Physician-assisted death: time to move beyond yes or no

Depression may be common among those re - questing physician-assisted death,8 and it can render patients incapable of providing consent if it prevents them from being able to understand and appreciate the consequences of physician-assisted death and alternative treatments. In the Netherlands and the United States, two physicians must use clinical judgment to determine whether a pa - tient is capable before physician-assisted death,5,6,9 but patients are rarely referred for psychiatric as - sessment.10 If a psychiatric assessment is re quired in the Canadian setting (as the trial judge in [Carter] v. Canada specified),3 psychiatric resources would be hard-pressed to provide urgent assessments for patients who request physician-assisted death. Furthermore, Quebec's Bill 52 would allow physicianassisted death for consenting adults who are at the end of life and experiencing "unbearable ... psychological pain" (s.26[6]).1 Depression could be simultaneously an indication and a contraindication for physician-assisted death. We need a plan for monitoring to promote compliance with established safeguards and prevent the vulnerable or incapable from receiving physicianassisted death against their will. Data from the Netherlands suggest that the incidence of involuntary euthanasia has fallen since physician-assisted death was legalized there and may be lower than in some countries where physician-assisted death is illegal.11,12Yet there is no guarantee that Canada will follow that trend without vigilant monitoring. Belgium and the Netherlands have mandated committees to review every reported case of physicianassisted death and provide individual feedback to ensure the use of proper procedures.9 They are supposed to emphasize education rather than punishment for failure to comply. Quebec's Bill 52 mandates the creation of a commission to review each case of physician-assisted death; reporting would be mandatory to monitor whether all legal requirements were met. If two-thirds of members felt that an instance of physician-assisted death did not adhere to the legislation, they would be obliged to report the physician to his or her institution and the Collège des médecins du Québec to take "appropriate measures."1 If these measures include notifying police, then phys icians could face criminal charges of murder or assisted suicide even for an unintentional departure from the legislation. Monitoring is clearly needed, but there is no medicolegal precedent in Canada for s