Open Conversation about Physician Assisted Dying

By:  Louise Lee  Posted On:  Feb 25th, 2016

On Feb 20, the Global Institute Psychosocial, Palliative and End-of-Life Care, the Institute of Health Policy, Management and Evaluation, and the Faculty of Law, of the University of Toronto hosted the “Conversation on Physician Assisted Dying". The event is organized to stimulate discussion about some of the challenges in implementing Physician Assisted Dying (PAD) in Canada.

The featured speaker of the event, Dr. Scott Kim, a psychiatrist-bioethicist of the University of Michigan and the U.S. National Institutes of Health, presented his study on euthanasia in the context of mental health in the Netherlands recently published in JAMA Psychiatry. The lecture is followed by brief commentaries, connecting the presentation to the discussion around legalizing PAD in Canada. After the commentaries, the discussion is open to the audience, made up of people from the health professions and regulatory colleges, patient advocacy groups, the judiciary, bioethics, the legal profession, the Ontario Consent and Capacity board, the media, and academia.

This meeting was held according to the Chatum House Rule - the identities of the speakers are not revealed - in order to promote open discussion on this controversial issue. But the following are some of the meeting highlights. A more detailed reported will be made available in the near future.

A number of concerns about physician assisted dying raised in the meeting include:

  1. While theoretically it seems unfair to deny patients with mental health issues PAD, practically it’s unclear how to protect the rights of those individuals. 
  2. Consent capacity assessment is not sufficient to protect vulnerable persons when coercion operates through distorted judgement.
  3. The Supreme Court assumed the mental capacity can be assessed by “qualified” and “experienced” physicians. However, many physicians are not trained in evaluating mental capacity, nor are they qualified to judge undue influence.
  4. The grievous & irremediable cases heard in court are not applicable to PAD or euthanasia for vulnerable persons.
  5. Given the above, there is a need for increased safeguards, scrutiny and transparency in order to protect the rights and interests of minors and people with mental health issues.

To alleviate these concerns, some argued for minimal legislation, limiting assess to minors, as in the case in Quebec.

However, others argued for equal access to PAD on the grounds of the Canadian Charter of Rights and patients’ autonomy. 

The Commentators


Sally Bean, bioethicist, Sunnybrook Health Sciences Centre


Jacques Frémont, Président, Commission des droits de la personne et des droits de la jeunesse de Québec


Michael Bach, Executive Vice-President, Canadian Association for Community Living & Adjunct Professor, Disability Studies, Ryerson University


David Baker, Former Director ARCH, Attorney BakerLaw


Lucy Costa, Systemic Advocate, Empowerment Council, Centre for Addiction and Mental Health

Elizabeth Peter, Associate Professor, Faculty of Nursing, University of Toronto 


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