In February 2015, the Supreme Court of Canada made a historic decision concerning End of Life laws. This stems from a ruling presented on February 6, 2015, court struck down a ban on medical-assisted dying for terminally ill patients who are suffering physically or psychologically. This decision came as a response to the Carter v. Canada (AG) case. The Court held that, “in circumstances where a competent adult seeks such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering, doctors should not be prevented from assisting him or her to hasten death.” While the debate rages on in Ottawa, the Federal government must vote on Bill C14 by June 6, 2016, you can imagine that here at Beneplan we have a vested interest on this matter as it relates directly to some of the claims services we provide. Medical-Assisted Dying may be a divisive topic to many Canadians, but one question we would like to ask is how will life insurance claims be impacted?What the Health Insurance Industry and their Patients need to Know about Medical Assisted DyingTo begin, it’s important we distinguish medical-assisted dying and euthanasia, as those can often be confused:

• Medical Assisted Dying: In this context, is suicide by a patient facilitated by means or information (as a drug prescription or indication of the lethal dosage) provided by a physician aware of the patient's intent. In these scenarios the patient is in full control of the process and self-administers the substance(s).
• Euthanasia: In this context, euthanasia is the intentional putting to death of a person with an incurable or painful disease intended as an act of mercy. There are multiple classifications for euthanasia: Active, Passive, Voluntary, Non-Voluntary and Involuntary. However, the main takeaway here is the fact that the physician is the one controlling the process.

The preamble to Bill C-14 sets out the Canadian Parliament’s recognition of the autonomy of persons who have grievous and irremediable medical conditions that cause them enduring and intolerable suffering and who wish to seek medical assistance in dying. While each Province has its own subset of rules, Bill C-14 defines medical assistance in dying as follows:

• the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death; or
• The prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request, so that they may self-administer the substance and in doing so cause their own death.

This is in line with the context of Medical Assisted Dying definition.Will Life Insurance Pay Out in a Case of Legal Medical-Assisted Dying?Most if not all life insurance policies contain a suicide exclusion clause. This says the insurer does not have to pay benefits if the insured person kill themselves within two years of purchasing the policy. While the industry was quick to point this escape clause in 2015, in the weeks after the ban on assisted-dying was struck down by the courts, today Life-insurance providers are more open to the concept. Frank Zinatelli of the Canadian Life and Health Insurance Association believes its members are willing to lift the standard two-year exemption for suicides and pay out policies on people who end their lives through physician-assisted death. "If you follow the process, which is outlined by the government or governments, then that possible exclusion won't be applied," he said in an interview last month.To receive medical assistance in dying, Bill C-14 requires a person to meet all of the following criteria:

• be eligible for publically funded health services in Canada;
• be at least 18 years of age and capable of making decisions with respect to their health;
• have a grievous and irremediable medical condition, meaning:
• a serious and incurable illness, disease or disability;
• an advanced state of irreversible decline in capability;
• enduring physical or psychological suffering, caused by the medical condition, that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and
• natural death has become reasonably foreseeable, taking in account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining;
• have voluntarily requested medical assistance in dying, which request was not made as a result of external pressure; and
• Provide informed consent to receive medical assistance in dying.

This month alone, a second woman from Manitoba has filed court documents to gain access to medical-assisted dying. Finally, the drugs most commonly used in Medical-assisted death procedures, Sodium thiopental and Pancuronium, have a DIN (Drug Identification Number) in Canada. Which implies that insurance companies would likely pay claims for procedures involving these drugs.The insurance hot potato of medical-assisted deathThe legalization of anything almost always leads to regulation. While rules are important, they come with certain moral hazards, or externalities: the cost or benefit that affects a party who did not choose to incur that cost or benefit. One of the most significant concerns about the legalization of medical-assisted death in Canada relates to the possibility that a chronically or terminally ill person from abroad would choose to end her or his life here, leading to the creation of a "suicide tourist" market.Looking at the two nations with over a decade’s history of legal doctor-assisted dying, Switzerland and the Netherlands, one could definitely discover some data to be concerned. As of August 2015, more than 300 Britton’s traveled to Switzerland from the UK to die. The legal framework in the Netherlands allows foreigners to travel to the country seeking medical-assisted death services, so long as a well-established relationship exists between doctor and patient.Others argue that end of life policies will increase suicide rates in Canada. Carrying on from the example of the Netherlands, today, 1 in 28 deaths, or 3% of deaths in the Netherlands people comes from assisted-death. The rate of increase is well over 200%, with 1923 reported deaths in 2006, rising to over 4500 reported in 2014, while in 2013 650 babies died under Holland’s assisted suicide law because their parents or doctors deemed their suffering too difficult to bear.Finally assuming insurance companies are willing to wave the two year escape clause, would chronically or terminally ill patients opt to end their life for financial reasons? How will Physicians and Healthcare provider’s and most importantly Hospital Managers respond? We have an overcrowded health-care system that can only do so much.Give Me Liberty, Give Me DeathAs insurance professionals, we only hope that in Canada the legislation comes with clear guidelines to insurers and most importantly protects the interests of the patient. The topic is an emotional one, while people may have reservations for diverse reasons, including moral, ethical, financial, medical or religious. The fact remains that the insurance industry must deal with it as medical-assisted dying will have an impact on life insurance payouts and premiums. End of Life laws can be a divisive topic, but I welcome your thoughts and comments. Feel free to let me know what you think in the comments section below.