Month: March 2020

COVID-19 Creates an Urgent Need for Legal Clarity in Medically Assisted Death (MAID)

 

A small percentage of Canadians infected with COVID-19 will die from the virus.  Their death will usually be horrible: lung failure creating oxygen deprivation, causing multiple organ failures.

Ventilators are used to pump oxygen into these compromised lungs, to give the patient a chance to recover.  However, the majority don’t recover, particularly not the elderly and those with other serious medical problems.  Such patients may occupy a scarce ventilator for days or weeks, with death inevitable and foreseeable.  Canada does not have enough ventilators, and it looks like we will be unable to acquire them soon enough for everyone in need.

Some very sick patients who will not get a ventilator will die slowly, from gradual suffocation.  With insufficient ventilators, physicians will have to make the godlike decision of who lives and who dies.  Physicians may be less tortured and traumatized if they know that those they have selected to die can choose, through medically assisted death (MAID), not to die slowly and painfully.  But this law is controversial. It was held unconstitutional in a recent court decision. When the law is unsettled it is risky for physicians to administer MAID because the consequence might be criminal prosecution.

For anyone whose death is reasonably foreseeable (with or without a ventilator), the current law permits a patient to choose MAID, provided they meet the legal requirements.  Most of these legal requirements can be met, but one could be an obstacle.

This is the requirement that the patient must read a request form and sign it in the presence of two independent witnesses.  Criminal Code Section 241.2 (3) (c) requires the medical practitioner or nurse practitioner who will administer the drug to:

(c) be satisfied that the request was signed and dated by the person — or by another person under subsection (4) [if the patient is too ill to sign personally] — before two independent witnesses who then also signed and dated the request; [underlining added]

Today, it would be unsafe for two witnesses to be near someone dying from COVID – 19 to watch the patient read and sign a form.  It would only be safe to do this virtually, e.g., via smart phones.  The legal question is whether the word “before” in the above-quoted law should be interpreted literally, as meaning physically in front of the witnesses, or whether it should be interpreted purposively.  The Supreme Court of Canada has repeatedly held that our laws should be interpreted purposively, which requires determining the purpose of the law.

In my view the purpose is to ensure that the patient made the request voluntarily (without pressure from family or medical staff), understood what they were requesting, and gave their informed consent.  This can be determined without being physically present.

Another requirement is that the two witnesses must sign and date the request form.  Again, a purposive interpretation would see these two signatures as being to provide the evidentiary record of the witnessing.  This could be done through a typed signature sent via text or email, or even via oral instruction to sign on their behalf given to someone physically present with the patient.

If our pet dogs or cats are terminally ill and suffering greatly we can end their lives humanely.  Should we not be able choose the same compassionate end for ourselves if we are unlikely to recover?

The Canadian Medical Association, which issues guidelines to physicians, should obtain a legal opinion (if it has not already done so) to provide physicians with guidance on how to administer MAID in the age of COVID – 19.  If necessary, the Prime Minister should recall a quorum of Parliament (as he did last week for financial assistance) to amend the Criminal Code to remove the legal uncertainty surrounding MAID.  This would help those of us who are likely to die soon to choose not to live their last few days on earth slowly suffocating in isolation.

Emergency Powers Without An Emergency?

Prime Minister Trudeau has been pressed by reporters about the COVID-19 “nuclear option” – invoking the federal Emergencies Act.

PM: “At this time we do not see the federal emergencies act as an essential tool today, but we are continuing to look at the situation and will make decisions based on the best recommendations of science.” (Saturday, March 21)

Provinces and territories are closing their borders to inter-provincial travel and shutting down all but essential industries. A COVID-19 positive woman was arrested in Quebec City for taking a walk while quarantined.  As the financial and emotional costs of self-isolation mount, is there still no emergency?  And what comes next?

Apparently, what comes next arrived yesterday (March 25) : Bill C-13, enacted by Parliament in the early hours of the morning. It grants emergency spending powers without a declaration of emergency.  Why does it matter?

Continue reading “Emergency Powers Without An Emergency?”

COVID-19 and the Cabinet’s Emergency Powers.

March 21, 2020.  Briefing by Prime Minister Trudeau, responding to a question:

PM: “We have not removed from the table any options. We are looking at a broad array of measures that we can move forward with. At this time we do not see the federal Emergencies Act as an essential tool today, but we are continuing to look at the situation and will make decisions based on the best recommendations of science.”

Question: “What do you need to see before declaring a federal emergency?”

PM: “I think the key issue is are there things that we need to be able to do as a government that we cannot do with the very strong existing regulations that are in place and that our government has as tools.”

 

Background

 

You would have to be a hermit living in a cave not to have heard of the COVID-19 pandemic.  Governments all over the world have introduced special laws to deal with the emergency.  As the rates of infections, hospitalizations and deaths have increased, so has the severity of government responses.

But the existing legal powers of government may soon become insufficient.  Prime Minister Justin Trudeau has recalled Parliament to enact legislation permitting special financial measures to support Canadians impacted by the closing of schools, workplaces, restaurants and bars.  That is his first Parliamentary step, but probably not his last.

There are two Canadian laws that have never been used before, but may have to be if conditions worsen.  These are the Emergencies Act and the Quarantine Act.  I had not been familiar with either of these laws until this pandemic arose, but now have read them both.  Fortunately, because these laws have not been used before there is no large body of case law to wade through to understand how they have been interpreted.  Because they have never been interpreted, my interpretation is as good as, or as bad as, anyone else’s.

As between the two laws, I would expect the federal government to use the Emergencies Act first, and if it later becomes necessary, to use the Quarantine Act.  Both of these laws give the government extraordinary powers of a somewhat dictatorial nature.  Because giving a government dictatorial powers is always dangerous, these laws provide some soft safeguards which, one can only hope, will prove to be adequate.

Continue reading “COVID-19 and the Cabinet’s Emergency Powers.”