Konder Ricarda M, Christie Timothy
Medical Student, Dalhousie Medicine New Brunswick, Saint John, NB.
Director of Ethics Services (Authority B) for Horizon Health, Saint John, NB.
Healthc Policy. 2019 Nov;15(2):28-38. doi: 10.12927/hcpol.2019.26073.
Canadian medical assistance in dying (MAiD) legislation was introduced in 2016. Although Bill C-14 attempted to balance patient autonomy and the protection of the vulnerable, recent court challenges suggest that an ideal balance has not been achieved. Numerous advocacy initiatives as well as a parliamentary review currently focus on three specific populations: mature minors, patients requesting MAiD via an advance directive and patients with a mental illness as the sole underlying condition. This article approaches these issues from an ethical and legal lens. We first outline a policy review on existing MAiD legislation in 11 jurisdictions. We then use the Oakes test (a critical assessment tool in the Carter v Canada case) to determine whether the restrictions on the three above-mentioned groups are consistent with the Canadian Charter of Rights and Freedoms. Finally, we consult our literature review to propose reasonable solutions that would be more consistent with the Charter.
加拿大的医疗协助死亡(MAiD)立法于2016年出台。尽管C-14法案试图平衡患者自主权与对弱势群体的保护,但近期的法庭质疑表明尚未实现理想的平衡。众多倡导举措以及一项议会审查目前聚焦于三个特定人群:成熟未成年人、通过预先指示请求医疗协助死亡的患者以及仅以精神疾病作为潜在唯一病症的患者。本文从伦理和法律角度探讨这些问题。我们首先概述对11个司法管辖区现行医疗协助死亡立法的政策审查。然后我们运用奥克斯测试(卡特诉加拿大案中的一项关键评估工具)来确定对上述三类人群的限制是否符合《加拿大权利和自由宪章》。最后,我们参考文献综述提出更符合该宪章的合理解决方案。