1. Françoise Hébert, Ph.D. Board of Directors

2. Woody Allen said “I’m not afraid of dying. I just don’t want to be there when it happens …”

3. Canadians Die About 260,000 Canadians die every year Most deaths for men at age 85, women age 89 Cancer, heart, complex chronic conditions Process of dying can be long 90% want to die at home, not alone 70% die in hospital, often in ICU 50% in long-term care die there

4. A Good Death Adequate pain and symptom control No unnecessary prolongation of dying A sense of individual control Wishes of patient and family respected No untoward burden on others

5. Personal Rights Now Advance care directive recognized Substitute decision maker recognized Pain and symptoms management Can refuse or discontinue treatment Can refuse food and drink (VSED) Can commit suicide ( 1972  )

6. Palliative Care Team approach to enhance quality of dying, for patients and families No life-prolonging interventions Allows natural death Access varies widely across Canada Palliative sedation allowed

7. Assisted Dying A small number (?) suffering greatly beg for help to die gently, not alone, at a time of their choosing.  Assisted suicide  Voluntary euthanasia

8. Canadian Law Today [ until February 6, 2016 ]

9. Criminal Code Section 241 “Everyone who counsels, aids or abets a person to commit suicide is guilty of an indictable offence and liable to imprisonment for a term not exceeding 14 years.”

10. CARTER CASE SUPREME COURT OF CANADA October 2014 Allow assisted death because 1.Current law causes some to suffer needlessly 2.Current law causes some to end their life sooner than they wish

11. Canadian Government Opposed Allowing assisted death for a small number suffering intolerably devalues all respect for life There may be unwarranted deaths of vulnerable people (including women, seniors and disabled people)

12. Opponents Say Palliative care is sufficient Slippery slope → vulnerable individuals may feel pressured to die Mental health problems / depression Selfish modern society → devalues life Religious or moral objections

13. Carter Decision - February 6, 2015 Current law infringes the right to life, liberty and security of the person (Charter s. 7), so current law is unconstitutional New constitutional right created: Physician-assisted dying (PAD)

14. Physician-Assisted Dying (PAD) Constitutional Parameters Competent adult who clearly consents to termination of life and has a grievous irremediable medical condition (illness, disease or disability) that causes enduring suffering intolerable to the individual in the circumstances of his or her condition. Right to object must be accommodated.

15. Timing of PAD One-year suspension for Parliament and provincial legislatures to enact legislation consistent with The Court’s constitutional parameters, if they wish If no legislation by February 6, 2016, PAD is a constitutional right anyway

16. Jurisdictions That Allow PAD Switzerland1937 (self-administered) Netherlands, Belgium 2002 Luxembourg2009 USA (self-administered) Oregon 1997 Washington State 2008 Vermont2013 Québec → Dec 2015? Canada  Feb 2016?

17. Québec End-of-Life Care Act Passed June 2014, implementation proceeding Medical aid to die reframed as a health issue, provincial jurisdiction Strong continuum of end-of-life care, including right to palliative care & medical aid to die Québec will not prosecute those who meet conditions laid out in this act

18. Québec - All criteria must be met Covered by Québec Health Insurance Act Full age (18), capable of giving informed consent At the end of life – terminal (undefined in the Act) Suffering from a serious incurable illness In an advanced state of irreversible decline in capability Constant unbearable physical or psychological pain which cannot be relieved in a manner the patient deems tolerable Con’t …

19. Québec – Physician Responsibility Ensure patient meets all criteria Ensure request is informed and options known Discuss request with care team and family Ensure patient can discuss with family Verification by a second independent physician Physician must administer medical aid to die Physician must stay with patient until death ensues Physician must file required paperwork

20. Challenges for Rest of Canada 1.Who will regulate? When? 2. Patients must not be abandoned:  Safeguards must not create barriers  Doctors who object must refer  Institutions must allow PAD on site

21. We Believe… Palliative care should be accessible to all Competent adults should have the right to make their own end-of-life decisions PAD, with clear access criteria and appropriate safeguards, should be available across Canada on Feb 6, 2016