In 2016, Canada became among a few countries that have permitted some adults to ask for doctor’s help in causing their death. Five years after Canada’s medical assistance in dying was legalized, a parliamentary committee is set to review the system that has authorized many Canadians to decide on the time and place of their deaths. Recently, the federal government has expanded access to the activity after the state’s highest court ruled that the original law was too limited.
A group of MPs and senators started reviewing the law on May 17. The committee is assigned to answer some critical questions like whether adults should access medical assistance in dying (MAID) and if patients should be left to request the exercise before their sickness becomes unbearable.
Some of the issues before the committee include;
History of medical assistance in dying
The Trudeau government made MAID legal when the Supreme Court ruled that some of the Criminal Code outlawing assisted suicide went against the Charter of Rights and Freedoms. A law allowing mature minors to have medically assisted death if they had an intolerable medical situation and their death was foreseen was passed by the parliament.
Critics viewed the provision of foreseeable death as too restricting. Those patients diagnosed with an untreatable disease, illness, or a disability that caused intolerable mental and physical agony could qualify – but in cases where they were almost dying.
The Senate passed Bill C-7 in March 2021. The new law allowed Canadian people with unbearable suffering, and they are not near the natural death, the right to seek medical assistance in dying immediately. Canadians whose suffering is from mental illness will have access to MAID in March 2023.
According to Health Canada, 13,946 patients in Canada went through a medically-assisted death between 2016 and 2019. Many of them were suffering from sicknesses related to cancer (67%), 10.8% had a respiratory illness, 10.4% with neurological conditions, and 10.1% had cardiovascular diseases.
Medical assessment and witnessing
Two independent health practitioners must assess any MAID request. Both practitioners must be independent of one another and can assess a patient’s eligibility based on; the two assessors must not be in a position of authority over the other, cannot benefit from a patient’s death willingly, and cannot be in any way be connected to the patient.
The written request must be marked with a date and signed in the presence of an independent Witness, who should also sign the request. The witness has to confirm the signature and dating of the request by the patient. An Independent Witness must be over 18 years, must clearly understand the concept of MAID, and should not benefit from the patient’s death in any way. Caregivers and owners of health facilities (unpaid) from where a patient receives treatment cannot be Independent witnesses to MAID.
A MAID request can be withdrawn even if an individual is found eligible for MAID; the patient is given a final chance to make another request right before the procedure.
The extension of Maid to Canadians who have schizophrenia, depression, post-traumatic stress disease, and other mental disorders left the lawmakers with many questions unanswered. For instance, how can the healthcare providers who assess patients’ eligibility for MAID know whether a psychiatric patient is impossible to cure?
Most mental conditions can always be treated with medicines or other therapies or can become better if life conditions that lead to poor mental health, such as loneliness, stress, poverty, or lack of shelter, can be looked into.
“Mental health field is quite complicated as there is not enough evidence to determine whether a certain person has an untreatable mental condition,” declared the Centre for Addiction and Mental Health in Toronto. Physician head of Humber River Hospital’s MAID team, Dr. Sonu Gaind, said he was worried about MAID being provided to individuals who could recover later.
The liberal government gathers a panel of experts to examine the mental health problem and suggest measures to protect vulnerable people. The board is expected to give recommendations by March 2022. Jocelyn Downie, a law professor at Dalhousie University who has researched MAID for decades, stated that they would have to decide what role psychiatrists should have in performing MAID assessments.
Another question left unanswered is whether patients with mental illness should have evidence that they have explored all treatment options before they can have MAID.
The existing law required that patients who had been approved for medical assisted dying to confirm their wishes again right before the exercises are conducted. Those people taking strong pain relievers or having degenerative conditions were afraid of losing the mental ability necessary for the late-stage agreement. This pushed them to consider requesting assisted death at early stages.
It happened to Audrey Parker, a woman from Nova Scotia who had terminal breast cancer that extended to her brain. In a video trending a few days after her assisted death in 2018, Audrey said her biggest fear was losing the ability to think clearly, and so she opted for choosing an earlier date for her death than she wanted. Bill C-7 involves “Audrey’s amendment,” which allows MAID patients to waive the late-stage consent need.
But the new law states that MAID recipients be in an irreversible state and going through unbearable agony. Some advocates want people to request assisted death immediately after a diagnosis and before their suffering becomes intolerable.
The age of consent
The age of consent is among the issues causing an argument in the MAID debate. Currently, only patients over the age of 18 are allowed to request a medically assisted death. The Pediatric Society in Canada has pushed to eliminate minors from MAID provision. The argument on the “mature minor” responsible for making decisions about medical treatment is acknowledged in Canada’s health care.
A provincial advisory team suggested in 2015 that the provision of MAID should be based on capacity rather than age. Another parliamentary seating also recommended access to MAID for able mature minors, but only after studying the patient’s moral, legal, and ethical issues. Downie said that mature minors should be allowed to choose an assisted death if they have the right to refuse life-saving treatments.