Policy and Legislation
Research summary Policy Issues, Palliative Care, and People with Disabilities
Because of the complexity introduced by the variety of people with illnesses and impairments entering palliative care the establishment of consistent guidelines about when palliative care should begin is difficult, and may only reinforce existing problems in the system resulting form the traditional focus on cancer. The decision to transfer people to palliative care is mostly up to the physician, or may be the decision of the person themselves. In palliative care for people dying of cancer the general policy appears to be to enter palliative care when the patient has six months to live. However, policies that provide any kind of consistency aren’t very likely when considering how difficult it is to make a prognosis for people with fluctuating terminal illnesses.
Many policies make it easier to refuse treatement or be denied treatment and hastenning death than to prolong life and increase autonomy. For example, in Manitoba, doctors can place a DNR order against the wishes of a patient and his/her family because in 1998 the Manitoba Court of Appeal decided in the case of Child and Family Services of Central Manitoba v. Raymond Lavallee and Susan Lorraine Hay thatdoctors have the sole authority to decide when a DNR would be placed on a patient’s chart.45
Criteria that limit access to services, including disability-related supports and palliative care, can also create a barrier to good end of life care for people with disabilities. Governments use criteria to determine who will receive a benefit and who will not. People’s access to disability-related supports can change if they move to a hospital setting for end of life care.46
For example in Manitoba the government discontinues servicing provincially funded wheelchairs when users are in an institution. In Newfoundland the government uses a family income criteria to assess eligibility for some disability-related supports possibly forcing people to leave their families in order to get supports at the end of their life.47
People with disabilities are also caregivers to people at the end of their life, but they may not be listened to as caregivers. Policy makers have tied care givers’ benefits to Employment Insurance, but because many people with disabilities are not eligible for employment insurance they are not able to apply to collect the EI Compassionate Care Benefit that supports those who provide informal care at end of life. People with disabilities, particularly women, are less likely to be employed than other Canadians, making them ineligible for EI.48
There are also gaps in disability-related supports to assist people with disabilities undertaking care giving. People with disabilities who want to provide care at end of life may need supports, including lifts, flexible respite, etc. 49
A Chronology of Legal Events and Euthanasia in Canada:50
1983 - The Law Reform Commission of Canada recommended against legalizing or decriminalizing voluntary active euthanasia. It also recommended that aiding suicide not be decriminalized where assistance has been rendered to a terminally ill person.
June 1987 - The Law Reform Commission of Canada released proposals for amending the Criminal Code. These included the recommendation that mercy killing be treated as second-degree murder (“ordinary murder”) rather than as first-degree murder (“premeditated murder”). Second-degree murder would carry no fixed or minimum jail term.
16 May 1991 - Private Member’s Bill C-203, An Act to amend the Criminal Code (terminally ill persons), was read for the first time in the House of Commons.
19 June 1991 - Private Member’s Bill C-261, An Act to legalize the administration of euthanasia under certain conditions, was read for the first time in the House of Commons.
10 September 1991 - In the Netherlands, the Remmelink Commission released findings from the first comprehensive study of Dutch euthanasia practices.
24 September 1991 - Bill C-203, An Act to amend the Criminal Code (terminally ill persons) received second reading and was referred to Legislative Committee H for consideration. The Committee began hearings on the bill on 29 October 1991.
24 October 1991 - Bill C-261, An Act to legalize the administration of euthanasia, was debated at second reading and dropped from the Order Paper.
6 January 1992 - The Quebec Superior Court ruled in the case of Nancy B., a woman suffering from an incurable disease, that turning off her respirator at her request and letting nature take its course would not be a criminal offence.
30 January 1992 - An Ontario surgeon was charged with second-degree murder in connection with the death of a seriously ill cancer patient. The patient is alleged to have died of a cardiac arrest after having been administered morphine and potassium chloride.
18 February 1992 - Legislative Committee H on Bill C‑203 adjourned sine die.
August 1992 - Scott Mataya, a Toronto nurse who had originally been charged with first-degree murder in the mercy killing of a terminally ill patient, entered a guilty plea to a lesser charge of administering a noxious substance. He received a suspended sentence and was ordered to surrender his nursing license.
22 March 1993 - Members of the House of Commons defeated a motion that called upon the government to consider the advisability of introducing legislation on the subject of euthanasia and ensuring that those assisting terminally ill persons who wish to die will not be subject to criminal liability.
April 1993 - An Ontario physician who gave a lethal injection to a seriously ill cancer patient was given a three-year suspended sentence after pleading guilty to a charge of administering a noxious substance to endanger life. The physician was originally charged with second-degree murder, but this charge was withdrawn.
30 September 1993 - In a five-to-four decision, the Supreme Court of Canada dismissed an appeal by Sue Rodriguez in which she challenged the validity of the Criminal Code prohibition on assisted suicide under the Canadian Charter of Rights and Freedoms.
3 November 1993 - The British Columbia Ministry of the Attorney General issued guidelines for Crown Counsel with respect to charging persons involved in cases of active euthanasia and assisted suicide.
12 February 1994 - Sue Rodriguez committed suicide with the assistance of a physician. The death was investigated by police, but no criminal charge was laid.
14 February 1994 - Justice Minister Allan Rock stated that the issues of cessation of treatment and assisted suicide should be considered by Parliament.
15 February 1994 - Prime Minister Chrétien stated that Members of Parliament would have a free vote on whether to legalize doctor-assisted suicide.
16 February 1994 - Private Member’s Bill C‑215, An Act to amend the Criminal Code (aiding suicide), was read for the first time in the House of Commons. This bill was debated and dropped from the Order Paper on 21 September 1994.
23 February 1994 - A Special Senate Committee was established to examine and report on the legal, social and ethical issues relating to euthanasia and assisted suicide.
November 1994 - Robert Latimer was convicted of second-degree murder in the asphyxiation death of his severely disabled 12-year-old daughter Tracy and sentenced to life in prison with no eligibility for parole for ten years.
June 1995 - The Special Senate Committee on Euthanasia and Assisted Suicide issued its report entitled Of Life and Death.
February 1997 - The Supreme Court of Canada ordered a new trial for Robert Latimer.
May 1997 - Dr. Nancy Morrison was charged with the first-degree murder of a terminally ill patent who had been removed from active life support.
December 1997 - Robert Latimer, having again been convicted of second-degree murder, was sentenced to two years less a day, notwithstanding that the minimum sentence under the Criminal Code is life in prison with no possibility of parole for ten years.
February 1998 - A Nova Scotia judge found that there was not sufficient evidence for a jury to convict Dr. Nancy Morrison, and refused to commit her to trial.
November 1998 - The Saskatchewan Court of Appeal confirmed the conviction of Robert Latimer and imposed a sentence of life imprisonment with no eligibility for parole for ten years.
June 2000 - The Senate Subcommittee studying developments with respect to the unanimous recommendations made in Of Life and Death in 1995 submitted its report, entitled Quality End-of-Life Care: The Right of Every Canadian, in June 2000.
January 2001 - The Supreme Court of Canada upheld the decision of the Saskatchewan Court of Appeal with regard to Robert Latimer.
September 2004 - Marielle Houle was charged with aiding and abetting the suicide of her 36-year-old son, Charles Fariala.
November 2004 - Evelyn Martens was acquitted of aiding and abetting the suicides of two women that took place in 2002.
June 2005 - Bill C-407, An Act to Amend the Criminal Code (Right to Die with Dignity) was introduced by Francine Lalonde, MP.
July 2005 - André Bergeron was charged with the attempted murder of his spouse, Marielle Gagnon, who had Friedreich’s ataxia.
October 2005 - Bill C-407 was given one hour of debate in the House of Commons. It died on the Order Paper in November 2005 with the dissolution of Parliament.
January 2006 - Marielle Houle pled guilty to aiding and abetting the suicide of her son, and was sentenced to three years’ probation.
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