The next chapter in medically assisted death laws in Canada

Advocates for the right to medically assisted death say Canada's new law will help more people suffering with debilitating illnesses to die on their own terms. But as Adrian Ghobrial hears, the changes venture into controversial territory.

By Adrian Ghobrial and Jessica Bruno

Cheryl Romaire said she felt a wave of relief wash over her when she heard legislation expanding access to medical assistance in dying (MAID) was now Canadian law.

“It hit me physically and I cried it out actually for a minute before I texted my parents,” she says.

Romaire has been living with a rare spinal and autoimmune condition since October 2017. The 44-year-old mother says she’s exhausted all treatment options available.

In 2019, after giving it extensive thought and consulting with her family, she applied to move forward with a medically assisted death. She was denied, because a natural death wasn’t deemed reasonably foreseeable, a key criteria at the time.

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As of late Wednesday night, the controversial Bill C-7 was signed into law after several rounds of debate and amendments by the House of Commons and Senate. Among the changes, a person’s death no longer has to be reasonably foreseeable for them to qualify. Two years after her initial application, Romaire says she intends to see her wish to die through.

“I don’t like to use the word suicide because its not,” she says. “I want to live. I want to live more than anything but this isn’t living, this is existing.”

Under the new rules, those seeking a doctor-assisted death are now put into two categories: those whose natural death is reasonably foreseeable and those whose natural death is not.

For those whose death is foreseeable, some rules are now relaxed. There is no longer a 10-day waiting period between being approved and going forward with the procedure. The number of witnesses has also been dropped from two to one. It also reduces the requirement that a person must consent again, right before receiving MAID.

“A classic example is terminal cancer,” Justice Minister David Lametti tells CityNews in a one-on-one interview. “So a person has the ability to set a date with their doctor, so that if they do lose capacity to make that final yes, their wishes will still be respected.”

For people who are not near death, there is a list of criteria. It includes having a serious and incurable “illness, disease or disability,” being in an advanced state of decline and suffering intolerably.

They must then complete a 90-day reflection period and meet with two doctors, who must both affirm that the patient has made an informed decision. That also includes access to counselling and support services.

“Those are quite important safeguards to make sure people have thought about this and have thought about the options,” says Lametti.

However, some members of Canada’s disability community have been fighting Bill C-7. They say it goes too far and would allow people with disabilities, who are suffering without proper societal support, to end their lives.

“There is a history in this country of legislating this idea that disabled people don’t have the right to exist,” disability rights advocate Sarah Jama told CityNews in January. “When you have a government that is allowing people the choice to die without really funding the choice to live and survive in our country, it scares me.”

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Lametti acknowledges the concerns of disability advocates, but says the new law was written with the concerns of disability advocates in mind. Still, he agrees that the government must do more to support people living with disabilities so that they are ultimately empowered to make meaningful end-of-life decisions.

“We do have to continuously seek to improve what folks have access to in the community, both in disability and in palliative care,” says Dr. John Clifford, who has provided MAID to dozens of patients over several years.

While Dr. Clifford is in favour of removing the “reasonably foreseeable” clause, he is also concerned about administering a medically assisted death to someone who doesn’t have a clear medical diagnosis for their chronic or insufferable pain, something that would now be allowed under the law.

“My concern is if the degree of suffering is based on subjective symptoms alone, be it a symptom or a collection of symptoms called a syndrome, then that will make it difficult for some healthcare professionals,” he says. “I won’t be involved in providing provisions unless there’s a clear association between the reports of suffering and a medical condition.”


Another controversial issue, which Parliament laid the groundwork for in this round of changes, is the ability of people suffering solely from serious mental illness to access MAID.

While some Senators were in support of extending provisions to that group, the final bill sticks to original government wording that explicitly excludes mental illness as a qualifying condition. However – there is now a two-year time limit on the ban.

As a compromise, a joint Senate-House of Commons committee will start working by mid-April on reviewing the impacts of the law. The group is expected to publish a report on mental illness and assisted dying and also to look at weather MAID should be extended to mature minors. A panel of experts will also review the provisions around mental illness.

“These are challenging issues,” says Lametti. “I just want to allay the fears that some people have raised that somebody can just walk off the street and say, ‘I’m depressed, I would like to have MAID.’ That can’t happen under the current regime with C-7, it’s certainly not going to be the end point after two years of study where we’ve looked at the conditions carefully and we’ve set out careful criteria.”

Romaire says she’s ready to move forward with her request to choose MAID, and says it’s been a difficult family discussion, but won both her parents’ and children’s support.

“They’re proud. They’re proud of the fight. They’re proud I didn’t give up three years ago,” she says. “Finally there’s an end in sight. And there hasn’t been one until now.”

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