Dr. Ellen Wiebe is pictured in her Vancouver office on March 9, 2016. With medically assisted death now legal in Canada, doctors need access to drugs that will quickly and effectively terminate the lives of eligible individuals. THE CANADIAN PRESS/Jonathan Hayward

Lametti sows uncertainty over meaning of foreseeable death in MAiD bill

Current law allows medical assistance in dying only for those whose natural death is ‘reasonably foreseeable’

Dr. Ellen Wiebe has helped 260 intolerably suffering Canadians end their lives over the past four years, including a few who likely would have lived up to another decade on their own.

The current federal law, passed in 2016, allows medical assistance in dying only for individuals whose natural death is “reasonably foreseeable” — an ambiguous term that some doctors initially interpreted to mean a person must have only six months left to live.

Then came the pivotal 2017 ruling in the case of a 77-year-old Ontario woman, known only as A.B., who suffered from severe osteoarthritis but had been denied medical assistance in dying because natural death was not imminent.

Ontario Superior Court Justice Paul Perell said natural death does not have to be imminent, within a specific timeframe or the result of a terminal disease — giving reassurance to doctors who feared criminal charges if they interpreted the term too loosely.

Using actuarial tables, Wiebe calculated that A.B. could have survived another 10 years, which became the timeframe the Vancouver physician has used ever since when she assesses a person’s eligibility for an assisted death.

ALSO READ: Chilliwack woman wins right to medically assisted death after three-year court battle

But now, some experts are worried the Trudeau government has revived uncertainty over reasonable foreseeability with proposed amendments to the law introduced last week.

Under Bill C-7, people whose natural death is not deemed reasonably foreseeable would no longer be prohibited from receiving medical help to end their suffering — a restriction that was struck down as unconstitutional by a Quebec court last fall.

The revised law would still use the notion of reasonable foreseeability to impose a number of eligibility requirements on those who are not near death that wouldn’t apply to those who are.

Some experts say they became alarmed when Justice Minister David Lametti, during opening debate on the bill last Wednesday, offered his view that reasonable foreseeability means a death that is expected ”in the relatively near-term” or “over a relatively short period of time.”

“A person’s natural death is not reasonably foreseeable just because they are diagnosed with a condition that will eventually cause their death many years or decades into the future,” he told the House of Commons. “In practice, we know that practitioners are more comfortable prognosticating when death is expected on shorter timeframes.”

Jocelyn Downie, a professor of law and medicine at Dalhousie University, said Lametti was advocating for an interpretation narrower than what is used by physicians across the country.

“I’m frankly shocked,” he said.

Dr. Stefanie Green, president of the Canadian Association of MAiD (medical assistance in dying) Assessors and Providers, said Lametti’s definition “would roll back access.”

Lametti was not available for an interview but in an email statement his office said the definition has not changed in the proposed update to the law.

“By retaining the same language in Bill C-7 practitioners will be using a standard that is already familiar to them as a means to determine which safeguards to apply.”

While “not crystal clear,” Green found the clarification ”reassuring.”

READ MORE: Strong support for expanding access to medically assisted dying: poll

But Grace Pastine, a lawyer with the British Columbia Civil Liberties Association, said her group is “very concerned” about Lametti’s messaging and what it could mean for Julia Lamb.

Lamb suffers from spinal muscular atrophy, a degenerative disease that has confined her to a wheelchair and left her needing almost round-the-clock care.

Not yet 30 years old, Lamb could live for decades as her condition deteriorates. On her behalf, the BCCLA launched a court challenge to the reasonably foreseeable death requirement. However, it adjourned the case last fall after the federal government submitted a written expert medical opinion that concluded Lamb does qualify for an assisted death.

Madeline Li, head of the assisted dying program at Toronto’s University Health Network, wrote that if Lamb indicated her intention to refuse treatment for recurrent pneumonia, that would make her death reasonably foreseeable. Li also noted that interpretation of reasonable foreseeability has evolved to the point that some clinicians are comfortable “extending prognostic timeframes out to many years.”

Pastine said if Lametti’s definition were to become the norm, Lamb’s natural death might no longer be considered reasonably foreseeable. She said that could mean ”a significant restriction” of Lamb’s rights, as well as those of other Canadians “suffering unbearably with no end in sight” from degenerative diseases.

Under C-7, those not deemed to be reasonably close to death would face a minimum 90-day assessment period, among other conditions not required for those who are near death.

Forcing Lamb to endure “90 days of intolerable suffering” before getting an assisted death “is cruel and it raises serious constitutional concerns,” Pastine said.

“Julia deserves to have the option of a painless and compassionate dying process if her suffering becomes intolerable. Unfortunately, she now finds herself in the position of not knowing whether she has more or fewer rights under Bill C-7 and contemplating whether she must continue with her lawsuit in order to vindicate her rights.”

For her part, Wiebe said she is “thrilled” with the bill, which she believes will make access to assisted dying easier for most people.

She also said she considers Lametti’s views irrelevant and that they won’t change her calculation that natural death up to 10 years down the road counts as reasonably foreseeable.

Still, Wiebe acknowledged not all medical practitioners may be quite so comfortable ignoring the justice minister’s view.

“I realize it may cause problems for some people who will feel very nervous about it and it may interfere with access because of that, and that would be sad.”

READ MORE: B.C. terminates contract with hospice society refusing assisted death

Joan Bryden, The Canadian Press

Like us on Facebook and follow us on Twitter.

medical aid in dying

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Signs of support to be posted on grounds of local hospitals

Individuals can purchase signs through program of Fraser Valley Health Care Foundation

Abbotsford politicians and city staff to consider cash-flow questions, tax deferments

Mayor says it’s unclear how many residents and business owners will be able to pay taxes on time

Sex offender charged again less than two months after prison release

Taylor Dueck, who was living in Mission, has history of sex assaults in Abbotsford

Cop who lives in Mission awarded almost $3.2 million for 2 car crashes

Jeffery Neufeldt was injured on the job in collisions in 2013 and 2016

Charity website hopes to help Abbotsford food bank

Residents urged to post their stuff for sale and donate proceeds

‘The Office’ star John Krasinski offers Some Good News in trying times

‘The human spirit still found a way to break through and blow us all away’

World COVID-19 updates: Putin may be exposed; 30,000 prisoners released

Comprehensive news update from around the world as of Tuesday, March 31.

Canada expands 75% wage subsidy to COVID-19 affected businesses of all sizes: Trudeau

Program will provide up to $847 per week for each worker

‘This is no joke’: B.C. woman in Alberta hospital asks people to stay home during COVID-19

‘I want people to start listening to what the doctors are saying. This is no joke, please stay home’

Rest stops barring washroom access to truckers a ‘huge problem’ as COVID-19 spreads

Teamsters Canada says truckers are increasingly being denied warm meals

Canadians asked to wash mailboxes, keep dogs at bay, to ensure safe mail delivery

Four postal workers in Canada have tested positive for COVID-19 infection:

Hospitality workers hit ‘first and hit hardest,’ says union seeking more support

Union represents workers in hotels, casinos, airports, arenas, universities, schools and remote resource camps

South Surrey hikers discover decades-old campsite hidden in Golden Ears Park

Group reconnects with original campers through social media, returns log book

BC Ferries able to restrict travel for sick passengers

Ferries working on schedule shifts to keep workers safe

Most Read