A Call for Safeguards

Submission by ARCH Disability Law Centre to the Standing Committee on Justice and Human Rights
regarding
Bill C–14  An Act to amend the Criminal Code and to make related amendments to other Acts (Medical Assistance in Dying)

April 2016

425 Bloor Street East, Suite 110
Toronto, Ontario M4W 3R4

http://www.archdisabilitylaw.ca/

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Introduction 

In Carter v. Canada, the Supreme Court of Canada tasked this Government with the 
creation of a framework to govern access to physician-assisted death while also 
protecting persons who are vulnerable to inducement or coercion. The Court concluded, 
“a properly administered regulatory regime is capable of protecting the vulnerable from 
abuse and error.” It further found that “adults who may be vulnerable to committing 
suicide in a time of weakness” should be protected. While Bill C-14 provides the 
minimum standards, additional safeguards are necessary to address the concerns of 
Canada’s diverse disability communities, including the need for a “carefully designed” 
and balanced system. 

About ARCH 

ARCH Disability Law Centre (“ARCH”) is a specialty legal clinic dedicated to advancing 
the equality rights of persons with disabilities. ARCH is primarily funded by Legal Aid 
Ontario and provides legal services to help Ontarians with disabilities live with dignity 
and participate fully in our communities. Through our Provincial mandate, we work with 
Ontarians with disabilities and disability communities providing direct legal 
representation in systemic litigation, we conduct law reform activities, and policy and 
community development work. We also provide public legal education to persons with 
disabilities and continuing legal education to the legal community. ARCH maintains a 
website at www.archdisabilitylaw.ca. Our submissions are driven by our work with 
Ontarians with disabilities and their experiences of coercion and the impact of ableist 
stereotypes, including about their prospects for recovery and quality of life. 

ARCH has endorsed the Vulnerable Persons Standard and two members of its Staff are 
Advisors to the Standard (http://www.vps-npv.ca/readthestandard/)  The five-part 
Standard developed a system that would support adults who may be motivated by a 
range of circumstances separate from their end-of-life conditions. Those circumstances 
include barriers to palliative care, presumptions about their quality of life and prospect 
for recovery, and barriers to disability supports and services. 

The following submissions are not comprehensive. Instead, ARCH relies on the work of 
the Vulnerable Persons Secretariat and the submissions made by its Advisers. ARCH 
commends the Government for adopting a minimum standard of safeguards to address 
the vulnerability of persons with disabilities who seek physician-assisted death. ARCH 

strongly urges the Committee to strengthen the minimum safeguards set out in Bill C-14. To do that, ARCH makes two specific recommendations. 
Recommendation 1: An Explicit Right to Information about Alternatives 

ARCH’s work is dedicated to the promotion of the inclusion of persons with disabilities 
in decisions that affect them. Bill C-14 must recognize the explicit right for persons to be 
informed of the full range of available supports that could reduce their sources of 
vulnerability and related barriers. Vulnerability can have many sources, including ableist 
presumptions about a person’s quality of life. The provision of information about 
palliative care options must be made explicit in the body of the amendments, and not 
only in the Preamble. 

Attention must be paid to the upstream factors that influence the wellbeing of persons 
with disabilities, including the social determinants of health such as poverty, housing 
and disability supports and services. ARCH provides legal services to Ontarians with 
disabilities whose legal issues are compounded by poverty, who also face barriers to 
accessing necessary and appropriate housing, community supports, health care and 
palliative care. 

ARCH acknowledges Canada’s commitment to “support the improvement of a full range 
of options for end-of-life care”, as set out in the Preamble. To fulfil this commitment, s. 
241.2(3) must codify a person’s right to information about those ”full range of options”. 
Persons with disabilities who seek a physician-assisted death must be informed of and 
understand all alternatives. Bill C-14 must include additional safeguards to support 
them to pursue any acceptable alternatives including palliative care. 

Access to this information is crucial to ensuring opportunities for persons with 
disabilities to make informed end-of-life decisions. Sections 241.2(1)(e) and 241.2(7) of 
Bill C-14 require that health care providers obtain informed consent. In Ontario, the 
Health Care Consent Act (HCCA) requires that a person’s consent is informed if the 
person receives information in respect to the nature of the treatment, the expected 
benefits of the treatment, the material risks of the treatment, the material side effects of 
the treatment, the alternative course of action, and the likely consequence of not 
having the treatment.  In order to meet the HCCA’s requirements, a person who seeks 
a physician assisted death must receive information about alternative courses of action, 
including access to palliative care or other means to remediate sources of vulnerability. 

Health care providers are responsible for the accommodation of the disability-related 
needs of their patients, including pursuant to statutory human rights instruments. In 
particular, the communication of the full range of available treatments, technologies and 
supports must take into account disability-related barriers to communication. Persons 

with disabilities -including at end-of-life -have a right to accessible information about 
alternatives. Physicians and nurse practitioners must communicate information about 
these alternatives in an accessible manner that accommodates the person’s disability 
related needs. This is particularly important for persons with communication disabilities. 

Recommendation 2: Voluntary Consent Must Include Freedom from Coercion and Inducement 

Presently, Bill C-14 only requires that physicians and nurse practitioners confirm that 
the request was made free from “external pressure.” Without definition its application 
remains vague. Bill C-14 must clarify that a physician-assisted death is unavailable 
where external pressure or any form of inducement exists. Physicians or nurse-
practitioners must be required to confirm that the persons who seek a physician 
assisted death do so voluntarily and without coercion. The lives of persons with 
disabilities are highly regulated, and they may depend on a variety of so-called 
“external” supports. Persons with disabilities are, in particular, vulnerable to 
inducement; a result of ableist stereotypes about their quality of life and prospects for 
recovery. Bill C-14 must clarify “external pressure” at s. 241.2(1)(d) to include explicit 
reference to “freedom from any form of inducement.” 

Conclusion 

ARCH applauds the Preamble’s affirmation of the “inherent and equal value of every 
person’s life” and its commitment to protecting against “negative perceptions of the 
quality of lives of persons who are elderly, ill or disabled.” We urge the inclusion of 
additional safeguards to deliver on these commitments. They must be more than 
rhetoric. Those safeguards, including the two outlined above, will guard against the 
perpetuation of the disadvantage and social vulnerability faced by persons with 
disabilities. 

ARCH urges Bill C-14’s adoption, with these additional safeguards, in advance of June 
6 2016.