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Friday, 6 February 2015

What does the Carter decision mean for medical care at the end of life?

by Erin Nelson

Today the Supreme Court of Canada unanimously ruled that Canada’s blanket prohibition on assisted suicide violates section 7 of the Charter. To the extent that the law prohibits a competent and consenting adult who seeks to end his / her life in circumstances of a “grievous and irremediable medical condition” that is causing intolerable suffering, it is of no force and effect. The Court suspended its declaration of invalidity to give Parliament 12 months to enact legislation that is consistent with its reasoning.

Three important facts about Carter and medical care at the end of life:

1. Competent adult patients are entitled to refuse medical care – even where that care is necessary to save the person’s life.

2. The focus of the claim, and the Court’s decision, in Carter is on competent adult patients who have expressed a clear wish to end their life in order to avoid continued intolerable suffering.

3. The shape the law will ultimately take is up to Parliament. The Court has provided guidance as to the constitutional imperatives that the law must meet, but has left the details to elected representatives.

Three myths about Carter and medical care at the end of life:

Myth #1:  The Court’s ruling will require physicians who object for moral or religious reasons to assist their patients to die.

Reality: The Court explicitly addressed this question, noting that nothing in its reasons would “compel physicians to provide assistance in dying”. The Court explained that the resolution of this issue is now for regulators and elected representatives.

Myth #2: The Court’s decision reflects its sense that some lives have less value than others.

Reality: The Court focused on the intimate and intensely personal nature of end of life decision-making, noting that  “s. 7 recognizes the value of life, but it also honours the role that autonomy and dignity play at the end of that life.”

Myth #3:  A law that permits physician-assisted suicide (PAS) will result a reduced focus on improving the reach and the effectiveness of palliative care.

Reality The Court notes that one of the trial judge’s findings was that in some jurisdictions with a permissive regime, the provision of palliative care actually improved after PAS was legalized.

Read more on this topic, from Dr. Eric Adams.

Dr. Erin Nelson is a professor in the Faculty of Law at the University of Alberta. She teaches Torts, Health Care Ethics & the Law and Law & Medicine. Her research interests focus on health law and policy.  

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