November 5 2019

Members of our Liberal government,

Re: danger to restraint in medically assisted death

I and other family doctors are fervently hoping that our current government will perceive  the importance of moving quickly  to correct the Truchon and Gladu ruling, a ruling which eliminates the “foreseeable death” safeguard placed with care and intent by the Liberal government in the 2016 Act to Amend the Criminal Code with regard to medically assisted death.

The loss of this safeguard provides a direct route to medical death for those with depression, psychosis, cognitive limitations and indeed for any member of the disability community who becomes vulnerable, for any reason, to the availability of medically assisted death.

This was brought home to me 3 years ago when a depressed young man in my practice admitted to searching the Internet for methods of medically assisted dying and admiring the YouTube postings of an attractive young woman with a brain tumor who described her preparations for carrying out her eventual medically assisted death.  My patient required an extended hospital stay before he was safe to return to the community, and now he is thriving. 

Around the same time, a friend described a neighbor who was often seen out gardening and whose husband reported that she had a nice walk around the Stanley Park Sea Wall on the day of her medically assisted death.  In 2016 I also visited a man living with multiple sclerosis who was later dealt a medically assisted death on the justification that he could hypothetically acquire bedsores which could hypothetically make him septic.

These 2 questionable medically assisted death procedures were carried out by the same Vancouver physician activist.

The intent, painstaking and arduous as government members may recollect, was to create an exemption from the charge of murder in exhaustively scrutinized cases involving intolerable suffering at the end of life.  The government had reasonable apprehension that without the “foreseeable death” safeguard, the new law might unravel in the field, to become an unrestrained license for ideologically motivated practitioners.  This appears to have happened.

Government members will be aware that the Julia Lamb case, asking for medically assisted death when her neurological problems had not put her anywhere near death, was recently dropped by the mutual request of Ms. Lamb’s lawyer and the crown.

The Lamb case was dropped not because both parties had sober second thoughts about the erasure of the end of life safeguard, but in recognition that assessment practices in the field have already become so lax regarding the foreseeability of death that no further legal action was necessary.

Allowing for the most extreme interpretation of our current law to go unchallenged means that practitioners who are plainly ideological outliers are in effect authorized to rewrite the law.  The Liberal government had intended a careful balance in full awareness of this danger. 

The lives of truly vulnerable people never intended as targets of the legislation are now in peril.  The medical assistance in dying system was justified by several references, in the relevant court rulings, to the responsibility, prudence, and caution of Canadian physicians.  The system was designed in a way that relied on  the restraint of the medical practitioners involved to respect the legislation.  Tellingly, the 5-year review of the Act, now in preparation, relies on good faith reporting on the integrity of their actions by those very practitioners themselves.

The elimination of the foreseeable death safeguard allows for the legal abandonment of medical diligence and creativity in favor of an ideological commitment to the provision of death in situations not foreseen, or foreseen and rejected, by the legislators.  Many hope that this government will take seriously its responsibility to correct the removal of this safeguard by the actions of one judge.

Yours sincerely,

Will Johnston MD