OTTAWA — A compromise bill that would legalize medically assisted suicide only for adults suffering intolerable illness or disability who would soon face a natural death was hailed Thursday by some medical professionals but denounced by a wide range of critics as a confusing betrayal of a Liberal promise.

Criticism was anticipated by the two Liberal ministers who introduced Bill C-14 Thursday, a legislative response to the Supreme Court of Canada’s Carter decision in 2015. They predicted it would not satisfy everyone, but reflected “all views” and met the requirements of the high court.

But the legal team that fought and won constitutional recognition of a right to die said Thursday that even Kay Carter, the woman at the heart of the landmark case to change Canada’s suicide laws, might not have qualified for a lawful death under the Liberal government’s proposed new regime.

The Liberal bill would limit medically assisted suicide to “competent adults” 18 or over whose natural death is “reasonably foreseeable” and are suffering “intolerably.”

“It’s totally unclear what that even means,” said Josh Paterson, executive director of the B.C. Civil Liberties Association which won the charter challenge filed by Carter and other individuals.

“As a physician, I don’t know what that means. Is reasonably foreseeable two weeks, is it three months, is it 12 months?” said Dr. Brett Belchetz, an emergency room doctor in Toronto, and member of physician advisory council to Dying With Dignity Canada. He welcomed a legalized regime, but Shanaaz Gokool, head of Dying With Dignity, said the group was mostly “deeply disappointed.”

“We expected compassionate political leadership. Canadians expected better,” she told a news conference.

The Liberal government signalled clearly that, like the Quebec approach, it views assisted suicide in the context of end-of-life care — a position praised by other groups like the Canadian Association for Community Living.

Still, the proposed requirement of a “reasonably foreseeable” death came “out of the blue” and creates an impossible bar for people like Carter, who had spinal stenosis, a paralyzing, painful condition, said Paterson. Carter ended up travelling to Switzerland to seek legal help from a doctor to end her life before the final ruling in her case. Her family continued her challenge at the high court and won.

“Kay Carter was suffering intolerably from a grievous disease but she wasn’t going to die from spinal stenosis; it’s not terminal. She might have lived who knows how much longer,” said Paterson.

Justice officials who briefed reporters said it is a “flexible standard” that allows a clinician to determine in light of all of a patient’s circumstances whether it is “reasonably likely a person would die in a period that’s not too remote.” They said a person suffering paralysis as a result of spinal stenosis, as in the Carter case, might meet the threshold.

Text of the bill on assisted dying View document on Scribd

Justice Minister Jody Wilson-Raybould and Health Minister Jane Philpott struggled to explain why the government added it to the bill, stressing the need to protect vulnerable persons, and promising a five-year review.

“The proposed legislation would allow competent adult patients who are suffering intolerably from serious and incurable medical conditions to apply for a peaceful death instead of prolonged, frightening, painful or undignified death that they may otherwise face,” said Wilson-Raybould.

The two ministers spoke of an “incredibly emotional” debate at the cabinet table, and of their own personal experiences. Wilson-Raybould cited her grandfather’s 15-year struggle with Alzheimer’s. Philpott, who has publicly written about losing a young daughter, referred to her young niece with a neurodegenerative disease, who is non-verbal and cannot communicate.

“We have to think of how we can protect the most vulnerable among us and societies are judged in the protection that they provide for the most vulnerable people,” said Philpott, a physician.

The bill prohibits medically assisted death for minors, persons who suffer solely from a mental illness, and persons who are incapacitated or not able to provide voluntary, informed consent at the time of death. In doing so, it bars “advance directives” for a doctor-assisted suicide. Instead the government has punted those issues, promising to study them further with the provinces.

“What this will do is it will force many people with conditions like dementia . . . Parkinson’s . . . Huntington’s disease to potentially actually end their lives prematurely while they are still competent,” said Belchetz, the Toronto emergency doctor.

“This is a huge risk and something that needs to be rethought urgently.”

It maintains a broad Criminal Code ban on aiding someone to commit suicide but sets out legal exemptions for medical practitioners — doctors, nurses, pharmacists and other professionals like social workers — who aid eligible patients to die.

To be eligible, patients must meet five criteria:

They are at least 18 years of age and capable of making decisions with respect to their health

They have a “grievous and irremediable medical condition.” This is defined as having a “serious and incurable illness, disease or disability;” in an “advanced state of irreversible decline” in capability; the condition causes “enduring physical or psychological suffering” that is intolerable to the person, and cannot be relieved; and natural death “has become reasonably foreseeable” without necessarily having a specific time prognosis.

They have made a voluntary request that was not made as result of external pressure

They give “informed consent” to receive medical assistance in dying.

They are covered under provincial health insurance plans — a move to prevent “suicide tourism” by non-Canadians or non-residents.

The law sets out what Wilson-Raybould called “robust safeguards” to protect the vulnerable:

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It requires two medical opinions, independent of each other, certifying a patient meets all the criteria;

It requires a request by the patient in writing, before two independent witnesses, that the patient wants a medically assisted suicide.

Patients would have the right to withdraw consent at any time.

It sets out a 15-day waiting period between the date of the written request and the medical action. “It’s intended to ensure a person doesn’t make a rash decision . . . a day after they receive a diagnosis, for instance,” said a justice official. But the period could be shortened if both medical professionals are convinced death or the patient’s loss of capacity to consent has become imminent.

The Conservative Party, the Evangelical Fellowship of Canada, the Coalition for HealthCARE and Conscience, the Campaign Life Coalition, and Canadian Physicians for Life slammed the Liberals for failing to include a clear provision allowing medical practitioners to opt out of assisting patients to die for reasons of religious belief or personal conscience.

That will be left up to provinces and professional regulating bodies to carve out.

For many, the bill represents a worthy attempt to meet the needs of patients and their medical caregivers.

Canadian Medical Association president Dr. Cindy Forbes said, “The overall approach announced today is both thoughtful and comprehensive.”

With files from Alex Boutilier

1) On physician objections:

“No other foreign jurisdiction in the world that has legalized euthanasia/assisted suicide forces health-care workers, hospitals, nursing homes or hospices to act against their conscience or mission and values. These conscience rights must be preserved.” Larry Worthen, Coalition member and executive director of the Christian Medical and Dental Society of Canada.

2) On mature minors:

“It will exclude mature minors. Young people, 16- and 17-year-olds, who may otherwise have the capacity to make their own medical (decisions). And when we’re talking about 16- and 17-year-olds, I want you to think about a 16-year-old with terminal cancer whose only option may be to voluntarily stop eating and drinking, to starve or dehydrate themselves to death.” Shanaaz Gokool, CEO of Dying With Dignity Canada

3) On mental illness:

“It establishes that medical assistance in dying is just that: it is assistance for the dying. This is as it should be. People who may be suffering with cognitive, psychiatric or neurological conditions which are not in themselves natural causes of death will not be eligible. To have done otherwise would have raised alarming prospects of legal authorization for putting people to death because of mental disability.” Canadian Association for Community Living:

4) On advance directives:

“Dementia is a terminal illness for which there is no cure. The end of life state of suffering of a dementia patient is horrific. The body declines, the mind fades and the person . . . slowly dissolves. We cannot ignore the rights of those patients by declining them the option of advanced consent while they are still of sound mind and able to make decisions for themselves.” Barb Brezezicki, whose deceased mother suffered from dementia.

5) Timeline:

Bill C-14 must pass through Commons and Senate committee study, be voted on by both chambers, and receive royal assent by June 6 to comply with the Supreme Court deadline. Parliament may work extended hours. If no law is enacted, doctors and patients will have to take guidance from the Supreme Court ruling in Carter vs. Canada. It said assisted suicide is constitutional under a physician’s care, for consenting adults who determine they cannot tolerate the physical or psychological suffering brought on by a severe, incurable illness, disease or disability.