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When the Canadian Minister of Justice first brought up the idea of legalizing medical aid in dying almost ten years ago, she recognized that it could create disagreement. Jody Wilson-Raybould stated in 2016, “For certain individuals, the concept of medically assisted dying may be concerning, while others may feel that this law does not go far enough.”
A new postponement in broadening the criteria for accessing medically assisted death has once again brought attention to the system, which both critics and advocates believe is among the most progressive in the world. However, the two groups hold contrasting views on how this impacts the overall quality of life and death in the nation.
Medical assistance in dying (Maid) laws, crafted in response to a supreme court decision, initially permitted only terminally ill Canadians to be eligible for the procedure. But in 2019, a Quebec judge ruled that restricting access to those who had a “reasonably foreseeable death” was unconstitutional, forcing federal lawmakers to amend and expand the existing laws.
Since then, Canada’s trial of physician-assisted death has gained global attention. Last year, the Atlantic magazine published a piece examining how the country’s laws on assisted dying have faced challenges. In 2021, three UN human rights experts warned that an extension to the law, allowing individuals with chronic conditions to request assisted death, would result in a divided system and potentially encourage individuals with disabilities to consider suicide.
According to official statistics, 13,102 individuals committed suicide using Maid in 2022, representing a 30% rise from the previous year.
According to Sonu Gaind, the chief of psychiatry at Sunnybrook hospital in Toronto, the definition and implementation of assisted death can vary depending on its purpose and method. It is not a singular concept. In light of this, the recent expansions of assisted death in Canada surpass what the majority of Canadians would endorse.
A study of 13,102 Canadians who chose to end their lives through Maid revealed that most of them attributed their decision to the “inability to participate in meaningful activities.” However, healthcare professionals have expressed concern over other reasons given by respondents. Over one-third stated that they felt like a burden to their loved ones or caregivers, which influenced their decision.
The increase indicates that Canada has one of the highest percentages of deaths assisted by doctors in the world, at 4.1%.
Gaind stated that no other nation has experienced the same level of growth after implementing assisted dying laws. He added that the rapid growth seen in this area is unprecedented.
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But for some, the rise is a result of the system functioning as expected – assisting a group of Canadians seeking relief from tremendous pain.
According to Chantal Perrot, a doctor and Maid provider, the rise in deaths with Maid indicates that Canada prioritizes individual human rights and autonomy. She believes that this increase signifies a choice for individuals to pass away with the support of their loved ones. As end-of-life experiences can be unpleasant, it makes sense that people would opt for a peaceful death surrounded by family and loved ones.
Out of the 13,102 individuals who passed away via assisted death, 96.5% were either terminally ill or confronted with impending death. A mere 463 people with a chronic condition utilized Maid’s services.
Mona Gupta, a psychiatrist at the University of Montreal and chair of the federal panel on Maid and Mental Illness, stated that she frequently encounters individuals with serious chronic medical conditions in the healthcare system. She does not find it unreasonable that 400 of these individuals, out of a population of 40 million, have exhausted all available treatment options and are seeking access to Maid.
Recent demands have surfaced in the UK for parliament to take action and vote on altering a law, following a publication in the Observer in December regarding a heartfelt appeal from actress Diana Rigg to legalize assisted dying. The message was recorded shortly before her passing from cancer three years prior.
Shortly before the holiday season, Esther Rantzen, the creator of Childline and a broadcaster, shared that she has contemplated assisted death if her treatment for lung cancer does not result in improvement.
Those opposed to a potential assisted dying law in Britain have cautioned against challenges in determining eligibility, the risk of coercion, and potential efforts to expand the law.
The province of Quebec, which has the highest rate of assisted dying, is investigating the reasons behind the increasing number of people seeking this option each year. Officials in the province have also asked for a change to the criminal code to allow individuals to give consent for medically assisted death before developing conditions such as Alzheimer’s.
However, critics argue that a series of well-known instances have exposed a flawed system, causing doctors to be defensive.
One Canadian veteran reported being offered Maid when requesting a wheelchair lift or ramp for their home. After an investigation, it was determined that assisted death was not offered, but four other cases were found where Maid was inappropriately suggested by Veterans Affairs. The case manager responsible was suspended and the incident was reported to the Royal Canadian Mounted Police.
In a separate incident, the relatives of Alan Nichols claimed that he passed away due to euthanasia, citing hearing loss as the only reason. They notified both the police and healthcare authorities, but no action was taken to look into the matter. The Royal Canadian Mounted Police informed the family that Nichols qualified for assisted death.
However, doctors who offer Maid treatment warn that stories of Canadians falling through the cracks often overlook important elements of their individual situations. These must include a serious and untreatable medical condition, and do not necessarily indicate a flaw in the healthcare system.
Perrot stated that he has not encountered any instances of the Maid criteria being incorrectly or unfairly used, or individuals receiving Maid who were not eligible for it. He also mentioned that he has not received any reports of such cases from coroner’s offices or provincial oversight groups. Perrot trusts his patients and believes their responses, unless proven otherwise.
Yet, she stated that physicians are unable to prevent patients from being dishonest.
Gupta expressed concern that there may be instances of maids not meeting the necessary qualifications. This would be deemed unacceptable, but there is currently no evidence to support this concern.
The next area of focus for the expansion of Maid is the incorporation of individuals with persistent mental illness. The federal government was under pressure from senators to amend its legislation to include mental illness as a valid reason for seeking assisted death.
Last year, Senator Stan Kuthcher stated that individuals with a mental disorder who are experiencing severe and ongoing distress should have the right to determine their own path in life. He argued that denying this right to those with mental disorders, while allowing it for those with other illnesses, is not only stigmatizing, but also exclusionary.
In December of 2022, the US government announced a temporary halt to the expansion of Maid, which was met with strong opposition from healthcare professionals concerned about the system’s ability to handle mental health cases. However, in a recent update, the government has once again postponed the expansion of Maid for those with mental illness, now scheduled for 2027.
The justice minister, Arif Virani, stated to reporters that it is crucial to ensure that there are thorough assessment and training procedures in place for individuals to accurately evaluate the situation. He also mentioned that the government believes that physician-assisted death for individuals with mental illness differs from other situations. He clarified that he does not feel obligated by the constitution to provide a healthcare service, specifically in this case, if it is deemed unsafe. The government has determined that it is currently unsafe to do so.
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Gaind, who was previously in charge of the Maid committee at Humber River hospital in Toronto, has become one of the most outspoken opponents of using mental illness as a determining factor. In the past, he spoke to a parliamentary committee about his concerns, along with other psychiatrists, about their inability to accurately predict the permanence of mental illness in their patients.
He warned that the assisted death system in the country has become too lenient and has moved away from its initial purpose of allowing those with a terminal illness the option to end their suffering prematurely.
“In the larger view, it can be compared to the saying: every system is flawlessly structured to produce the exact outcomes it produces,” he stated. “Ultimately, we are causing the demise of individuals who are not actually dying.”
The disagreement has brought attention to a contentious conflict between moral principles and legislation – in which courts have deemed regulations that limit certain groups from obtaining assistance in dying to be in violation of the constitution.
Gupta stated that having a different opinion about the law does not necessarily mean that the law is not being followed or that there are instances of misconduct. The decision of whether or not to have Medical Assistance in Dying (Maid) is ultimately determined by society, as evidenced by court decisions and legislation, and it is not limited to those who are terminally ill.
The debate surrounding medically assisted death arises amidst a healthcare system that is overwhelmed and struggling to provide sufficient care to numerous Canadians.
According to Tammy Moore, the leader of the ALS Society of Canada, 25% of individuals living with amyotrophic lateral sclerosis opt for assisted death through Maid. She clarifies that their goal is not to restrict access to this option, but rather to provide individuals with a variety of choices. Due to the lack of resources available specifically for those with ALS, many feel as though they have no other option.
ALS Canada, like other advocacy organizations, has appealed for financial support. They state that in Ontario, the most heavily populated province, a sum of C$6 million (£3.5 million) – which is minuscule in the grand scheme of things – could greatly improve the quality of life for individuals living with ALS. However, if this funding is not provided, Moore expresses concern that without financial assistance, more individuals with ALS may opt for assisted death.
For Gaind, the country’s push to liberalise suicide has deterred much-needed investment in the ailing healthcare system and reshaped how society thinks about alleviating suffering.
I hope that by focusing on offering peaceful deaths and ending suffering, people will remain aware of the various ways in which others may be experiencing pain.
Instead of suggesting that the only solution to suffering is death, we should focus on finding ways to alleviate it. How can we improve the quality of life for those who are suffering? How can we assist individuals in obtaining necessary care? How can we support people in living with dignity?
Perrot believes that the disagreement among experts is negatively impacting patients, particularly those who have been patiently waiting for many years to have the opportunity to control their own end of life decisions.
The opinions of patients are often disregarded. They are not seeking attention from the media or politicians, nor do they write letters to them. They confide in us as healthcare providers and it is our responsibility to advocate for them. However, our efforts often go unnoticed.
Source: theguardian.com
