As Geriatric Psychiatrists, we may soon be consulted to assess a person’s capacity to request physician assisted death. We must be prepared to deal with this scenario very quickly as the clock is ticking on, triggered by the February 6, 2015 unanimous decision by the Supreme Court of Canada which has struck down the existing law prohibiting physician assisted death. The current prohibition of physician assisted dying will be lifted in one year from the date of the decision.
In terms of some background, the Province of Quebec has been at the leading edge of recent development in this area. In 2009, the Collège des Médecins du Québec began reflection on this issue. A special Parliamentary Commission of the Québec National Assembly considered the question of dying with dignity in 2010 with widespread consultation and public hearings throughout Québec in 2011. This led to Bill 52, which was finally adopted in June 2014, and is due to be the law in Quebec no later than December 2015. This law on end-of-life care encompasses a “continuum of care”, from palliative care, terminal sedation, and includes “medical aid in dying”, understood by many as being equivalent to euthanasia.
Subsequently, on February 6th, 2015, the Supreme Court of Canada, in a rare unanimous decision, invoking Section 7 of the Charter of Rights (life, autonomy and security of the person), struck down the provisions of the Criminal Code pertaining to homicidal acts by a physician, at the request of a capable adult, in the context of subjectively defined physical and psychological suffering, with no reference to a terminal illness. This decision is suspended for one year, to leave room for legislative initiatives by the federal and provincial governments, colleges and professional organizations, to further regulate or modify end-of-life care. It will take full effect throughout Canada on February 6th, 2016, if no legislative action is undertaken before this deadline to restrict its wide and profound implications for every day care.
The CAGP would like its members to have an opportunity to fully reflect on this important and sensitive issue. It will bring about significant change to the way we practice our profession and has the potential to vastly alter our core values. Many of our patients are extremely frail, vulnerable, and do not have the ability to speak for themselves, causing concern to many geriatric psychiatrists.
We have been asked to solicit the participation of interested geriatric psychiatrists to form a working group on this important issue to begin reflection and dialogue. This group could communicate electronically between 2015 into 2016, with the goal of producing a position paper accepted by CAGP to be presented at the Annual Meeting in 2016. I have personally been reflecting on euthanasia since 2010. I presented an expert Memoir to the Commission in 2010, and was heard at the National Assembly in 2011 and again in 2013. However, input from colleagues across Canada is needed and is essential to enrich our common approach to this issue.
Other members of this group will include the following: Kiran Rabheru will be the liaison person between the CAGP, the CPA, and the CMA, allowing the coordinated efforts with our psychiatric and physician colleagues. Jessika Roy-Desruisseaux, a young geriatric psychiatry colleague from Sherbrooke, Québec, will assist in this effort. She is currently President of the Ad Hoc Committee of the Québec Psychiatrists Association on end-of-life care. She has helped coordinate a thoughtful Document de réflexion which is to be presented at the 49th Annual Meeting of this organization in Québec City on May 29th, 2015. Harvey Chochinov, Canada Research Chair in Palliative Care, a distinguished Professor of Psychiatry at the University of Manitoba in Winnipeg and a prominent ethicist for the University of Chicago, has kindly agreed to be an advisor to our group.
We therefore urge all interested CAGP members to join in this reflection as this issue will impact all of our practices and challenge our core values. To which extent are we willing to “help” our patients? Would we provide assistance with dying at their request? Many factions of our society including politicians, journalists, judges, and others are welcome to reflect on end-of-life care. However clinicians working exclusively with the elderly must be a crucial part on this national conversation about this pivotal change in the way medicine will be practised, and momentous challenge to the core foundation of human civilization and evolution.
All interested colleagues are invited to email the secretariat of CAGP (CAGP@secretariatcentral.com) expressing their area of interest, using the subject line: “Physician Assisted Death”. We will then develop a list of topics to be discussed based on the expressed areas of interest and consider the Document de réflexion, translated in English, as a starting point.
Thank you for your interest and your response.
Geriatric Psychiatry, Hôtel-Dieu de Lévis and Laval University