Posts tagged ‘aging’

April 14, 2016

Medically Assisted Death Bill Introduced in Parliament

On April 14, 2016 Parliament introduced Bill C-14 to amend the Criminal Code and related statutes in response to the Supreme Court of Canada’s Carter ruling on medical assistance in dying.

The bill removes criminal liability for assisting a person to end her or his life if carried out in compliance with the new s. 241.1.

The bill first defines “medical assistance in dying” as the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death, or the prescription or provision of such substance to be self-administered.

In order to be eligible to receive medical assistance in dying, a person must:

  • be 18 years of age and capable of making decisions with respect to their health;
  • have a grievous and irremediable medical condition;
  • have made a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure; and
  • give informed consent to receive medical assistance in dying.

Clearly the most debated portion of the bill will be defining what constitutes a “grievous and irremediable medical condition”.  The government has defined it in the bill as requiring all of the following:

  • a serious and incurable illness, disease or disability;
  • an advanced state of irreversible decline in capability;
  • enduring physical or psychological suffering that is intolerable to the person and cannot be relieved under conditions that they consider acceptable; and
  • natural death being reasonably foreseeable, taking into account all medical circumstances, without a prognosis necessarily having been made as to the specific length of time that a person has remaining.

The requirement of “an advanced state of irreversible decline in capability” and “natural death being reasonably foreseeable” have been viewed as overly restrictive by some, but are largely approved of by the medical community.

Safeguards are included in the bill, requiring that before a medical practitioner or nurse practitioner provides a person with medical assistance in dying, they must:

  • be of the opinion that the person meets all of the eligibility criteria above and obtain a written opinion to that effect from another, independent medical practitioner or nurse practitioner;
  • ensure that the person’s request for medical assistance in dying was made in writing, signed and witnessed after the person was informed that their natural death has become reasonably foreseeable;
  • ensure that the person has been informed that they may, at any time and in any manner, withdraw their request;
  • ensure that there are at least 15 clear days between the day on which the request is signed and the day on which the medical assistance in dying is administered, unless a shorter period is deemed appropriate in the circumstances;
  • immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying.

The bill extends protection to pharmacists who prescribe substances and to others who assist the medical practitioner or nurse practitioner is administering assistance in dying.  A criminal offence is established for failing to follow the safeguards, with potential jail sentences of not more than 5 years.

No manner of providing medical assistance in dying is set out.  The bill only requires that assistance be provided with reasonable knowledge, care and skill and in accordance with any applicable provincial laws, rules and standards.  Indeed, as health care is within provincial rather than federal jurisdiction, it will be up to the provinces to implement and oversee the practice of delivering medical assistance in dying.

Much debated before the bill was introduced were issues such as the eligibility of minors, mental illness and advance consent.  Minors are clearly not eligible and will be the subject of further study.  As for mental illness, it is not specifically deemed ineligible and indeed the definition of a grievous and irremediable medical condition illness references psychological suffering.  However, the issue of mental illness will undoubtedly be problematic as mental illness may affect the ability of a person to give informed consent.  Connected to this issue is the matter of advance consent.  What happens if a person has a serious and incurable illness, disease or disability but is not yet in an advanced state of irreversible decline in capability?  If they are suffering from a progressive cognitive disease, by the time their disease and suffering has advanced, they may no longer be capable of giving informed consent to treatment.  This bill would not allow that person to give consent to medical assistance in dying before their cognitive abilities decline.

The government has taken a cautious approach with this bill.  Given what is really a short period of time to deal with such a large social issue, this was not unexpected.  Once this bills passes, whether intact or with amendments, the debate will continue and there will undoubtedly be many calls for amendment, both for more restrictive and for more liberal measures.


March 17, 2016

First Ontario Physician-Assisted Death Approved

Justice Paul Perrell of the Ontario Superior Court of Justice today granted the application of an 81-year-old man, permitting him to proceed with a physician-assisted death.  Known as A. B., the applicant has aggressive, advanced stage lymphoma.

The application is the first granted in Ontario since the Supreme Court of Canada’s decision in Carter.  A. B. met the Superior Court of Justice’s test for an exemption under Carter.  The test is a temporary measure put in place while the federal government deals with a legislative framework for physician-assisted death.

Read more here and here

February 11, 2016

Lifestyle, education and dementia

Some interesting news about lifestyle and education and their potential relationship to certain types of dementia.

The originating article is in the New England Journal of Medicine but you will need to be a subscriber to read it.

October 1, 2015

Today is National Seniors Day

A day to recognize accomplishments and work to be done as, for the first time, Canada’s population counts more seniors than children.

May 20, 2014

60 Minutes on Aging

Watch this 60 Minutes story about what researchers have been able to learn about aging by studying a community of retirees.  There are some great insights, in particular into what we know (and more importantly don’t know) about dementia.

It is the second story on the feed.


January 8, 2014

What May Surprise You About Dementia Rates

Dementia in its various forms is, quite properly, a syndrome that is receiving more and more attention, in the media, in medical writing and research and in the law. I was a bit surprised then to learn from an article in the New England Journal of Medicine that dementia rates, by percentage of population, have actually declined since 1982, according to a number of studies reviewed. Of course, in real numbers cases are on the rise given an aging and longer-living population. However, it is good to know that advances in prevention and treatment are being made, even if slowly. It was interesting to note some of the factors highlighted in preventing or forestalling dementia, being “improving educational opportunities in both early and later life, reducing vascular risk factors, and promoting greater physical activity”.

October 31, 2013

Tragic Double Suicide Places Spotlight on Heath Care for Elderly and Fuels the Debate on Assisted Suicide

The double suicide of an elderly couple in Toronto this week is raising the debate over both chronic care for the elderly and, importantly, mental heath care. It will undoubtedly also add to the debate over assisted suicide.

September 9, 2013

The Rise of “grey stocks”

June 11, 2013

Ontario to Double Number of Nursing Home Inspectors

This is a too-long neglected hole in the long-term care system that is at least now getting some attention – better late than never?

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February 22, 2013

Driving “hotline” a concern for seniors

It appears that the Sudbury, Ontario police have set up a hotline to receive anonymous complaints about older people behind the wheel.

While physical and cognitive ability are important to safe driving and are to be taken seriously, this sounds a bit too “big brother” for my liking and smacks of ageism. Perhaps we could use driverless technology sooner rather than later.