interpretation ◽  
Relational Approach ◽  
Medical Assistance In Dying ◽  
Doctors And Nurses

In 2016, Canada legalized Bill C-14, which removed from the Criminal Code medical assistance in dying (MAID) under certain circumstances. In essence, the Bill legalized what is commonly described as euthanasia, under the provisions that the patient has a terminal medical diagnosis, anticipates extreme suffering, is at least 18 years old and still maintains their own medical power of attorney, has received the same diagnosis from two separate doctors, and requests such a procedure without duress. The bill exempts doctors and nurses from culpability in murder, along with those aiding the medical staff. The bill replaces sections of the Criminal Code that criminalize death by suicide. In this article, I first review the theological and historical interpretation of suicide within the Christian church. I then offer a specifically Lutheran feminist framework of our baptism into death, Luther’s explanation of the First Commandment, and Christian freedom to affirm Christians’ faithful decisions in seeking medical assistance in dying.

Medical Assistance in Dying: A Review of Canadian Regulatory Documents

2020 ◽  
Vol 21 (2) ◽  
pp. 56-59
Author(s):  
Michael J. Villeneuve
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Professional Associations ◽  
Criminal Code ◽  
Care Providers ◽  
Ethical Practice ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Regulatory Documents

After years of heated debate about the issue, medical assistance in dying (MAiD) was legalized in Canada in 2016. Canada became the first jurisdiction where MAiD may be delivered by nurse practitioners as well as physicians. Experience has revealed significant public demand for the service, and Canadians expect nurses to advocate for safe, high-quality, ethical practice in this new area of care. Pesut et al. offer a superb analysis of the related Canadian nursing regulatory documents and the challenges in creating a harmonized approach that arise in a federation where the Criminal Code is a federal entity and the regulation of health care providers and delivery of care fall under provincial and territorial legislation. Organizations like the Canadian Nurses Association contribute to the development of good legislation by working with partners to present evidence to help legislators consider impacts on public health, health care, and providers. Nursing regulators across Canada responded quickly to the unfolding policy landscape as the federal legislation evolved and will face that task again: In February 2020, the federal government tabled legislation to relax conditions related to MAiD requests that will force regulators and professional associations back to public advocacy and legislative tables. The success of the cautious approach exercised by nursing bodies throughout this journey should continue to reassure Canadians that their high trust in the profession is well placed.

Nurse leaders’ role in medical assistance in dying: A relational ethics approach

2017 ◽  
Vol 26 (4) ◽  
pp. 993-999 ◽  
Author(s):  
Tracy Thiele ◽  
Jennifer Dunsford
Keyword(s):  
Moral Dilemmas ◽  
Routine Care ◽  
Criminal Code ◽  
Nursing Leadership ◽  
Relational Ethics ◽  
Medical Assistance ◽  
Ethics Framework ◽  
Medical Assistance In Dying ◽  
The Individual

Recent changes to the Criminal Code of Canada have resulted in the right of competent adult Canadians to request medical assistance in dying (MAID). Healthcare professionals now can participate if the individual meets specific outlined criteria. There remains confusion and lack of knowledge about the specific role of nurses in MAID. MAID is a controversial topic and nurses may be faced with the challenge of balancing the duty to provide routine care, with moral reservations about MAID. The role of a nursing leader is to support nurses by ensuring they have the knowledge they require to care for patients requesting the service, whether or not the nurse is directly involved in the MAID process. The moral dilemmas raised by MAID provide an opportunity to look at a relational ethics approach to nursing leadership both for MAID and other difficult situations that arise in nursing practice. Relational ethics is a framework that proposes that the ethical moments in healthcare are based on relationships and fostering growth, healing, and health through the foundational concepts of mutual respect, engagement, embodiment, and environment. This article will use a relational ethics framework to examine how nursing leadership can support nurses who care for patients requesting MAID.

A Values-Based Analysis of Recovery-Oriented Practice in Mental Health Care and Medical Assistance in Dying

2020 ◽  
Vol 39 (2) ◽  
pp. 1-10
Author(s):  
Rosanna Macri ◽  
Frank Wagner ◽  
Melanie I. Stuckey
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Medical Condition ◽  
Criminal Code ◽  
Comprehensive Analysis ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
People With Mental Illness ◽  
Considerable Debate ◽  
Underlying Medical Condition

The Criminal Code of Canada has been amended to allow medical assistance in dying (MAiD) under prescribed criteria. There has been considerable debate regarding whether people with mental illness as the sole underlying medical condition should be eligible. It is argued that access to MAiD is not compatible with recovery-oriented care. Based on a comprehensive analysis exploring the ethical principles guiding decision making around MAiD, this paper offers a discussion of the compatibility between MAiD and recovery-oriented care and demonstrates significant overlap of these principles. The discussion around MAiD as an option in recovery-oriented care is legitimate and needs to continue.

scholarly journals Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

2018 ◽  
Vol 5 ◽  
Author(s):  
Timothy Christie ◽  
John Sloan ◽  
Dylan Dahlgren ◽  
Fred Koning
Keyword(s):  
Health Care Professionals ◽  
Criminal Code ◽  
Conscientious Objection ◽  
Supreme Court Of Canada ◽  
Conscientious Objector ◽  
Medical Assistance ◽  
Right To Life ◽  
Medical Assistance In Dying ◽  
Deontological Ethics ◽  
The Right

Background: The Supreme Court of Canada (SCC) has ruled that the federal government is required to remove the provisions of the Criminal Code of Canada that prohibit medical assistance in dying (MAID). The SCC has stipulated that individual physicians will not be required to provide MAID should they have a religious or conscientious objection. Therefore, the pending legislative response will have to balance the rights of the patients with the rights of physicians, other health care professionals, and objecting institutions. Objective: The objective of this paper is to critically assess, within the Canadian context, the moral probity of individual or institutional objections to MAID that are for either religious or conscientious reasons. Methods: Deontological ethics and the Doctrine of Double Effect. Results: The religious or conscientious objector has conflicting duties, i.e., a duty to respect the “right to life” (section 7 of the Charter) and a duty to respect the tenets of his or her religious or conscientious beliefs (protected by section 2 of the Charter). Conclusion: The discussion of religious or conscientious objections to MAID has not explicitly considered the competing duties of the conscientious objector. It has focussed on the fact that a conscientious objection exists and has ignored the normative question of whether the duty to respect one’s conscience or religion supersedes the duty to respect the patient’s right to life.

KEBIJAKAN MODERASI PIDANA MATI

2017 ◽  
Vol 10 (2) ◽  
pp. 193
Author(s):  
Mei Susanto ◽  
Ajie Ramdan
Keyword(s):  
Human Rights ◽  
Death Penalty ◽  
Capital Punishment ◽  
Criminal Code ◽  
Right To Life ◽  
Life Imprisonment ◽  
Research Results ◽  
Moderation Model ◽  
The Right

ABSTRAKPutusan Nomor 2-3/PUU-V/2007 selain menjadi dasar konstitusionalitas pidana mati, juga memberikan jalan tengah (moderasi) terhadap perdebatan antara kelompok yang ingin mempertahankan (retensionis) dan yang ingin menghapus (abolisionis) pidana mati. Permasalahan dalam penelitian ini adalah bagaimana kebijakan moderasi pidana mati dalam putusan a quo dikaitkan dengan teori pemidanaan dan hak asasi manusia dan bagaimana kebijakan moderasi pidana mati dalam RKUHP tahun 2015 dikaitkan dengan putusan a quo. Penelitian ini merupakan penelitian doktrinal, dengan menggunakan bahan hukum primer dan sekunder, berupa peraturan perundang-undangan, literatur, dan hasil-hasil penelitian yang relevan dengan objek penelitian. Penelitian menyimpulkan, pertama, putusan a quo yang memuat kebijakan moderasi pidana mati telah sesuai dengan teori pemidanaan khususnya teori integratif dan teori hak asasi manusia di Indonesia di mana hak hidup tetap dibatasi oleh kewajiban asasi yang diatur dengan undang-undang. Kedua, model kebijakan moderasi pidana mati dalam RKUHP tahun 2015 beberapa di antaranya telah mengakomodasi amanat putusan a quo, seperti penentuan pidana mati di luar pidana pokok, penundaan pidana mati, kemungkinan pengubahan pidana mati menjadi pidana seumur hidup atau penjara paling lama 20 tahun. Selain itu masih menimbulkan persoalan berkaitan dengan lembaga yang memberikan pengubahan pidana mati, persoalan grasi, lamanya penundaan pelaksanaan pidana mati, dan jenis pidana apa saja yang dapat diancamkan pidana mati.Kata kunci: kebijakan, KUHP, moderasi, pidana mati. ABSTRACTConstitutional Court’s Decision Number 2-3/PUU-V/2007, in addition to being the basis of the constitutionality of capital punishment, also provides a moderate way of arguing between retentionist groups and those wishing to abolish the death penalty (abolitionist). The problem in this research is how the moderation policy of capital punishment in aquo decision is associated with the theory of punishment and human rights and how the moderation policy of capital punishment in the draft Criminal Code of 2015 (RKUHP) is related with the a quo decision. This study is doctrinal, using primary and secondary legal materials, in the form of legislation, literature and research results that are relevant to the object of analysis. This study concludes, firstly, the aquo decision containing the moderation policy of capital punishment has been in accordance with the theory of punishment, specificallyy the integrative theory and the theory of human rights in Indonesia, in which the right to life remains limited by the fundamental obligations set forth in the law. Secondly, some of the modes of moderation model of capital punishment in RKUHP of 2015 have accommodated the mandate of aquo decision, such as the determination of capital punishment outside the main punishment, postponement of capital punishment, the possibility of converting capital punishment to life imprisonment or imprisonment of 20 years. In addition, it still raises issues regarding the institutions that provide for conversion of capital punishment, pardon matters, length of delay in the execution of capital punishment, and any types of crime punishable by capital punishment. Keywords: policy, criminal code, moderation, capital punishment.

scholarly journals Association of socioeconomic status with medical assistance in dying: a case–control analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e043547
Author(s):  
Donald A Redelmeier ◽  
Kelvin Ng ◽  
Deva Thiruchelvam ◽  
Eldar Shafir
Keyword(s):  
Socioeconomic Status ◽  
Palliative Care ◽  
Low Socioeconomic Status ◽  
Case Control ◽  
Control Analysis ◽  
Medical Assistance ◽  
Low Socioeconomic ◽  
Medical Assistance In Dying ◽  
Income Status ◽  
Economic Constraints

ObjectivesEconomic constraints are a common explanation of why patients with low socioeconomic status tend to experience less access to medical care. We tested whether the decreased care extends to medical assistance in dying in a healthcare system with no direct economic constraints.DesignPopulation-based case–control study of adults who died.SettingOntario, Canada, between 1 June 2016 and 1 June 2019.PatientsPatients receiving palliative care under universal insurance with no user fees.ExposurePatient’s socioeconomic status identified using standardised quintiles.Main outcome measureWhether the patient received medical assistance in dying.ResultsA total of 50 096 palliative care patients died, of whom 920 received medical assistance in dying (cases) and 49 176 did not receive medical assistance in dying (controls). Medical assistance in dying was less frequent for patients with low socioeconomic status (166 of 11 008=1.5%) than for patients with high socioeconomic status (227 of 9277=2.4%). This equalled a 39% decreased odds of receiving medical assistance in dying associated with low socioeconomic status (OR=0.61, 95% CI 0.50 to 0.75, p<0.001). The relative decrease was evident across diverse patient groups and after adjusting for age, sex, home location, malignancy diagnosis, healthcare utilisation and overall frailty. The findings also replicated in a subgroup analysis that matched patients on responsible physician, a sensitivity analysis based on a different socioeconomic measure of low-income status and a confirmation study using a randomised survey design.ConclusionsPatients with low socioeconomic status are less likely to receive medical assistance in dying under universal health insurance. An awareness of this imbalance may help in understanding patient decisions in less extreme clinical settings.

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