 in the School of Law, it's a mini law school, professor here at the Law School and the director of our Health Law Institute. And I'm absolutely thrilled to be introducing one of my favorite colleagues, Dr. Downey. Dr. Downey is a professor in the Faculty of Law, as well as a professor in the Faculty of Madison. And to my pleasure, she's also a member of the Health Law Institute. She flirted with the Supreme Court of Canada a good assistant a couple of years ago. And since that time, she published a book. She's got over 100 articles. She served on various national bodies that had significant consequences for how our Health Law and policies had evolved in Canada. So for example, she worked on the alleviary inquiry. She knows where the controversy is and tells you both of these. One of her, I would say, most significant areas of work in the past judgment here is on end-of-life law and policy. And throughout her work, we see a real commitment to promoting unsafe, aggressive, and responsible changes in health law and policy. And this goes back many years. We can see this evidenced in her work with the Senate Committee on Euthanasia and Sister Suicide. We get it in her book from 2004, Dying Justice, in which she makes a case for decriminalizing euthanasia and assisted suicide in Canada. She argues to opening the laws in some ways, but in other ways, being more restrictive than the approaches that we have been taking. She's sent to the Royal Society of Canada's expert PIM on end-of-life decision-making. And I was at the pleasure of co-organizing with Jocelyn's past summer, the first international conference on end-of-life decision-making. We brought together physicians, ethicists, legal scholars, people from a whole variety of backgrounds in Australia, smaller for the world to debate these issues. And at the diversity was, she was exciting. She was extremely exciting. Most recently, of course, she was a member of the Pro Bono legal team in the case of Carter versus Canada, a decision that was released by the Supreme Court of Canada just last week on physician-assisted suicide. So I'm here to ask you, Jocelyn Daly. Thanks, Frances. When people stand up and start their talk, they often say, I'm really happy to be here. I am so happy to be here tonight and under these incredible conditions. Two weeks ago, I was scheduled to give a talk on a conversation about assisted dying. What does the law have to say? But thanks to Snowmageddon 2015, which left me stranded in Utah. And then thanks to the Supreme Court of Canada's impeccable sense of timing, releasing its decision on Friday. Instead, today I'm going to talk about a conversation about assisted dying. What did the Supreme Court say? The switch in the title slide, indeed, I actually threw out my entire talk that I had prepared for two weeks ago. It got me reflecting on title slides over the years. I have been talking about this topic for quite a long time. It's one way to tell the tale of how we got here tonight. I went back into my files, and it's so far back. This is actually an overhead that I had to scan to put in because we don't have overhead machines anymore. And you also have to love the old comic sans-serif that we all used back then, thinking we were very cool and hit by using that. But at any rate, we started with reflections on end-of-life law and policy. And then we started making arguments for decriminalization of euthanasia and assisted suicide. Then in 2007, started thinking it really was time to revisit Rodriguez, to retry the Sue Rodriguez case. Soon there was a glimmer of hope with a dash of healthy realism in the title. Were we at the crossroads, exciting things were happening, or were we actually just at another dead end in the process of reforming law and policy? And then in 2012, Justice Smith's decision came out in the Carter case. And that's the trial level decision in the case that we're going to spend most of tonight talking about. And I imagine most of you are here keen to hear about that decision. The title slides became more optimistic. Change is going to come, end-of-life law and policy in Canada. Hopeful song titles abounded. The times they are changing. But it wasn't all sweetness and light. Pitched battles ensued. Really heated battles were fought in the courts, in the legislatures, in the media, at kitchen tables around the country. These really were turbulent times. Yet last year, I hesitatingly suggested, perhaps we really were poised for change. I noticed when I looked at this how I had a kind of smaller font, because I almost didn't want to say it too loudly. But then came last Friday. Carter v. Canada, boom, the Supreme Court of Canada decision comes out. End-of-life law and policy in Canada changed dramatically last Friday. It feels like it was six weeks ago. But really, this is Wednesday. That was Friday. It's kind of hard to believe. Out came those amazing words, appeal allowed, and for Joe, our way what mattered more, with costs even, proving that public interest litigation can actually be a decent business case. So getting here wasn't easy. We have Sue Rodriguez, the first challenge to the prohibitions on assisted suicide in euthanasia back in 1993. Unsuccessful. You have Beverly McLaughlin. Look how young she looks. I went looking for that. This is from the time. This is when she actually went to the bench, went to the Supreme Court bench. And she was, of course, in dissent in Rodriguez back then. This one you may not recognize, but it again is a very young, Joan Nieman. She's a retired senator. It's taken us that long that she's now retired. And she led the Senate Committee on euthanasian assisted suicide. Again, a valiant effort. Again, an unsuccessful challenge. You have Jim Wakeford, who was also, he tried to do a challenge. His challenge didn't even get off the grounds. In fact, because of stereotyosis, which we can come back and talk about. And Francine Lalonde, who was a federal member of parliament, she was with the bloc. And she introduced legislation to decriminalize. And again, she was unsuccessful. So all of this together left us thinking we really weren't going to get anywhere. But along came Kay Carter. This is a woman who had spinal stenosis. She was facing intractable compression of her spine and from that chronic pain and loss of capacity. Not mental capacity, but physical capacity. And along came Gloria Taylor, a woman with ALS, the same condition that afflicted Sue Rodriguez, a degenerative neurological condition that leads to what most people would agree is a horrific death. She faced a steady loss of physical capacities and significant pain. Both of these women wanted an assisted death. Both were confronted, though, with the prohibition against assisted dying, that is in the criminal code. Both rejected the prohibition. Kay went to Switzerland. Her daughter and son-in-law took her there. And she had an assisted suicide. Gloria joined in the challenge. Kay's daughter and son-in-law were the face of the challenge on behalf of Kay, basically. And these two women themselves and through their proxies argued that those with grievous and irremediable medical conditions facing enduring suffering that's intolerable to them and unrelevable by means that were acceptable to them should have access to assisted dying. So we had signs of life again in the process of attempting to reform the law. So the key question was, of course, should assisted dying be permitted in Canada? Should these women be able to access assisted dying when their suffering became intolerable to them? At the heart of the court case is the question that can be expressed as simply, does the criminal code prohibition of assisted dying violate the Canadian Charter of Rights and Freedoms? Now, before getting into the case, we need to get a little bit clear on some of the definitions so that you understand what I'm talking about when I quote from the court. And also, most importantly, that when we're in our discussion period, we're all talking about the same thing. These are definitions from the case itself, which I hope means we've now settled the debates on the definitions for the purposes of law in Canada. This is what these terms mean. So assisted suicide is the act of intentionally killing yourself with the assistance of another who gives you either the knowledge of how to do it or the means of doing it. So the archetypal instance is I am dying, somebody brings me a glass of orange juice with barbiturates ground up in it and I drink it. I take that final step. Physician assisted suicide, it's just a suicide where it's the physician who provides the assistance. Euthanasia as defined by the court actually imports the physician. The intentional termination of the life of a patient by a physician or someone acting under the direction of a physician at the patient's request for compassionate reasons. Assisted dying, assisted death, these are just generic terms to describe both assisted suicide and euthanasia. So it's an umbrella and then you have the two categories inside it. And not surprisingly, physician assisted death and dying is the generic term for assisted dying where it is provided by a physician. Now a little bit of background law as well so that again you know what the provisions are that we're talking about. When I start throwing around section seven, section 241B and so on, we actually know what they are. We have to review just quickly the criminal code provisions. So that's what's being challenged and the charter provisions, those are the mechanisms for the challenge. So under the criminal code, the prohibition on voluntary euthanasia basically comes from the impact of section 14 of the criminal code, which says you're not allowed to consent to your own death. So if somebody inflicts death on you, you can't consent to it. Therefore, they're committing culpable homicide. They're committing murder if they kill you. The piece that prohibits assisted suicide is a little more straightforward because it just states explicitly, expressly, everyone who aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offense and liable to imprisonment for a term not exceeding 14 years. So very clearly, both of these are illegal. Now turn to the charter. Section seven, key piece for this case. Section seven establishes that everyone has the right to life, liberty and security to person and the right not to be deprived thereof, except in accordance with the principles of fundamental justice. Section one establishes that the charter guarantees the rights and freedoms, so the rights in section seven, subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society. I'm gonna explain how each of these played a role so you see a bit more of how they work once we get into the case. Just wanna make sure we're all familiar with the elements of the decision. Okay, so Bucco, your seatbelts here, we go. This is the decision. Okay, it starts at trial. We have a decision in June of 2015. I commend to you the decision. If you have not read it yet, set aside some time because it's 400 pages long, but it's a brilliant, brilliant decision. It's very readable, it's very powerful, and it has the evidence and the arguments all set out in it, so I commend that to you. So Justice Lynn Smith, a former dean of law at UBC, a constitutional law scholar, feminist legal scholar, wrote this decision. She decided to strike down the prohibitions on assisted dying in Canada under actually seven and 15. She said it wasn't saved under section one. Boom, it's gone. Then she said, okay, I'll give you 12 months. She said, the federal government, suspend the declaration of invalidity for 12 months so you can get your ducks in a row. Not surprisingly, it was immediately appealed. The BC Court of Appeal heard it and then issued its decision October 10, 2013. And then the Supreme Court of Canada heard the decision October 15th of 2014, and it really became a conversation between the trial judge and the Supreme Court of Canada because that intermediary court really didn't do anything meaningful with respect to the issues because they just said, oh, trial judge, you were bound by the Supreme Court of Canada's decision in the Rodriguez case, back in 1993, you didn't get to do that. So they didn't get into the merits of the argument. So it really is a conversation between the trial judge and the Supreme Court of Canada. Now a slate of issues were before the court in this case Stereo decisis, so being bound by precedent, inter-jurisdictional immunity, can the federal government even do this? Section 751 of the charter, the issue of what's the remedy if it's a breach? What about the conscientious objection on the part of healthcare providers and what about costs? Because as I said, this was done pro bono, but it costs upward over $2 million to take a case like this. The focus of my remarks is gonna be on seven, all the bolded ones, seven and one, and then the remedies in conscientious objection because that's where the assisted dying all happens, the issues there, the other things are important and I'm happy to talk about them in the discussion period, but we wanna get to the discussion period, so I'm not gonna cover them as I talk. So first then, section seven. The argument is that the criminal co-probations violate section seven, specifically, it was argued all three rights, life, liberty and security of the person, and that these limits on the rights are not in accordance with the principles of fundamental justice. In brief, the court found the prohibitions breach section seven. They limit the right to life, they limit the right to liberty and they limit the right to security of the person and did so in a way that's not in accordance with the principles of fundamental justice, specifically in this case, the principle against overbreath. It's not in accordance. So first the limit on the rights. It limits life. Now it may seem paradoxical because you said this is about people dying, so how is it limiting life? Well, how it limits life is that if you know that you're not going to be able to access assisted suicide or euthanasia, you may kill yourself sooner than you otherwise would in order to ensure that you have control over the timing of your death. And that's exactly what happened with Kay Carter. She went to Switzerland, she hadn't assisted suicide long before she wanted to because she had to be sure she could get there before she would not be able to get there before she was not able to travel any longer. Jillian Bennett, another woman who was out in BC and wrote the website dead at noon that some of you may have seen. She too killed herself sooner than she otherwise would have probably and certainly in a different manner than she otherwise would have because of the prohibition. So the Supreme Court of Canada said it limits the right because it deprives some individuals of life as it has the effect of forcing some individuals to take their own lives prematurely. I'm putting the quotes up in part so that you are assured that this is not my interpretation of what they're finding, but rather these are their words, this is what they found. One of the things about this decision is it's incredibly clear, it's very concise, it's very straightforward to read. You put the two of them together, it's just judicial decision writing 101. They also found that it limits liberty because it denies you decision making authority. You don't get to choose when you die, how you die. It also limits security of the person because it leaves people in conditions of intolerable suffering, dying of ALS. Gloria Taylor would have felt that to be intolerable suffering and so she was precluded from having an assisted death so she would have faced that. So all of those were limited. Then you turn to the principles of fundamental justice because you can limit it as long as you do in accordance with these principles. Now the objective of the law the court said is not this global to protect life, they weren't allowed to say that. Rather it was to protect vulnerable persons from being induced to commit suicide at a time of weakness. And the court found that the reach of the law in relation to this in pursuit of this objective was overbroad because it captures more people than just the vulnerable. Put it this way, you have the big ban, inside that ban you capture the vulnerable, those who are vulnerable to coercion and or incompetence, that's who you're concerned about. And yet you also capture all of those people who are not in the least bit incompetent, not the least bit coerced. So the Gloria Taylor, the Kay Carter, the Sue Rodriguez, they're captured even though they're not vulnerable because it's a blanket ban. So it's overbroad. So it violates section seven of the charter. Now the government of course is allowed to limit your rights. They have to balance competing interests and rights and they're allowed to do that as long as they can show the court that the limits are demonstrably justified. Here the court asked, is it demonstrably justified and in particular are the means proportionate to the ends? So the means, the prohibition, are they proportionate to the ends, the protection of the vulnerable from committing suicide in times of weakness? To answer that question they turned to a sub-question which is, could a regime less restrictive of life, liberty and security of the person, address the risks associated with physician assisted dying? Could you avoid the risks and still allow some people to access assisted dying? And the answer from the court was a resounding yes. It was a shouted yes from the trial judge and it was an echo chamber of yeses from the Supreme Court of Canada, quite remarkable. Here's where the facts are so significant in relation to this case. They played a pivotal role here because of course it turns on, can you? It's not a legal question, that's an empirical question. Can you protect people? And here's what they found. With respect to a series of key concerns that many people who are opposed to assisted dying share and I think they should take comfort in the findings of the court. First, their concerns expressed about the vulnerable. Of course, physicians not being able to tell if someone's competent for instance, not being able to tell whether somebody is being coerced or pressured into this. And the court found vulnerability can be assessed on an individual basis using the procedures physicians apply in their assessment of informed consent and decision capacity in the context of medical decision making more generally. They recognize that doctors are constantly deciding whether somebody is competent, whether somebody's being coerced, when for instance they decide to refuse treatment. Somebody's at the end of their life, they say I don't want any more kidney dialysis. Are they competent? Are they being pressured? Doctors have to make that decision every time that comes up and we rely on them to do that and we don't say oh no, we can't do that, we have to limit liberty and security of the person in order to do that. So the court said no. Concerns reasonably expressed about whether persons with disability will be pressured or otherwise placed at high risk. The court said no, there is no evidence from permissive regimes that people with disabilities are at heightened risk of accessing physician assisted dying. I have to emphasize here how much evidence was put before the court, a bookshelf from here to over here, like this, full of binders, full of paper, it was an electronic case management system and she had to come to grips with all of that. On top of that, the experts were brought into court, they give affidavit, some of them were brought in and cross examined it in front of the judge. So the crown had the opportunity to test every single piece of empirical evidence that the judge was considering. It was tested and the claims about placing persons with disabilities at risk were found wanting. The trial judge said no, there isn't evidence of that. Concerns are also expressed about other socially vulnerable individuals. So for instance, you'll hear a lot about elder abuse, the thought of the elderly being at risk or newborns being at risk through allowing for assisted dying. Again, no evidence of an ordinary impact on socially vulnerable populations in permissive jurisdictions. Concerns are also expressed about the impact on end of life care. Will it corrode palliative care, for instance? Will it corrode other forms of end of life care? If you allow assisted dying, will we just sort of get worse at palliative care and other end of life care? Again, no. In some cases, palliative care actually improved post legalization. There's evidence of that in Belgium, for instance, where the budget for palliative care went up dramatically at the exact same moment that they decriminalized it. You also see improvements in end of life care from the court. Physicians were better able to provide overall end of life treatment once assisted death was legalized. Studies in Oregon, for instance, demonstrate that end of life care gets better once you decriminalize. Some people speculate in part it's because you can now have conversations about end of life with your patients so people do better with that. Also, you don't have people being scared that what they do is gonna be taken as euthanasia and here will come the cops, so they know that it's all legal as long as they're following so they can have those conversations. They can do proper pain management because they don't think, oh, somebody's gonna misinterpret that. They can just do proper pain management. The big, big, big concern, of course, is often expressed in sort of an umbrella term, slippery slopes. It's really important. Probably read this one slowly. The trial judge, after an exhaustive review of the evidence, she retired after this. I'm not sure she wasn't just exhausted by it. Rejected the argument that adoption of a regulatory regime would initiate a descent down a slippery slope into homicide. It's important to know. So now the Supreme Court of Canada has said that no slippery slope. The Royal Society of Canada Expert Panel and End of Life Decision Making has said no evidence of a descent down a slippery slope. The Quebec Commission that spent more than a year studying the issues, studying the evidence said no evidence of a slide down a slippery slope. You can, if you allow it carefully and you regulate it carefully, you can protect the vulnerable and you will not go down. You do not go down a slippery slope. So as a result, the Supreme Court of Canada said is a violation of section seven. It's not safe by section one. So the prohibitions are invalid. They issued a declaration of invalidity and then they too suspended that declaration for 12 months to give the federal government time to introduce new legislation. And we will come back to whether that will happen. So the bottom line of all of this is assisted dying will be legal in 12 months in Canada at the latest, 12 months in Canada, but only where, and these are the constraints that the Supreme Court established. It's an adult. The person is competent. It's a voluntary decision on part of the person. They are in a grievous medical condition, including an illness, disease or disability that cannot be alleviated by means acceptable to the individual, and that's the irremediable you'll have read in the terms. And causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition. I hasten to say it is not for children. It will not be legal for children. It will not be legal for incompetent persons. It will not be legal against the wishes or without the knowledge of the individual who is having the assisted death. It's also important to note here that the Supreme Court of Canada went out of its way to say this decision does not compel physicians to participate in assisted dying. That remains an issue for the legislatures, policy makers to determine. They're finding that it violates the law does not in any way compel any healthcare provider to participate. So I used to end my talks on this with two options for people. Where are we gonna end up? A lot of the time I thought we'd be ending up in the green hills in the cliff. Occasionally every so often something would happen like the trial decision in Carter would happen or the Quebec legislature would pass legislation and you would think yes we actually are getting somewhere. But that choice has now been made by the Supreme Court of Canada. We now join a number, an increasing number of permissive regimes in the world that recognize preserve and protect the vulnerable but also recognize preserve and protect autonomy. We've got some big questions ahead. Where do we go from here? Well with respect to the instruments of the subsequent law reform we're going to need, we don't know. You could have federal legislation. I hope we have federal legislation but think who's there in Ottawa right now and what's being said. I'm not sure we will. At any rate, the federal legislation could establish the change to the criminal code. It could put into clear language the circumstances within which the criminal code will not apply to assisted dying. It could and I hope it will establish an oversight system, the commission for the oversight of assisted dying in Canada that can track all the data, that can ensure people that everything is going according to plans, the safeguards are in place. The legislation could establish the reporting requirements and so on. Or you could have provincial territorial legislation. So if the federal government says decides it's just not going to do anything, it doesn't want to touch this. It's too hot with respect to its base. The provincial government still could legislate. Quebec already has. And other provinces could say, okay, we're not going to leave a vacuum. We don't accept the federal government doing that. This is not a good result to just leave things open. So we'll legislate under our health legislation, under our consent legislation probably. Or if they did nothing, you still could have healthcare professional regulatory bodies say, well, we'll step in then and we're going to tell our members what they can and can't do. Still interpreting the case, like they can only work within the constraints of the case, but they then might set standards. But we don't know what the instrument will be. We have to wait for a little bit for the dust to settle on the decision and for the federal government and the other parties to do their political analysis to decide whether they enter into this fray in the context of the election that is imminent. More interesting perhaps for us because it's something we can talk about and you will need to engage in as members of the public, as Canadians, we are all going to have to engage in these issues. We don't have to, but you should because they really, really matter. And these are issues that are going to be discussed in the context of development of any standards or legislation. These are the questions for public engagement. What should be the procedural access safeguards? Do you need two doctors? Do you have to have one look at you and then another one confirm or is one enough? Think about that in the context of rural access. Do you have to wait 14 days between your first request and when you actually get it? Do you need two witnesses, four witnesses, one witness? Do you go to a judicial body and say, give me preemptory agreement that this is okay? Do you go to a committee? We don't know. But what are the safeguards that are going to be built in with respect to how you access? That which the court has said, you need to be able to access if you meet the criteria. These are questions other than criteria. They are how you access, not who accesses. What are the reporting requirements? Does the physician have to send a chart that explains under what circumstances this person had an assisted death? Do they have to send data with respect to demographics? The reason we were able to persuade the court in Carter that there's no evidence of a slippery slope is because the other permissive regimes, most of them, have been keeping extraordinary data and they could answer the question. They know women. They know whether it's men. They know whether people have disabilities. In Oregon, they know the income, the education level, whether they were in hospice, all kinds of things about them. They keep that data so that you can show. There's no evidence of a slide down a slippery slope. In fact, you look at the data from Oregon and it's a picture of privilege. People are used to controlling their lives and having power and they're just carrying that on right through to their death. You only know that because you have data. So will we have reporting requirements that enable us to be sure there's no slide down a slippery slope and also that allow us to contribute back out to the world in the same way that Oregon, Washington state, the Netherlands and so on did for us. Because now the United Kingdom is going to be looking at us, Australia, New Zealand. So if we're contributing to that broad data pool, we'll be helping other people figure out, is this a good path to go down? Advanced Directives. Been being asked about this 12 times a day since Friday afternoon by the media of course, right? Can you get this? Can you get assisted dying through an Advanced Directive? Under the case, no. But it's really important to know the Supreme Court of Canada decision establishes a floor not a ceiling. It says, it violates the charter if you don't allow assisted dying for these people. It doesn't say you violate the charter if you do allow it for these other people. So one of the things that's open to us is to say, terrific, thank you. Supreme Court of Canada has cleared it up that for where you have a grievous and irremediable medical condition and intolerable suffering, you can have access. People might want to say, you know what? For instance, in the case of dementia, Alzheimer's disease, we actually want to allow people to access assisted dying through an Advanced Directive. That's a key conversation we all need to have. It's not an easy one, it is an easy answer. But for something like that condition, do we want to allow people to have access through an Advanced Directive? Mature Miners, another question. Of course, you have people who are under the age of majority, but way more mature than somebody who's 25. Is it, you know, you suddenly turn 19 and you can have access to this? That's what the law is under the Supreme Court of Canada decision in that it says you have to be an adult. But we've recognized that somebody who's 17 years, 359 days, could well be absolutely competent to make a decision to refuse treatment, for instance. We've got the concept of a mature minor. So it's someone who's under the age of majority but understands the nature and the consequences of the decision to be made. Will those individuals be allowed access? Should they be allowed access to assisted dying under the new regime? That's an open question and that's one we will have to confront. And the third one just throughout, and I know there are more and you'll be able to bring more to the table, but these are the ones I wanted to flag for you, is the duty to refer. So while the court said this decision does not compel any physician to provide, you know, we've been having debates about conscientious objection on the part of physicians for many years in the context of abortion. And how does this play out in relation to that? I think that you're going to find that people will say physicians should not be compelled to provide assisted death. I haven't heard any of the advocates for assisted dying ever saying physicians should be compelled. In no jurisdiction where it's allowed are physicians compelled. So I don't think that's the question. I don't think that's the fight. Question will be should a physician be compelled to refer? And that's something that we're going to have to talk about. So the Carter case is a major, major, major, major milestone, but we have many, many, many miles to go. And now it's your turn. System of place that you think- I would actually look at what we've already developed in Canada because what's been developed as proposals was developed looking at all of the other countries. So we've already, a lot of people have already done the work of saying let's look at what's in Oregon and Washington state, they have a particular model, let's look at the Netherlands, Belgium, and let's take all of that, let's reflect on it in the context of our values, our constitutional values, our society, and put forward what the system should look like. So the Royal Society, you have Quebec, you have, there's draft legislation. There's legislation in front of the House of Commons and the Senate in Ottawa right now that Stephen Fletcher put in. And that legislation was developed by looking at everything. So what I would say is, I don't think we should go looking outside anymore, we've done that, we should look inside, we should look at the legislation that's been drafted by people and the reports that have been written and decide what do we wanna do. That's why I also have confidence that if the will is there, we absolutely can do this in a year. You know, if you were starting with nothing, you might say, well, no, to do that responsibly, you might take a bit more than a year. So much work has been done, we totally can. So when you look at what the court did and how it circumscribed who can have access, that's in light of everywhere else. So it's already reflecting the thought that's gone into it. So for example, it doesn't include terminal illness. That's on purpose. We look to Oregon and Washington, they do include terminal illness. We look to the Netherlands, they don't. And we said, what goes on when you do that? What are the constraints? And said, don't do terminal illness. The question, do you have assisted suicide in euthanasia or just one? Look to euthanasia, I mean, the Netherlands, they have both, look to Oregon. They only have assisted suicide in the United States. Archive for political, strategic reasons. But that choice was made in the litigation and then in what happened. So a lot of the choices you would normally make, I think have already been canvassed. Now the question of procedural or the open questions, I think those have to be answered in light of the Canadian healthcare system. Federalism, which will give us interesting challenges on the oversight. And our own values. When I say things like duty to refer conscientious objection, the mature minors, I don't think we get answers to those from looking elsewhere. I think we know what the issues are, we can see what others have done. But the answers to that depend on what our values are. So, yeah. Based on your reports of the United Canada detention and on these points in the study where we have to go from here, how should the discussion be different? Would it be different in regards to the disability or should it not be different? I don't think it should be different. I think what matters is competence. And I think we slide into dangerous territory when we assume that mental illness equals incompetence. We got out of that pit a number of years ago and we should stay out of it. And I think some of the conversation around this issue risks pulling us back into that. When people keep talking about, oh, but people with depression, they can access it. It's like, if they're competent, yes. Depression doesn't equal incompetence. So, I think that you can see from the conditions that they put on, it isn't limited in terms of physical or mental on purpose because what matters is the second bullet, are they competent? And that's, yeah, that's where it sits. They deliberately, that's one of the interesting differences. Very little different, in fact, between the trial judge and the Supreme Court, apart from the length, for the crazy difference in length, but it's because they just were like, she was right, she was right all along. And they just had to affirm a lot of what she said, but they didn't affirm everything. And one of the things the trial judge had in hers was a requirement that you not have clinical depression. And they have not included that. I think they're absolutely right not to have included it. I think it was a sort of odd little blip in Justice Smith's decision. I understand kind of why she did it, but I think it's a great thing that it's not there because otherwise it has that stigmatizing effect that, well, you can, everybody can have it except if you have a clinical depression, and then you think about, what are we trying to protect? Well, the assumption, and the hidden assumption in that is that people with clinical depression are incompetent. And I think that this is terrific for not reinforcing that stigmatizing piece. Doesn't mean we don't have to be careful with competence. We absolutely do. But this is why when Constance mentioned earlier that I sort of want things more open and more restrictive, it's the more restrictive is around the withholding of withdrawal and the potentially life-shortening palliative treatment so that I want to be saying, do we have people really checking that people are competent and that they're making these decisions to stop treatment not from feeling like a burden or they can't access the care, all these kinds of things. I want more attention there. So that's the way in which it's sort of slightly less restrictive. So I think with mental illness, I want people paying very close attention to competence, but I want it for everyone. I could be incompetent because of my physical condition, nothing to do with my mental condition. So it seems... I'll let you. I'm wondering if a lot turned on the way in which they defined the objective. So the objective was protectable and believable. And I think I'm right about this, but you're directing me along. The suicide, some of these provisions that they originally based in a concept of morality and the sanctity of life. So what I'm worried about is what happened in Bedford, which is the government articulates one objective, court really opened the door for them to come back and say, okay, nine women are highly qualified for women and that's your stated objective and then it's no longer personally disproportionate. So is there any risk of a federal government that you really have coming back to legislation that protects the sanctity of life that engages in a really moralistic approach to this? So that's what they did to sex work. The new federal legislation on quantified sex is preamble, it's unbelievably moralistic. Yeah. There's a risk that the federal government do anything it can think of to subvert this decision. Can it? Is there talk? Is there talk about that? There's talk about that I would say mostly from people who are in law who know what they did in Bedford. I think the general public doesn't realize that the federal government would be so disrespectful and contemptuous of the judicial branch as to deliberately do an end run around a decision. I find that stunning and I've been in law for a long time. I just hold on to that notion that you don't do that. I think it's harder with this case for them to do it for this reason. I think prostitution, the society is much more conflicted about it in relation to what the right model is. How do you deal with it? I think there's, there are different reasons that people are opposed to it. There are different reasons that people are supportive of it and there's all this evidence from around about what happens when you do this, that and the other. It's muddier. Whereas this isn't. So I think they'll have a harder time in part because I think more people will be just outraged if they do come back. Imagine what would happen if they came back and said the purpose of this legislation is to preserve the sanctity of life. Whoa, Canadian public is not gonna buy that. 85% of Canadians support decriminalization. They don't buy the sanctity of life argument for this. So I think it's a different strategic choice and there's reasons to think it could be strategically less wise to go down the path they did with prostitution. They'll get less support for it. I mean, I'm not a political science type so that's getting into that territory of figuring out those kinds of strategic moves but it's just so clean, tight, grounded in the evidence, grounded in public opinion or consonant with public opinion and the legislation. There's draft legislation ready to go and Quebec has already gone down the path. So there's all those variables that make me feel less horrible-sinking feeling in my stomach that we're just gonna have another bedford. Oh yes, first of all, this is the second time, I believe, that I have had the privilege of hearing you speak and it's on this subject. So I want to commend you for your clarity and the decision and the thinking and I stand or sit rather in envy of your students. What that in mind, the first time it was in darkness, you would call about how many months ago it was a year or so? In like a library? It was snowy, I remember that so it's probably a year ago. Yes, yes, it was wonderful as you worked with that. But the only thing I came away with and this is purely anecdotal, we have no impact on our lives and I have no doubt in spite of all of my eighth decade that I don't know, I may have to call in some of you. But I remember the one thing that stands out in my mind from that occasion, you were the lawyer speaking and you did what you did tonight without of course part of the city to wrap things in. But the decision was both both. And I don't know if you remember what a line that he used in his comments. And that line was, he was very much in support of Dr. Assistant Suicide, that was his term, how it can be suicide by a third party lawyer or second lawyer. The point is he said, he looked forward to changing the law in the direction of what happened under the court's rule. Because he says what he believed a doctor, the ability to quote, to come to the relief of those who are living a pointless life. I was appalled. I wanted to shout, Richard, you're leading a pointless life. You're ready to go. But so I mean I have no time for the strictly slope argument on this context and others but I'm worried about people like that. I don't think they're going to admit it. But that's a dreadful thing to say. People living a pointless life, that's a dreadful thing to say. Weren't it on medicine or by... Knowing the physician, I would say it was actually reflective of an incomplete choice of words. So you could say pointless life, meaning from my perspective it's a pointless life in which case I'm with you. That's intolerable, unacceptable. But if you mean pointless life according to the individual and it's shorthand for their life has become no longer worth living to them, then it's a reflection of respect for autonomy and it doesn't take you down that judgmental inappropriate slippery slope. I think having, that can happen, right? It's why you don't want to get recorded. You don't want to get recorded when you say things. No, I just, yeah. Yeah, I just happen to know him so I don't think that he holds that view. That said, I mean, some physicians do. And that's why we need a regulatory framework that ensures that only those who should have access, have access, that the procedural safeguards are followed and then no physician who is deciding that that person's life is pointless and therefore I'm going to speed them on their way should be able to do that without sanction. And one of the advantages of decriminalization, I think here, decriminalize and then regulate is we're gonna start enforcing the law, one would hope. Because what you have now is a law that most people disagree with. So practice going on that's inconsistent with the law and nobody prosecuting it because they'll be very unpopular if they prosecute because it's really hard to tell what's going on because everything's happening in the shadows. So what happens is you clear, you put it out, the sunlight is the disinfectant, right? You get it out and we see what's happening and then when things are happening that are not appropriate then I'm gonna be the first person on the phone calling the college positions or calling the police and saying this is wrong, this person needs to be prosecuted because it was involuntary euthanasia. That should stay murder and should be prosecuted and people should go to jail for it. But right now we have no idea when that's going on and I would hazard it is. But we have no way of knowing. So I agree that that would be inappropriate. That's not part of what's in the decision. That's not part of what is in any legislation that anybody who's an advocate is advocating for in Canada and we need to protect against that. I don't think there's many healthcare providers who believe that. I think the greater risk on that, on the sense of life is that life there is pointless, comes actually in the withholding and withdrawal of treatment terrain where healthcare providers have an able-bodied bias and they make judgements about whether the life is worth living and then we'll say treatment's futile and so I'm gonna withhold treatment. That's where you see I think it manifesting and that's where we need to step in. It's again where I hope this is a broader spectrum of law reform where we protect against that and we say you don't get to do that. That's discriminatory. It's also a violation of autonomy and you can't do that. So we actually regulate unilateral withholding and withdrawal because that's where I do believe persons with disabilities are more at risk of having treatment with held or withdrawn from them than they are in any way at risk of having an assisted death that they don't want. But I'll tell him to watch his words. Justin, being confident, shouldn't that be the time that somebody like me decides this is what I want when I become incompetent? Shouldn't we have a bank of, like you mentioned, there should be a bank where we could, not that we have to tell us how much money we make but there shouldn't be a bank where we have our information. Also, I mean we do, not most people but a lot of people have their own doctor. She should be involved in filling our piece of paper out telling us we are competent at the time that we've made this decision, goes into the bank and we should be able all through our life to say, no, I don't want to do this. I don't, even to the last minute, I do not want this because how can an incompetent person make a decision now I want to die? Dementally ill as you mentioned. All these disabilities that people have shouldn't be. A person that is disabled now and is competent can make that decision just like I can't, just like anybody else here. So I think either the federal government has to make some federal law that says we all have to have it in the federal bank or if we go to provincial way, we should be in the provincial banks. And there are a lot more, I mean they've made this decision but it's like me in a way, you have to decide if you're going to redo your kitchen but you don't know yet where you're going to put the covers. You know, it's that kind of feeling that I'm getting and you've wonderfully explained it all like usual. So how do you see this bank develop or whether it should be developed and how much or what you put into our bank. So you have started the very conversation we need to have. This is one of those issues that's unsettled coming out of the decision and that it doesn't tell us what to do with that. It doesn't say you can't but it doesn't say you can. So it's the advanced directives question. Can you in advance, the same way that I can now write down I do not want artificial hydration and nutrition should I become in a persistent vegetative state and then once I become incompetent they cannot give me that and I will die. That is clear in law. Can we ask for assisted dying for assisted, it wouldn't be assisted suicide, it would only be euthanasia obviously. Can we ask for euthanasia through an advanced directive? Open question, difficult question. I think one of the things you have to watch and people have to be very careful when they draft their legislation now is do they say that you must be competent, you can give assisted death to a competent individual blah blah blah or do you say a valid request is made by a competent individual. Think about it because if you say you can give it to a competent person then they have to be competent at the time. So no advanced directives. If you say a valid request is one made by a competent individual and you don't say contemporaneous to the event you've just opened up advanced directives because you can ask in an advanced directive for anything that is legal. It's now legal. You're competent at the time of the request i.e. when you wrote the advanced directive boom you got it. So be careful and watch the legislative drafting but more importantly participate in the conversation about it. You believe that it should be allowed through an advanced directive and then the bank issue is how do you implement that? Other people will say not comfortable with advanced directives, here's why. And that's the debate we need to have. So I hope we park the conversation about whether you can have assisted dying. We park the slippery slope on assisted dying for competent individuals under these circumstances and we focus on these issues and that's a key one because there's a lot of desire amongst individuals with an early diagnosis and diagnosis of early stage dementia or others facing the prospect of it or other neurological degenerative conditions in particular the neurologists are gonna have to spend some serious time on this that they want that and you can in the Netherlands as you know in Belgium. They crossed the philosophical bridge to allowing it. They actually messed up their legislative drafting actually so it's not quite available the way I think they thought it was going to be but they did go the route of saying yeah you actually should be able to access it through an advanced directive or in Washington the US is totally not there and they're not even with euthanasia. So that's an open question. It's one that's already being asked and I hope people also recognize that we have the conversation. The biggest decision has been made for making a massive difference in people's lives and also we have to really focus on the fact that people are benefited by this decision narrow as one might want to say because it doesn't allow advanced directors for instance is it's huge. You have the group who are actually gonna access assisted dying it's this big. Then you add those who talk about it get the prescription for instance and are given enormous peace of mind because they know the door's not locked. If it gets to the place that they gotta get out they can they never access it but they know it's there. The calm, the peace that comes with that and then you have this huge group who benefit because end of life care develops and we get better about talking with each other about dying. Doctors get better at giving pain meds get better at symptom management because it's not all about pain at the end of life. A lot of the time the really intractable suffering comes from breathlessness and intractable nausea. We get better at managing that stuff. We get better at having conversations. So much of what makes death difficult at the end is the silence. So we open it all up. So we just have gone from there to there and we get all of that whether we go down the path of advanced directives or not. Advanced directives is just another, it's a group in there but we've got a whole lot of gain that comes from this. You're looking anxious. No, I'm just wondering how this decision is that the same argument that was made under section seven in not allowing these short peoples who are there by shorting list that's an argument not made for advanced directives in the sense that if we are preventing people from or not allowing people to say it in advance and I'm confident that I want it in my life at this point, essentially I do think that's the same earlier in the hour still as a conference stage. Yeah, the answer to that is yes but the section one discussion will be quite different. Yeah, I know that. Yeah, that's why. Because also with respect to advanced directives, I mean I'm a huge fan and everybody should go home and write it tonight, be sure you have one but they're real challenges with advanced directives in terms of people not knowing how to write them including lawyers and people, so they're not clear enough, they can't anticipate circumstance all kinds of things like that. So that I could see playing out in section one that you would actually come to a different result. Now I think you could also argue the other side standing in law school, I'm supposed to be able to do that, right? So there we go there and then I come over here and I say, well look, this could be very, very specific. So we could say for instance, it is only allowed in the context of Alzheimer's disease or several diseases which are very clearly staged where we know the prognosis, we know we have reliable diagnosis where you wouldn't have those, does it apply here? We'd be saying when I am stage seven Alzheimer's, I want euthanasia. There's no grainus to that, right? So I don't know how the section one analysis would go but I think the section seven analysis, you're absolutely right, would be very similar. Allow me to sum up. Which we have, we have huge variability. Yeah, but early days advanced, advanced directives now is basically everywhere but early days of advanced directives, we went province by province by province and there was a very few and it's more and more and then like PEI took forever, New Brunswick took forever. So they were so holdouts. So that's also one reason, that's a great example. Actually I'm glad you're raising up why I don't want provincial, I want federal. Because of patchwork, you think about it that you can have access because you happen to get hit by a car in Nova Scotia and not in non-PEI. I don't, lots of people will disagree with that because of the joy of federalism debate but I don't like that kind of variability around something like this. Just in terms of the process of making the decisions at the physician level, do you think there's a role for decision making bodies like the Consent and Capacity Board in Ontario to help sort of alleviate some of the gravity of the decision that the physician is making? So you were saying earlier that physicians make these kinds of judgments on a daily basis, sometimes multiple times a day. But for a physician who may perhaps be a little bit unsettled by the idea of providing volunteering for the nation. Yeah, yeah, I probably wouldn't go to the Consent and Capacity Board but I like the concept of saying we have to recognize that people need support in this. And I'd go a different mechanism for supporting physicians because I totally, totally get, especially at the beginning, physicians can be uncomfortable with this, they don't feel they know what to do and yeah, they know how to do a competency assessment but this has got to feel really different. Well the way that you see it in other jurisdictions is you provide education, you provide support, they have docs you can call in who can either work with you as a doc or they can come in and actually provide the care. I would love to see something like that. So you're developing competency. Among those who are prepared to participate, you develop competency. You train during medical school, then residency and then you provide training and we can borrow, we were asked before about what can we learn from other places. We can borrow training modules. I mean, we don't have to reinvent this, right? Teaching someone how to do youth in Asia is very straightforward, some of it. And then other aspects you would have more conversation about. So I'd like to see that. So I buy the concept of supporting people and recognizing it can be challenging for a variety of reasons, either informational, they don't feel they know enough or emotional because it's a morally charged issue. So, but we need to support them when they're letting a 24 year old die because she's just not having blood after a car accident too, right? For a physician to stand there when you have a Jehovah's Witness come in after a car accident and you have to let them die for the nurses to stand there and watch. That's really hard too. So it fits into me, for me, into a bigger picture of let's support people when we put them in positions that can cause moral distress. And this would be another one. It just would be a newer one, but I'm not sure that's, I can see absolutely there'd be circumstances where it's way better than, for instance, those docs who had to watch the little girl in Ontario die for lack of chemotherapy, right? That's, so I think it isn't actually the nature of the intervention. It's the fact of healthcare providers of all different disciplines face really complex, morally challenging situations and we need to support them, both through education and ongoing support. It's only flying in the face. Okay, so you're mentioning the concept of the mature minor wasn't considered in this. Was there a reasoning behind that? Because right now, like as you're saying, like was there a reason why they did include that? Because we were saying with the approval witness, they have the right to refuse a blood transfusion. Children also have, if they're assessed as a mature minor, assessed as competent, they can refuse treatment that will result in their death if they don't have that treatment, right? And there seems to be a major focus right now in moving towards autonomy over benefits. And I would just want to be like, they also have the section seven, I would think you would just apply to the children as well. And if they could be assessed as competent, I'm not really seeing why they would have that ceiling in there whereas they kind of left it as a floor for other aspects that you were saying. It's the nature of the litigation. So this is what was asked for. This was the challenge. This group not getting it violates the charter. So the court said, huh, does this group not getting it violate the charter? Answer, yes. So the plaintiffs did not argue for mature minors to have access. The plaintiffs did not argue for advanced directives. So it could be litigated in the future. I mean, we have the AC decision from the Supreme Court of Canada, which is the mature minor decision or the best decision, but it starts you down a path toward this. So people can litigate and they might win on mature minors. They might win on advanced directives. They might win on a variety of things. They're less likely to litigate, I would say because of the cost and the support that they would get. There was enormous support for this litigation. So it's just probably less likely as opposed to less likely to be successful. Although it is less likely to be successful, but I think you're getting into all those sort of reasons why it may not end up in front of the Supreme Court, but it could be argued for sure. I mean, the section seven analysis and the 15, they didn't do 15. Section 15 was argued in front of them. That's the equality provisions, which I didn't lay out because I wasn't gonna cover them, but the equality provisions were argued, but the court just said, we don't need to go there because we find seven was breached. So seven's breached, it's not saved by one, so we're not even looking at 15. I think in part they did that to just avoid putting stuff out there that then is gonna be triggering things and people saying, what does this do to section 15, jurisprudence and all those kinds of things, but it does leave it there and also to avoid sort of seeming to set up the next case, which is so if you say, yeah, it's a violation of 15, then you're giving the frame for people to use to make their 15 argument, their equality argument, on the next thing, on age, for instance. And I think they like to sort of keep things a bit smooth. And I also think they got it out in record time, and there's no way they could have done the 15 as fast and I bet they couldn't get agreement on the, it wouldn't surprise me if they wouldn't get agreement on the 15 and they really, really, I think really wanted a unanimous court and from the court. And so if I was just as McLaughlin sitting there and trying to navigate this, I would have done the same thing. I'm assuming that's what she did. I have no idea that she did that. I'm making it up, but I would have done that, which is to say, let's not go there. We can all agree on this, right? And we can all say the court, good, because we need this for the sake of how this moves forward. It is so amazing that it is from the court that will help us enormously as a society proceed with this. And I don't know, 15 might not have got us there. But you're totally right. It's a long, long answer to your right. Yeah? My kind of goes back to the previous comment about federal or provincial. So if it were federal and the criminal co-over just amended to say, does the legal accept bringing these circumstances? Yes. Could the, could the say support for doctors that you were just talking about and all the support for medical practitioners, could that happen at a federal level? Could it happen at a federal level or also could it happen concurrently, provincially? Well, I guess, so as you've kept the criminal code for me to comment today, is it possible to have these uniform, provincial, all the doctors are treated in the same way and trained in the same way? Well, training follows money so you could. You could do training federally because if the feds just give you the money to run a national training program, the training can happen. The requirements around in-hospital procedures and so on, the feds can't do that as much. They'll have to dance, it'll have to be a delicate dance as they draft because the more they get into what looks like regulation, the more in trouble they will be. But one thing that's really important to note and I didn't cover it, but is the inter-jurisdictional immunity? They expressly said, physician assisted dying is shared. So they were asked to say this is just provincial. At its core, its health, therefore, it's just provincial by the plaintiffs. It was one of the things that was actually not unhappy we lost on because I don't get that myself. But you have to try everything. So they have said expressly it's joint which opens, I think that's fabulous because it means people can get together and say, okay, this part's ours. We're gonna deal with the criminal code. We're gonna do a national oversight system for the medical system. For these reasons because it's public house, Pog and those kinds of things. And then the provinces can say, okay, under our consent legislation and the regulation of health providers we're gonna do this and the other because you have to change your pharmacy regs and things like that, right? Because that's supposed to give illegal things like that. So they do that. And then the colleges establish their standards that relate to misconduct. And then the medical schools engage develop education. The feds pay for the development of national curriculum because that's the efficient way to do it. But everybody delivers it. We get a system of education like they have in the Netherlands and in Belgium, education and support. That could be, I mean, nobody will fight about where that lives in terms of power. So it's just gonna be about resources. So let's get the feds to put that under the oversight system. So it's gotta be collaborative. It can be collaborative. And the court I think in a nice passage says, come on, play together, nicely. Well I think you've probably answered my question but jurisdiction and just for a little primer federal provincial jurisdiction could have some presuming from the administration or is it to the provinces? Well they would do that by simply not doing anything. Right, so what has happened is the court has said your criminal code, which belongs to the federal government, these pieces of it are invalid in so far as they preclude this group of people from having access to assisted dying. We're gonna strike that down and so in 12 months, that's gone. But just for those people. So the federal government could say, that's fine. We don't have to do anything. It's just not a crime. And then we just leave it there. Now that's what they did with abortion. And it then devolves and doesn't devolve to provinces. It devolves to the healthcare providers. That to me is, to go to Kate's point, I think we want a robust system not the most anemic system possible. But anemia is possible. They have shown them, they have in the past, not this government, prior governments have said, we're not, we're just not gonna touch it. So they can. So the piece on the inter-jurisdictional is just the court saying explicitly. And it's important they said it because there's a Quebec legislation. Quebec has passed legislation on assisted dying and it's coming into force in December and there's a challenge to it. So there's some people in Quebec saying, that's not your jurisdiction because the federal government has criminal law power. You're doing an in-run around the criminal law power. You're calling it health. It's not health, it's just an in-run around the criminal law power. And so there was a constitutional challenge happening. I think by, I defer to the constitutional lawyers about where that's gonna go. But the passage is, it's certainly, if I were part of the challenge, I wouldn't be feeling very optimistic as a result of reading that passage. I'd go, ooh, maybe not such a good chance. Because they said explicitly, it's not just that, they didn't say the obvious. Criminal law is federal and health is provincial. They said, physician assisted dying is shared. So, you know. The same parts about people living early. Yes. And I was wondering if you could speak to how other jurisdictions have dealt with people who want to access the stuff, is they're living somewhere where the only physician doesn't want to deliver it, or if they're not living close to the facility that offers it, or something like that. And especially here in Canada, with abortion, how you get a P.E.I. who runs those sorts of issues. How do things like that happen with physician dying and other areas? Yeah, it doesn't seem to be a terrible problem. It's not a complex intervention, particularly if physician assisted suicide is writing a prescription. You don't have to be there. Their law, for instance, in Oregon, you don't have to be physically present. So, compassion and choices, which is a very large advocacy group around better end-of-life care writ large, the whole thing. They have volunteers who go and are present with the person, and they're present with them through the whole process. They're not just, oh, I show up and I'm gonna make you your cocktail. They're there through the whole process, and then they are there with them when they die, or not, it just depends on the person's choice. So, I think that there isn't evidence of the kinds of problems we've seen with abortion, because people are willing also to help. And the numbers, again, the numbers are small. I have fought for this in part because I see that big group of people who get advantage, not this group. It was just about this group. I'm not sure I wouldn't have thought, I really should be spending my time trying to change the world on some topic that affects more people, but I do feel this affects many, many people, but they get that advantage without needing a whole lot of doctors to be willing to provide. So, we have to watch it. This is why groups like Dying with Dignity here or Compassion and Choices in the US, they will be important players in this terrain, as will the physician groups, the pharmacist groups, the nurses groups, to say, we need to make sure, look, this is legal. So, we need to make sure that people have access to it. And it's not like, with abortion, you need, till we get medical abortion, you need certain instrument, you need the clinic and so on. This, you don't, at all. So, that will help with access too. There's no way that, you know, the hospital can block you from the answer, that kind of thing. So, I think it's something we have to watch, but I don't foresee the same kind of problem. I'm not sure how this will look like, but I'd like to show you how this will look like. Oh, yes. Yeah? I mean, you know how that will fit into your body. Sure. You know how it will fit into your body. If you commit suicide, they don't hang out. So, how does this be possible? Sure, sure. And that's been confronted in the other jurisdictions. And one of the things I didn't know till I started studying this topic is that, in fact, your policy doesn't pay out with respect to suicide. If you just bought it the day before you then went and committed suicide. There's a window. So, if I bought, I started on my life insurance like five years ago, and now I commit suicide, actually you'd pay out. So, it's a window of time. Because, if you think about it, that's based on a sense of unequal access to information. Like if I buy it the day before I commit suicide, I knew I was going to. So, I knew the risk of payout. I knew what it was in a way the insurance company didn't know. Five years ago, we had the same level of information. So, it will operate similarly in that the insurance companies will look at it. They'll set their parameters for how far out you have to be. One of the things that happened in Oregon does a weird thing with how they report the death. They don't report it as an assisted suicide. They report it as your underlying condition, in part because you have to have a terminal condition. That does kind of weird things in terms of insurance because it actually looks a bit like fraud. And so, but they've navigated it with their companies. I hope we're just more straightforward and we just figure out how you're going to record this on death certificates, work with the insurance companies to make sure. And really it should be covered unless you do go out and get it the day before. Because that's just unfair. Yeah. Mm-hmm. Mm-hmm. So, it was a person saying that they also terminal cancer, they would just have passed away from those items. It wouldn't, they would have to put on there that it was assisted suicide. No, the issue is what caused your death? Did the cancer cause your death or did the barbiturates cause your death? Right, so what they did in Oregon is more sort of say, well, the cancer caused your death. Well, maybe there's sort of a logic of because if you didn't have that you wouldn't have done this. But that's a, I don't think we get into that. They do that now, because they just do more pay helps. Yeah, or they don't write down on your cause of death, we took the ventilator off. That's not your cause of death. Your cause of death was cardio respiratory failure. Yeah, so those are the things that you would work out, but it's against a backdrop where it's actually not what most people think I certainly thought, which is, oh, your policy never pays out if you commit suicide. It won't be as disruptive as it sounds because they do pay out. It's just that little quick window. But they'll be, so that isn't so much the problem. There'll be other wrinkles, I'm sure, to sort of say, how does this work? Let's make sure it's all fit together and be coordinated. That's the kind of thing that variety of groups need to work on this topic for the next 12 months. Sort of you'd want your, okay, here's your insurance group and here's your this group and your education group and your pharmacy access to, well, the meds aren't a problem, but you know, those kinds of things. I'm gonna ask this while I ask you all, join me in thanking Professor-