Law school co‑hosts second international conference on end‑of‑life issues

The journey to Bill C-14, Canada’s Medical Assistance in Dying (MAiD) law, is one of the most turbulent legal battles in the country’s history. The history of that journey was the subject of a lively panel discussion at the Halifax Central Library that kicked off the second International Conference on End of Life Law, Ethics and Practice, which took place from September 13 to 15.

The conference was hosted by Dalhousie’s Health Law Institute, the Australian Centre for Health Law Research at the Queensland University of Technology and the Dutch- and Belgian-based International Collaborative for End of Life Care Research. Presenters over the two-day conference included Dalhousie professors Christine Chambers (Departments of Pediatrics and Psychology and Neuroscience), Jocelyn Downie (Faculties of Law and Medicine), Adelina Iftene (Faculty of Law) and Kenneth Rockwood (Department of Medicine).

An engaging panel discussion

The panel, which was moderated by Schulich School of Law Professor Constance MacIntosh (also chair of the organizing committee) brought together three of Canada’s prominent voices in end-of-life issues: lawyer Joe Arvay, retired Senator Jim Cowan (former chair of Dal’s Board of Governors who received his arts and law degrees from Dal) and psychiatrist Mona Gupta. They summarized the history of assisted dying legislation in Canada that began in the years before 1972 when attempted suicide was declared to be no longer a criminal office in Canada, then continued through high- profile cases, including Rodriguez v British Columbia and Carter v Canada, to the passing of Bill C-14 in 2016.

One of Canada’s most influential lawyers, Arvay has been counsel on a number of landmark cases in the Supreme Court of Canada, including Carter v Canada, a physician-assisted dying case that has defined much of the debate. He said that in order to work, assisted dying legislation can’t be limited to people whose deaths are imminent. In fact, those most in need of assisted dying legislation are those condemned to live with years of excruciating pain and suffering without the prospect of imminent death.

“We can’t limit this law to people whose end of life is only a few months away,” said Arvay. “It’s the people who have a lifetime of living in that kind of horrific condition and suffering who are most deserving of such a right.”

Dr. Gupta, a Quebec-based psychiatrist and researcher with a PhD in bioethics, has been actively engaged in the development of provincial end-of-life legislation in Quebec. She said much of that work was in response to patients asking their loved ones for assistance in dying, forcing them to make a difficult decision that would affect them for the rest of their lives. “This was obviously not an ideal situation for the patient to have to ask his or her loved ones to take this risk and to live with the guilt,” she said.

The challenges with legislation

As Leader of the Opposition in the Senate from 2008 until 2016 and a member of the Special Joint Committee on Physician-Assisted Dying, Senator Cowan played a pivotal role in the development of Bill C-14. Despite that role, he said the bill that ultimately passed the House of Commons was watered down and disappointing.

“Most of us were surprised and deeply disappointed by the government’s legislative proposals,” said Cowan. “It certainly did not reflect in any way the work of our committee. Most important, the eligibility requirements that were made in C-14 were significantly different than those set out by the Supreme Court of Canada in Carter. Individuals who would have qualified under Carter would not qualify under Bill C-14.”

Cowan laid out three areas where Bill C-14 failed. First, it rejected the idea of advanced requests where a patient can place an assisted dying request into a living will before becoming incapacitated. It also excluded mature teenagers from making assisted dying requests, and it limited eligibility only to those whose natural deaths were reasonably foreseeable, excluding people who are not terminally ill but are facing a life of extreme pain and suffering. Cowan predicted that if Bill C-14 was to be challenged in court, it would likely be found to be unconstitutional because it goes against the Carter decision.

One of the most powerful moments of the panel presentation came when Arvay, a paraplegic himself, talked about the time shortly after his own life-altering accident when he considered the option of assisted death. He said that most people in his situation go through a similar period of darkness – a darkness that usually passes in time. “The crazy thing about assisted dying is that very few people are going to want to use it,” he said. “We all cling to the wreckage of our bodies and our lives. We want to hold on as long as possible.”