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The Special Senate Committee on Euthanasia and Assisted Suicide

Of Life and Death - Final Report

June 1995


Table of Contents


Membership

Orders of Reference

Acknowledgements

Recommendations

Introduction

Chapter I: Overview

Chapter II: Terminology

Chapter III: Palliative Care

Chapter IV: Pain Control and Sedation Practices

Chapter V: Withholding and Withdrawal of Life-Sustaining Treatment

Chapter VI: Advance Directives

Chapter VII: Assisted Suicide

Chapter VIII: Euthanasia

Conclusion

Appendices

Appendix A: Witnesses at Public Hearings

Appendix B: Written Submissions Received

Appendix C: Material Received by the Committee

Appendix D: Chronology of Major Canadian Developments and Events

Appendix E: Legislative Proposals Previously Introduced to Parliament

Appendix F: Relevant Provisions of the Criminal Code and the Quebec Civil Code

Appendix G: Sample Amendment Proposals

Appendix H: Suggested Procedural Guidelines

Appendix I: British Columbia Policy Guidelines

Appendix J: Citations for Advance Directives Legislation in Canada

Appendix K: Sources for Sample Directives

Appendix L: Summary of Relevant Canadian Court Decisions

Appendix M: Palliative Care in Canada

Appendix N: Recent Reports from Foreign Jurisdictions

Appendix O: Medical Decisions Concerning End of Life In the Netherlands

Appendix P: Assisted Suicide and Euthanasia in Foreign Jurisdictions

Membership

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The Honourable Joan B. Neiman Q.C., Chair

The Honourable Thérèse Lavoie-Roux, Vice-Chair

The Honourable Senators:

Gérald-A. Beaudoin Q.C.

Sharon Carstairs

Eymard G. Corbin

Mabel M. DeWare

Wilbert J. Keon

*Joyce Fairbairn P.C. (or Alasdair B. Graham)

*John Lynch-Staunton (or Eric A. Berntson)

Original Members agreed to by Motion of the Senate:

The Honourable Senators:

Beaudoin, DeWare, Gigantès, Keon, Lavoie-Roux, Neiman, Perrault
*Fairbairn (or Molgat), *Lynch-Staunton (or Berntson)

Other Senators who participated in the work of the Committee:

The Honourable Senators:

Cochrane, Cools, Desmarais, Grafstein, Haidasz, Johnson, Kinsella, Lucier, Marchand, Molgat, Nolin, Rossiter, Stratton, Watt

* Ex Officio Members

Orders of Reference

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Extract from the Minutes of the Proceedings of the Senate, Wednesday, February 23, 1994:

"The Honourable Senator Neiman moved, seconded by the Honourable Senator Lavoie-Roux:

THAT a special committee of the Senate be appointed to examine and report upon the legal, social and ethical issues relating to euthanasia and assisted suicide;

THAT notwithstanding Rule 86(1)(b), the Honourable Senators Beaudoin, DeWare, Gigantès, Keon, Lavoie-Roux, Neiman and Perrault act as members of the special committee, and that three members constitute a quorum;

THAT the Committee have power to send for persons, papers and records, to examine witnesses, to report from time to time and to print such papers and evidence from day to day as may be ordered by the committee; and

THAT the Committee present its final report to the Senate no later than December 15, 1994.

After debate,

The question being put on the motion, it was adopted."

Gordon L. Barnhart<R>Clerk of the Senate

Extract from the Minutes of the Proceedings of the Senate, Tuesday, November 29, 1994:

"...that the date of presenting its report be extended from December 15, 1994, to no later than March 15, 1995, and that the Committee retain all powers necessary to publicize the findings of the Committee contained in the Final Report until March 30, 1995.

After debate,

The question being put on the motion, it was adopted."

Paul C. Bélisle<R>Clerk of the Senate

Extract from the Minutes of the Proceedings of the Senate, Wednesday, March 1, 1995:

"THAT notwithstanding the Order of the Senate adopted on Tuesday, November 29, 1994, the Special Senate Committee on Euthanasia and Assisted Suicide, which was authorized to examine the legal, social and ethical issues relating to euthanasia and assisted suicide, be empowered to present its final report no later than May 10, 1995 and that the Committee retain all powers necessary to publicize the findings of the Committee contained in the final report until May 24, 1995.

After debate,

The question being put on the motion, it was adopted."

Paul C. Bélisle<R>Clerk of the Senate

Extract from the Minutes of the Proceedings of the Senate, Thursday, April 6, 1995:

"THAT the name of the Special Senate Committee on Euthanasia and Assisted Suicide be modified in French to "Comité spécial sur l'euthanasie et l'aide au suicide".

The question being put on the motion, it was adopted."

Paul C. Bélisle<R>Clerk of the Senate

Extract from the Minutes of the Proceedings of the Senate, Thursday, May 4, 1995:

"THAT notwithstanding the Order of the Senate adopted on Wednesday, March 1, 1995, the Special Senate Committee on Euthanasia and Assisted Suicide, which was authorized to examine the legal, social and ethical issues relating to euthanasia and assisted suicide, be empowered to present its final report no later than May 31, 1995 and that the Committee retain all powers necessary to publicize the findings of the Committee contained in the final report until June 14, 1995.

After debate,

The question being put on the motion, it was adopted."

Paul C. Bélisle
Clerk of the Senate

Extract from the Minutes of the Proceedings of the Senate, Thursday, May 25, 1995:

"THAT notwithstanding the Order of the Senate adopted on Thursday, May 4, 1995, the Special Senate Committee on Euthanasia and Assisted Suicide, which was authorized to examine the legal, social and ethical issues relating to euthanasia and assisted suicide, be empowered to present its final report no later than June 7, 1995 and that the Committee retain all powers necessary to publicize the findings of the Committee contained in the final report until June 21, 1995.

After debate,

The question being put on the motion, it was adopted."

Paul C. Bélisle
Clerk of the Senate

Acknowledgements

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The study which this Special Senate Committee undertook would not have been possible without the assistance of a great many people. The members of our small and dedicated Committee, the majority of whom have been with it since its inception in February, 1994 worked tirelessly. Other colleagues came to listen to the witnesses, sometimes to offer opinions and advice and occasionally to replace one of us temporarily. All members added the very demanding schedule of this Committee to their other responsibilities in the Senate and on other committees.

The Committee worked in a totally non-partisan manner. Every member brought his or her own predisposition toward and understanding of the legal, social, moral and other issues involved and yet the group was able to reach an accord on many important issues. It is significant that where we agreed to disagree, we also decided to make those differences and the reasons for them very clear. We hoped that, by so doing, the readers of this Report will be able to follow all of the arguments.

All our colleagues in the Senate, and especially the leadership, deserve a special word of appreciation, not only for giving us the mandate but also the support and resources needed to carry out our study.

Our Report owes much to the individuals and organizations who appeared before our Committee, often on short notice, and who gave us the benefit of their experience and expertise.

The Committee received thousands of letters and even detailed briefs from concerned people and professionals interested in various aspects of our study. All their comments and recommendations have been considered.

We were aided by the services of the Committee staff, Gary Levy, Clerk of the Committee, Michel Patrice and Cathy Piccinin, all of whom gave many hours to serve us well.

The Committee was fortunate to have the services of Jocelyn Downie who, with her legal background and additional experience in the delivery of health care, advised us on the sources of information we would need and how to collect that information in a Report which we hope will prove useful to the public. She prepared the first draft of the Report, which was revised and expanded by Mollie Dunsmuir, our legal advisor from the Research Branch of the Library of Parliament. A special recognition must be given to Deborah Palumbo, my legal assistant, who revised and wrote the final edition of the Report. She was helped by the assistants of the other members of the Committee, Jacqui Drope, Pierre Thibault, René Leduc and John Terry, who offered recommendations for changes or additions to the text. Courtney Tower provided assistance with rewrites and the media.

The Committee is especially grateful to Jacques Dubé who was responsible for the translation and production of the French text of the Report.

Seven Bulletins were prepared and sent out during the course of the hearings to all the witnesses, the media, including weekly newspapers and radio stations, and all people and organizations who had indicated an interest in our study. Their preparation was the prime responsibility of Marie-Claude LaRose.

The Committee worked long hours over many weeks and often far into the evening requiring the services of a large number of Hansard reporters, interpreters, translators, messengers, technical and secretarial staff who ensured that its work went smoothly. We are grateful to them.

In order to understand the situation in the Netherlands with respect to euthanasia and assisted suicide, the Committee held a day long video-conference with a number of witnesses. We extend our appreciation to everyone involved in this excellent first experience for the Senate.

It was a long and detailed process. As the Chair of the Committee I am grateful to all who assured its thoroughness.

Thank you

Joan B. Neiman, Q.C.

Recommendations

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Chapter III Palliative Care

The Committee recommends:

governments make palliative care programs a top priority in the restructuring of the health care system.

the development and implementation of national guidelines and standards be continued.

the training of health care professionals in all aspects of palliative care be increased.

there be an integrated approach to palliative care. The delivery of care, whether in the home, in hospices or in institutions, with the support of volunteers, must be coordinated to maximize effectiveness. The provision of respite services is an essential component.

research into palliative care, especially pain control and symptom relief, be expanded and improved.

Chapter IV Pain Control and Sedation Practices

The Committee recommends:

the Criminal Code be amended to clarify the practice of providing treatment for the purpose of alleviating suffering that may shorten life.

the division of Health Canada responsible for health protection and promotion, in cooperation with the provinces, territories and the national associations of health care professionals, develop guidelines and standards for the provision of treatment for the purpose of alleviating suffering where that may shorten life.

education and training with respect to pain control be expanded and improved for all health care professionals.

the division of Health Canada responsible for health protection and promotion, in cooperation with the provinces, territories and the national associations of health care professionals, develop guidelines and standards for the practice of the total sedation of patients.

the federal government, in cooperation with the provinces and territories, undertake a study in order to determine the frequency and conditions under which total sedation is practised.

Chapter V Withholding and Withdrawal of Life-sustaining Treatment

The Committee recommends:

the Criminal Code be amended and necessary legislation be enacted in order to explicitly recognize and to clarify the circumstances in which the withholding and withdrawal of life-sustaining treatment is legally acceptable. The criteria enunciated in this chapter under "Committee Deliberations" should be considered.

the division of Health Canada responsible for health protection and promotion, in consultation with the provinces and territories and the relevant professional associations, establish guidelines to govern the withholding and withdrawal of life-sustaining treatment.

professional guidelines be amended so that they are consistent with these recommendations, the amended Criminal Code, and the national guidelines.

the Federal Ministry of Health, in cooperation with the provinces and territories, sponsor a national campaign designed to inform the public as to their rights with respect to the refusal of life-sustaining treatment.

research be conducted in order to determine the frequency with which and conditions under which life-sustaining treatment is withheld or withdrawn under the recommended legislation and guidelines.

Chapter VI Advances Directives

The Committee recommends:

those provinces and territories that do not have advance directive legislation adopt such legislation.

the provinces and territories establish a protocol to recognize advance directives executed in other provinces and territories.

Chapter VII Assisted Suicide

The Commitee recommends no amendments be made to the offence of counselling suicide under subsection 241 (a) of the Criminal Code.

The majority recommends subsection 241(b) of the Code also remain intact.

The majority recommends research be undertaken into how many are requesting assisted suicide, why it is being requested, and whether there are any alternatives that might be acceptable to those who are making the requests.

A minority recommends an exemption to subsection 241 (b) of the Criminal Code be added, under clearly defined safeguards, to protect individuals who assist in another person's suicide. These safeguards should include, at a minimum, the elements listed in this chapter under "Committee Deliberations". They further recommend, that in order to avoid abuse, procedural safeguards must provide for review both prior to and after the act of assisted suicide.

Chapter VII Euthanasia

Nonvoluntary Euthanasia

The Committee recommends:

nonvoluntary euthanasia remain a criminal offence.

the Criminal Code be amended to provide for a less severe penalty in cases where there is the essential element of compassion or mercy. Parliament should consider the following options:

A third category of murder could be created that would not carry a mandatory life sentence but rather would carry a less severe penalty; or

A separate offence of compassionate homicide could be established that would carry a less severe penalty.

The essential elements of compassion and mercy must be clearly and narrowly defined in order to limit the cases in which a less stringent sentence would be available.

Parliament should determine the appropriate penalty.

Voluntary Euthanasia

The majority recommends voluntary euthanasia remain a criminal offence. The Criminal Code, however, should be amended to allow for a less severe penalty similar to that provided for nonvoluntary euthanasia in cases where there is the essential element of compassion or mercy.

A minority recommends the Criminal Code be amended to permit voluntary euthanasia for competent individuals who are physically incapable of committing assisted suicide. This amendment would be subject to the same or similar minimum safeguards as outlined in the chapter on assisted suicide.

A minority further recommends, that if voluntary euthanasia remains a criminal offence, the Criminal Code be amended to provide for a less severe penalty similar to the penalty for nonvoluntary euthanasia.

The Committee recommends research be undertaken into how many are requesting euthanasia, why it is being requested, and whether there are any alternatives that might be acceptable to those who are making the requests.

Involuntary Euthanasia

The Committee recommends the prohibition against involuntary euthanasia continue under the present murder provisions in the Criminal Code.


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