{"id":46488,"date":"2020-01-22T18:00:32","date_gmt":"2020-01-22T17:00:32","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=46488"},"modified":"2020-03-09T09:45:02","modified_gmt":"2020-03-09T08:45:02","slug":"richard-smith-learning-from-canada-about-assisted-dying","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/01\/22\/richard-smith-learning-from-canada-about-assisted-dying\/","title":{"rendered":"Richard Smith: Learning from Canada about assisted dying"},"content":{"rendered":"

\"\"<\/a>Discussions on assisted dying are usually heated and about whether it should be legalised. But I recently found myself in the privileged position of discussing with a well informed group of people from Canada not whether assisted suicide should be introduced in Britain, but what Britain might learn from the Canadian experience of introducing a form of assisted dying. There are many issues to decide. The meeting took place as part of the UK-Canada Colloquium, and the group included a lawyer who took a case to introduce assisted dying to the Supreme Court in Canada, a palliative care physician who provides assisted dying, and other doctors and academics who have firsthand experience of the system.<\/span><\/p>\n

Canada introduced Medical Assistance in Dying (MAID) in Quebec in 2015 and the rest of the country followed in 2016. It was introduced because of a Supreme Court ruling that said the criminal laws prohibiting assistance in dying limited the rights to life, liberty, and security of the person under Canada’s Charter of Rights and Freedoms. The legislature in Quebec and subsequently the whole country then defined how it would work, but the courts have a continuing role in its evolution.<\/span><\/p>\n

There was opposition to its introduction by palliative care physicians who opposed it on ethical grounds, but also feared that it would mean that palliative care would be neglected. Palliative care has not worsened, but only about a third of Canadians have access to palliative care and only 15% to palliative care at home. There is an uncomfortable anomaly in that MAID is provided for free, but some parts of palliative care (depending on the province) are only partially funded.<\/span><\/p>\n

The Canadians at the meeting agreed that despite opposition to the introduction of MAID, it has rapidly become a normal part of Canadian life. There seems to be no serious possibility that MAID will be abolished. Indeed, it is more likely that its availability will be extended. In September last year the Quebec Supreme Court ruled that<\/a> it is unconstitutional to deny MAID to persons with intolerable suffering who do not meet the criterion for \u201creasonably foreseeable death,\u201d such as those with incurable degenerative illnesses. The court directed the federal government to make amendments to the MAID law by March 2020.<\/span><\/p>\n

To qualify for MAID people must meet <\/span>all<\/span><\/i> the following criteria:<\/span><\/p>\n