A report launched today calls on the federal government to take an evidence-based approach to designing safeguards to protect vulnerable persons in the system for physician-assisted death. Released by the Canadian Association for Community Living (CACL), the report on " Assessing Vulnerability in a system for physician-assisted death in Canada" draws on extensive research on safeguards and risks of vulnerability in systems for physician-assisted death in other jurisdictions. 

Based on evidence from an extensive review of scientific studies, the report recommends that requests for physician-assisted death be considered through a 'vulnerability lens' to discern: risk of suicidality; predominance of psychosocial suffering and unmet needs; dynamics of undue influence or coercion that could motivate the request; personal resilience to vulnerability; and, the extent to which a person is potentially vulnerable or actually vulnerable. 

Joy Bacon, CACL President, said: "This research report also raises very serious concerns that in the current health care system in Canada, it would not be possible to implement a consistent, pan-Canadian approach to vulnerability assessment."

The research points to four main limitations in the current system: incomplete and inconsistent statutory obligations for health care consent and to assure absence of coercion, inducement and undue influence; varying health profession guidelines for informed consent and response to vulnerable persons; limitations of relying solely on physicians to assess vulnerability; and lack of proven tools and protocols to assess and respond to vulnerability. 

To ensure a pan-Canadian approach to safeguarding vulnerable persons, the report recommends federal legislation amending the Criminal Code to: 1) establish a national standard for obtaining informed consent for the procedure, requiring the adult's decision to be non-ambivalent, voluntary and free of undue influence or coercion; 2) require vulnerability assessment in response to each request; and, given that the Supreme Court legalized physician-assisted suicide as an exception to the Criminal Code, 3) mandate prior independent review and authorization of requests. 

Michael Bach, CACL Executive Vice-President, said: "The Supreme Court of Canada declared a constitutional requirement that the system must balance access with protecting persons who are vulnerable to being induced to commit suicide. This is the first report to provide an evidence base for how that balance can be accomplished in a way that protects vulnerable Canadians. We are hopeful that the federal government will be guided by the evidence in presenting its proposed safeguards to Parliament."