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Ottawans will get a say in setting new rules governing assisted suicide when the province’s consultations on the subject reach the national capital Jan. 7.
For one of the stickiest moral challenges of our time — even people who are in favour of allowing doctor-assisted death worry about just how freely available it should be — the talking will be brief: two hours in English and two more in French, starting at 5:30 in a conference room at the Sheraton at 150 Albert St. It’ll be in roundtable format, run by government staff, not a chance to harangue politicians directly.
It’s not impromptu, exactly, but there is an element of haste, caused by a Supreme Court decision last winter that gave governments a year to work out how to allow ill adults to end their lives with doctors’ help.
“People are asked to register if they plan to attend,” says health ministry spokeswoman Joanne Woodward Fraser. “But it is not mandatory that they register — they can just show up.”
The issue is a jurisdictional nightmare: Helping someone end his or her life is forbidden now by federal criminal law, but regulating how doctors will do it is a health-care matter for the provinces, but paying for health care is a joint responsibility (kind of) and national standards require national-level agreement.
Somehow the feds and 13 provinces and territories have to get on the same page, and fast. The original deadline was February; the new Liberal government has asked for a six-month extension. There’s been a blizzard of work: the federal government has a panel working on a report on what should be allowed and what shouldn’t, the provinces formed an expert panel of their own that reported at the end of November. Now the consultations in Ottawa, and eight others across this province over two weeks in January, are aimed at helping Ontario settle its position. There’s also an online survey.
The Supreme Court has already made the critical ruling, unanimously at that, that competent adults who are suffering intolerably have a right to die with medical help. What’s at issue is what safeguards and obligations will surround that right.
The provinces’ expert panel, whose 43 recommendations from a month ago form the skeleton of the discussion, was big on leaving decisions in the hands of patients and doctors. Two physicians — a main care provider and a reviewer — would have to agree that the patient was competent to make the decision to die and was genuinely suffering terribly, but otherwise most of the panel’s advice was about removing obstacles.
For instance, assisted suicide should be publicly funded like other health care, and hospitals couldn’t just refuse to allow it on their premises. Individual physicians wouldn’t have to help patients die if they object to assisted suicide on principle, but they’d have to make sure their patients knew about the option and ultimately transfer them to more willing doctors. People who die with medical assistance shouldn’t void their life insurance. That kind of thing.
More starkly, the panel advised against hard age limits, so even suffering children could choose to die if their guardians and doctors believed they had a full understanding of the decision. It said there should be no explicit list of qualifying afflictions. And patients should be able to make declarations of their wishes that would persist even if their capacity to reaffirm those wishes failed.
If there’s hope in this dark discussion, it’s that the panel also recommended that all the provinces do a better job with palliative care, keeping people as comfortable as possible in the last months and weeks of their lives. We’re better at this than we used to be, but it’s still a fringe element of medicine and the health system. The more seriously we take it, and the more aware patients are of the possibilities, the less we should have of the intolerable suffering, or the anticipation of such suffering, that makes assisted suicide seem like the best option.
But sooner or later in 2016, that option will become reality in Canada and the provinces’ experts have recommended relatively broad access to it. Agree or not, the next few weeks are the time for Ontarians to speak up.
dreevely@ottawacitizen.com
twitter.com/davidreevely
查看原文...
For one of the stickiest moral challenges of our time — even people who are in favour of allowing doctor-assisted death worry about just how freely available it should be — the talking will be brief: two hours in English and two more in French, starting at 5:30 in a conference room at the Sheraton at 150 Albert St. It’ll be in roundtable format, run by government staff, not a chance to harangue politicians directly.
It’s not impromptu, exactly, but there is an element of haste, caused by a Supreme Court decision last winter that gave governments a year to work out how to allow ill adults to end their lives with doctors’ help.
“People are asked to register if they plan to attend,” says health ministry spokeswoman Joanne Woodward Fraser. “But it is not mandatory that they register — they can just show up.”
The issue is a jurisdictional nightmare: Helping someone end his or her life is forbidden now by federal criminal law, but regulating how doctors will do it is a health-care matter for the provinces, but paying for health care is a joint responsibility (kind of) and national standards require national-level agreement.
Somehow the feds and 13 provinces and territories have to get on the same page, and fast. The original deadline was February; the new Liberal government has asked for a six-month extension. There’s been a blizzard of work: the federal government has a panel working on a report on what should be allowed and what shouldn’t, the provinces formed an expert panel of their own that reported at the end of November. Now the consultations in Ottawa, and eight others across this province over two weeks in January, are aimed at helping Ontario settle its position. There’s also an online survey.
The Supreme Court has already made the critical ruling, unanimously at that, that competent adults who are suffering intolerably have a right to die with medical help. What’s at issue is what safeguards and obligations will surround that right.
The provinces’ expert panel, whose 43 recommendations from a month ago form the skeleton of the discussion, was big on leaving decisions in the hands of patients and doctors. Two physicians — a main care provider and a reviewer — would have to agree that the patient was competent to make the decision to die and was genuinely suffering terribly, but otherwise most of the panel’s advice was about removing obstacles.
For instance, assisted suicide should be publicly funded like other health care, and hospitals couldn’t just refuse to allow it on their premises. Individual physicians wouldn’t have to help patients die if they object to assisted suicide on principle, but they’d have to make sure their patients knew about the option and ultimately transfer them to more willing doctors. People who die with medical assistance shouldn’t void their life insurance. That kind of thing.
More starkly, the panel advised against hard age limits, so even suffering children could choose to die if their guardians and doctors believed they had a full understanding of the decision. It said there should be no explicit list of qualifying afflictions. And patients should be able to make declarations of their wishes that would persist even if their capacity to reaffirm those wishes failed.
If there’s hope in this dark discussion, it’s that the panel also recommended that all the provinces do a better job with palliative care, keeping people as comfortable as possible in the last months and weeks of their lives. We’re better at this than we used to be, but it’s still a fringe element of medicine and the health system. The more seriously we take it, and the more aware patients are of the possibilities, the less we should have of the intolerable suffering, or the anticipation of such suffering, that makes assisted suicide seem like the best option.
But sooner or later in 2016, that option will become reality in Canada and the provinces’ experts have recommended relatively broad access to it. Agree or not, the next few weeks are the time for Ontarians to speak up.
dreevely@ottawacitizen.com
twitter.com/davidreevely
查看原文...
