Global perspective: A cross-jurisdictional look at medical assistance in dying.

• Author: Ferguson, Ashley

On February 6th 2015, the Supreme Court of Canada delivered the landmark decision of Carter v Canada (Attorney General) 2015 SCC 5, [2015] 1 SCR 331. The Court unanimously ruled to overturn the legal ban on medical assistance in dying in Canada. The Court declared that sections 14 and 241 of the Criminal Code of Canada, which created the legal ban on medically-assisted suicide, infringed s.7 of the Charter. Therefore, these sections were declared of no force or effect, to the extent that they prohibit medical assistance in dying for a competent adult person who:

(1) clearly consents to the termination of life; and

(2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition

In light of the Carter decision, the federal government was challenged with creating a legislative framework that is flexible enough to achieve its intended purpose, but also has sufficient safeguards to protect vulnerable individuals.

While the idea of medical assistance in dying is a novel issue in Canada, there are other jurisdictions around the world that have embraced this reality for many years. Those jurisdictions with medical assistance in dying legislation include Switzerland and Germany, as well as the states of Washington, Oregon, California, Montana and Vermont in the United States. Medical assistance in dying in these countries usually means a doctor prescribes a lethal dose of medication, which the patient then self-administers in the setting of their choice. Euthanasia, in which a doctor assists in the dying process in either a hospital or other setting, is legal in the Netherlands, Belgium, Luxembourg, and Colombia.

In the European countries where either medically-assisted dying or euthanasia is legal, the legislation is quite liberal. For example, in Switzerland, article 115 of the Swiss Criminal Code allows for people to assist in another person's suicide, as long as it is not for selfish motives or personal gain. The legislative scheme also does not require that the recipient be a Swiss citizen. One of the results of such permissive laws is that an adult, who wishes to die but is neither terminally ill, nor a Swiss resident, can access end of life treatment. Switzerland has seen the emergence of 'suicide tourism' a particular phenomenon that the Canadian version of medical assistance in dying would not...