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Assisted suicide and euthanasia should be legal in Canada, an expert panel concludes in a report released Tuesday in Ottawa that also says Canadians are not preparing well for death.
The report was commissioned by the Royal Society of Canada, and the panel was made up of six Canadian and international experts in bioethics, clinical medicine, health law and policy, and philosophy.
The group says it is time that public policy on end-of-life issues be revisited and it hopes to spark a new, national debate.
It makes a number of recommendations related to the full spectrum of end-of-life care, but key among them is the proposal that the Criminal Code be amended to permit euthanasia and assisted suicide.
It says public support for the decriminalization of assisted suicide and voluntary euthanasia is high among Canadians and it calls for a "permissive yet carefully regulated and monitored system" for assisted death.
The panel said it carefully considered Canadian values, international evidence, and legal and ethical arguments to reach that conclusion.
"The evidence from other jurisdictions ... does not support claims that decriminalization will actually result in vulnerable persons being subject to abuse or a slide down a slippery slope from voluntary to non-voluntary euthanasia," panel chair Udo Schuklenk said at a news conference.
"Assisted suicide and voluntary euthanasia should be legally permitted for such competent individuals who make free and informed choices that their life is not worth living, to them – that's the important bit – so nobody will make those decisions on their behalf," he said.
The panel says individuals have a moral right grounded in the principle of autonomy to make their own decisions about ending their lives. It notes that health-care providers should not be bound to assist someone in ending life, but are duty-bound to refer the patient to someone who will help them.
The panel says it is an "open question" as to whether only health care providers should be permitted to provide assistance with dying.
It suggests that the federal government, in collaboration with the provinces and territories, establish a national oversight body to monitor and report annually on assisted suicide and euthanasia. It also says that requests for assisted death, statements of reasons for requests, and document filing should be set out in legislation.
The report was released at a press conference a day after a major legal challenge in British Columbia on assisted suicide began in the province's Supreme Court.
Margaret Somerville, founding director of the McGill Centre for Medicine, Ethics and Law, said the report does not present a balanced portrayal of the controversies around assisted suicide and euthanasia.
"There is absolutely nothing in the report to put the case against it," she told CBC News. She said the report was too focused on the individual and not enough on the fallout on health and legal institutions and on societal values.
Somerville said "doctors killing their patients" is not the right solution to problems associated with end-of-life care.
The experts also found Canadians do not have access to high quality palliative care, and that access and the scope of care need to be improved, particularly because of the aging population and rising rate of chronic diseases.
Another main finding of the report is that Canadians are not talking about what they want to happen at the ends of their lives.
The experts found many Canadians think it's wise to make their wishes known to their families for what kind of care they want, but few are actually doing it.
"They talk about it but then they don't act on it," Schuklcnk said.
The panel encourages governments and health-care providers to educate the public on how to make advance directives that state their preferences for end-of-life care.
The panel also calls for clearer clinical guidelines for current end-of-life practices and says there is uncertainty around the legality of health care professionals withholding potentially life-sustaining treatment.
"Palliative sedation and decisions to withhold or withdraw potentially life-sustaining treatments from patients against the wishes of their families require attention," the report says.
One form of palliative sedation is known as terminal sedation which involves life-shortening sedation combined with the cessation of food and liquid.