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When the justice minister of Canada initially proposed legalizing medically assisted dying nine years ago, she recognized that it could potentially cause disagreement. Jody Wilson-Raybould stated in 2016 that some individuals may have concerns about the concept of medical assistance in dying, while others may feel that the proposed legislation doesn’t go far enough.
The recent delay in broadening the eligibility for medically assisted death has brought attention back to the system, which is considered to be one of the most lenient in the world by both critics and advocates. However, these two groups have differing opinions on how this impacts the overall quality of life and death in the country.
Legislation for medical assistance in dying (MAID) was created following a ruling by the Supreme Court, which initially allowed only terminally ill Canadians to qualify for this procedure. However, in 2019, a judge in Quebec deemed it unconstitutional to limit access to only those with a “reasonably foreseeable death,” prompting lawmakers at the federal level to revise and broaden the existing laws.
In recent years, Canada’s exploration of physician-assisted death has gained global attention. This included a detailed piece in the Atlantic magazine last year that examined the faults in the country’s laws on assisted dying. In 2021, three human rights experts from the United Nations warned that expanding the law to allow those with chronic illnesses to seek assisted death would create a discriminatory system and potentially lead individuals with disabilities to consider suicide.
According to government statistics, 13,102 individuals chose to end their lives through Maid in 2022, which marks a 30% rise from the previous year.
“The concept of assistance varies depending on its purpose and method of delivery,” stated Sonu Gaind, head of psychiatry at Sunnybrook Hospital in Toronto. “It encompasses a range of factors and cannot be reduced to a single entity. In this context, the recent expansions of assisted death in Canada go far beyond what the majority of Canadians would agree with.”
In a survey of those 13,102 Canadians who ended their lives under Maid, the vast majority cited the “loss of ability to engage in meaningful life activities” as the reason for wanting to die. But other responses have troubled healthcare experts. More than one-third of respondents said their decision was, in part, informed by a feeling they were a perceived burden on family, friends or caregivers.
The increase signifies that Canada has one of the top rates of euthanasia globally, with 4.1% of fatalities assisted by physicians.
Gaind stated that no other nation has experienced the same level of growth in terms of rate after implementing laws for assisted dying. The significant increase that has occurred is unmatched in any other location.
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However, for some, the increase indicates that the system is functioning as planned – providing support to a group of Canadians seeking relief from immense suffering.
Chantal Perrot, a physician and provider of Medical Assistance in Dying (Maid), believes that Canada’s increase in Maid cases indicates a strong focus on individual human rights and autonomy. To her, the rise in deaths through Maid suggests that individuals are opting to pass away in the presence of their loved ones. She questions why anyone would want to endure the potential suffering of their final days, weeks, or months when they could have a peaceful death surrounded by family and loved ones.
Out of the 13,102 individuals who passed away through assisted death, 96.5% were either terminally ill or expected to die soon. Only 463 people with a chronic illness utilized Maid.
Mona Gupta, a psychiatrist from the University of Montreal and chair of the federal panel on Maid and Mental Illness, shared that she regularly encounters individuals with serious, ongoing medical conditions in the healthcare field. She believes that the number of people who have requested to access Maid (medical assistance in dying) in a country with a population of 40 million is not excessive, considering that only 400 of them have exhausted all other treatment options.
There is currently a renewed push in the UK for parliament to vote on a potential change to the law. This comes after a report published in the Observer in December, which shared a heartfelt plea from the late actor Diana Rigg to legalize assisted dying. Rigg’s message was recorded shortly before her death from cancer three years ago.
Recently, Esther Rantzen, the founder of Childline and a broadcaster, shared that she has contemplated assisted dying if her lung cancer treatment does not improve her health before the Christmas holiday.
Opponents of a proposed assisted dying legislation in Britain have raised concerns regarding the challenges of determining eligibility, the potential for individuals to feel coerced into making a decision, and the possibility of expanding the scope of the law afterwards.
The province of Quebec, which has the highest percentage of Maid cases, is investigating the reason for the increasing number of people seeking assisted dying each year. Authorities in the province have also proposed a change to the criminal code that would allow individuals to give consent for medically assisted death before developing conditions such as Alzheimer’s.
However, a series of well-known instances that opponents argue demonstrate a flawed system have placed doctors in a defensive position.
One Canadian military veteran reported being offered Maid after requesting a wheelchair lift or ramp for her home. A follow-up investigation did not find evidence of assisted death being offered, but four other cases were discovered where Maid was inappropriately suggested by Veterans Affairs. The case manager responsible was suspended and the matter was referred to the Royal Canadian Mounted Police.
The family of Alan Nichols reported that he died by euthanasia, citing hearing loss as the only reason. They informed both the police and health authorities, but no further investigation was deemed necessary. The RCMP informed the family that Nichols qualified for assisted death.
However, doctors who offer Maid services warn that stories of Canadians falling through the cracks often overlook important information about their individual situations. This includes having a “severe and incurable medical condition” and does not necessarily indicate a flaw in the system.
Perrot stated that she has never come across a situation where the Maid criteria were misused or exploited, or where someone received Maid when they were not eligible. She has not received any reports from coroner’s offices or provincial oversight groups indicating otherwise. Perrot expressed her faith in her patients and believes their responses unless proven otherwise.
Nevertheless, she stated that physicians are unable to prevent patients from being untruthful.
Gupta stated that it is worrisome if there are instances of maids not meeting the requirements. This would be unacceptable, but there is no evidence of this occurring.
The next frontier for the growth of Maid is the incorporation of individuals with persistent mental health conditions. When the government was compelled to revise its legislation, senators urged for the inclusion of mental illness as a valid grounds for seeking assisted death.
Last year, Senator Stan Kuthcher expressed that individuals with a mental disorder who are capable and experiencing severe and ongoing suffering should have the ability to make decisions about their own life. He stated that denying this right to those with a mental disorder, while allowing it for those without, not only perpetuates stigma but also excludes them.
In December 2022, the government announced a temporary halt to the expansion of Maid, following backlash from healthcare providers who expressed concerns about the system’s ability to handle mental health cases. However, earlier this month, the government announced a second pause on expanding Maid for individuals with mental illness, now scheduled for 2027.
“We must ensure that our assessment and training processes are thorough in order for individuals to make accurate evaluations. It is crucial that we get these evaluations right,” stated Justice Minister Arif Virani in a recent press conference. He also emphasized that his government views physician-assisted death for those with mental illness as distinct from other cases. “I do not believe that the constitution requires me or our government to offer a service, specifically healthcare, if it is not deemed safe to do so. Our determination is that it is currently not safe.”
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Gaind, who was formerly in charge of the Maid committee at Humber River hospital in Toronto, has become one of the foremost opponents of using mental illness as a determining factor. In a previous testimony to a parliamentary committee, he expressed concern, along with other psychiatrists, about the difficulty in predicting the incurability of mental illness in patients.
He warned that the assisted death system in the country has become too lenient and has deviated from its initial purpose of providing Canadians with a terminal illness the option to end their suffering prematurely.
“When considered from a systems perspective, it’s similar to the old adage: every system is designed to produce the exact results it produces,” he stated. “Ultimately, we are causing harm to individuals who are not actually in danger of dying.”
The disagreement has brought attention to a contentious clash between moral principles and legal regulations – in which courts have deemed restrictions on certain groups from obtaining assisted death to be in violation of the constitution.
Gupta stated that disagreeing with the current law does not necessarily mean that the law is not being followed or that there are instances of misconduct. The decision to have Maid (medical assistance in dying) is ultimately determined by society through its legal system and representatives, as they have allowed access to Maid for individuals who are not terminally ill.
The debate surrounding medically assisted death is happening amidst a strained healthcare system that is struggling to provide sufficient care to numerous Canadians.
According to Tammy Moore, the leader of the ALS Society of Canada, 25% of individuals with amyotrophic lateral sclerosis opt for assisted death through Maid. Moore stated that while they support access to this option, they also want individuals to have other choices. However, due to the lack of available services for those with ALS, many may feel like they have no other option but to choose assisted death.
ALS Canada, along with other advocacy organizations, has requested for financial support. In Ontario, the largest province in terms of population, they state that a sum of C$6m (£3.5m) – which they view as insignificant – could greatly improve the well-being of individuals with ALS. However, if the funding is not provided, Moore is concerned that individuals with ALS will turn to assisted death without adequate financial assistance.
The efforts of Gaind to make suicide more acceptable in the country have hindered necessary investments in the struggling healthcare system and changed the perspective of society on easing suffering.
“This focus on providing easy deaths – curing ‘suffering’ by ending life – I hope it keeps people sensitised to the reality of how people are suffering in different ways.
Instead of suggesting that the only solution to suffering is to end life, we should focus on finding ways to alleviate it. We should be asking ourselves how we can improve the quality of life for those who are suffering and help them access necessary care. Let’s strive to help people live with dignity.
Perrot believes that the disagreement between experts has negative consequences for patients, especially those who have been waiting for many years for the opportunity to have control over their own end-of-life choices.
The voices of patients are often overlooked. They are not seeking attention from the media or politicians, nor do they write letters to them. Instead, they confide in us as healthcare professionals and it is our responsibility to speak on their behalf. However, our efforts often go unheard.
Source: theguardian.com
