A group of ethicists, medical professionals, lawyers and advocates has released a list of requirements and safeguards that they want built into any new assisted-dying legislation. They say the safeguards are meant to balance access to physician-assisted death with the need to protect "vulnerable" people, such as those with disabilities.

The "Vulnerable Persons Standard" was publicly unveiled Tuesday morning in Ottawa.  The document is supported by several different organizations, including the Canadian Association for Community Living, the Council of Canadians with Disabilities, and the Catholic Health Alliance of Canada.

It includes several different "evidence-based" requirements and safeguards meant to protect the lives of vulnerable Canadians. According to the standard, a person’s vulnerability can be affected by a number of factors, including disability, grief, loneliness, stigma and shame.

“These safeguards will help ensure that Canadians requesting assistance from physicians to end their life can do so without jeopardizing the lives of vulnerable persons who may be subject to coercion and abuse,” the document says.

The standard contains five different requirements and a sub-list of safeguards. The requirements include:

1. Equal protection for vulnerable persons: "Any amendments to the Criminal Code concerning physician-assisted death must not perpetuate disadvantage or contribute to social vulnerability," the standard says.

2. End-of-life condition: Physician-assisted death should only be authorized for end-of-life conditions for adults in a state of advanced weakening capacities with no chance of improvement, and who have enduring and intolerable suffering as a result of a "grievous and irremediable" medical condition.

3. Voluntary and capable consent: Patients seeking physician-assisted death must show "voluntariness, non-ambivalence and decisional capacity" to request and consent to an assisted death.

4. Assessment of suffering and vulnerability: A request for physician-assisted death should require a careful exploration of the causes of a patient's suffering, including psychosocial or non-medical conditions and circumstance.

5. Arms-length authorization: Any request for physician-assisted death should be subject to an review and authorization by a judge or independent body with expertise in health care, ethics, and law.

The standard says that any new legislation, the assessment process for patients seeking assisted-death, and the arms-length review and authorization process must be “transparent and consistent” across the country.

Parliamentary committee recommendations

The standard was publicly released days after a parliamentary committee released recommendations that the federal government make physician-assisted dying available to all adults with a "grievous and irremediable" medical condition, including mental illnesses.

The recommendations, released last Thursday, will guide the government as it drafts new assisted-dying legislation. In January, the Supreme Court of Canada granted the federal government a four-month extension to come up with assisted-dying laws. 

The Parliamentary committee behind the recommendations said the new rules should be implemented in two stages.

The first would apply immediately to those over the age of 18, who are experiencing "intolerable" physical or mental suffering. The second stage, which they say should be implemented no later than three years after the first, would extend to "competent mature minors."

The committee said each patient seeking medically-assisted death must be fully assessed by two independent doctors, to ensure the patient has the capacity to provide informed consent. The report also recommended that provisions be made for doctors who object to assisted-dying.