The Ottawa think tank Cardus hosted a launch event for a new book that argues medically assisted death is being used to help people escape a painful life rather than a painful death.
Legal experts and medical practitioners presented their contributions to the book, Medical Assistance in Dying (MAiD) in Canada: Key Multidisciplinary Perspectives, at the Tuesday event in Ottawa.
“We have moved away from people escaping painful death, to escaping painful life,” said Dr. Sephora Tang, assistant professor in the department of psychiatry at the University of Ottawa.
Medical assistance in death (MAID), which became law in 2016, was originally limited to Canadian adults whose natural death was reasonably foreseeable.
Revisions to the law since 2016 have expanded its scope. In 2021, the government expanded MAID’s eligibility criteria to include adults whose natural death is not reasonably foreseeable. In March 2024, the law is set to further extend to adults whose sole medical condition is mental illness.
‘Lives of despair lead to deaths of despair’
Experts at the event argued that a person’s ability to meaningfully consent to MAID is compromised when the person is in a vulnerable physical or mental position.
“If the government could investigate the coroner’s records and if one wrongful death [is] found, one case of someone who chose euthanisia or assisted suicide under duress of their circumstances, then the law needs to be repealed,” says Dylan McGuinty, a lawyer who specializes in advising families in consent and end-of-life care.
When people are first diagnosed with a debilitating condition, they need time to grieve and adjust, said Dr. Irmo Marini, a professor in the school of rehabilitation at the University of Texas.
The latest Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association accepts that patients grieve for about a year after diagnosis. Marini says people need to take at least that year to become accustomed to their disability.
In addition to his professional work, Marini also has personal experience with disability. He became a quadriplegic in a sporting accident more than 40 years ago.
“When we’re first injured, and I’ll be the first to admit… I did want to die… I hated being inside my body,” Marini said. “As time went on and I went through rehab[ilitation]… and learned to live and do with what I had left, my mood and everything got better.”
Marini believes practitioners shouldn’t be permitted to greenlight MAID until at least one year post-injury. Currently, the law imposes a 90-day eligibility assessment period for persons whose death is not reasonably foreseeable (although this period can be shortened if the person is about to lose capacity to make health care decisions.)
Instead of offering MAID, Marini says society at large should make accommodations to include people with disabilities within daily activity, and make healthcare more accessible. Without accessible public and private spaces and dedicated support, people with disabilities can find life very hard to manage.
“If these things are not in place… this leads to lives of despair which eventually leads to deaths of despair,” says Marini.
Mental illness expansion
The March 2024 expansion of MAID, to those solely with mental illnesses, was delayed from its original implementation date of March 2023 due to significant opposition.
Currently, MAID eligibility criteria include that a person “be in an advanced state of irreversible decline in capability” and “have enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable.”
Tang says there is no agreement among mental health professionals on whether a patient will respond to treatment, making it difficult to accurately predict if MAID is an appropriate option for the patient.
Patients who are suicidal or unable to afford mental health treatment will be at risk of accepting death, she said.
“As a psychiatrist, my professional life is spent preventing suicides. It’s very difficult to imagine what life is going to be like when we are now being asked to facilitate the suicides of our patients,” says Tang.
At the event, speakers lambasted the lack of accessibility to health care services for people struggling with homelessness, addiction and disabilities. But even patients with means can have difficulty getting therapy, due to long waitlists.
“I think that when the law rolls out in March of next year, we’re going to have people die who could’ve otherwise gotten better if this law wasn’t there, [if] we had the social supports — accessible housing, actual medical care — and a community around them to support them and help them to feel loved and welcomed,” says Tang.
MAID versus palliative care
Dr. Leonie Herx, a palliative care physician in Kingston and senior fellow in Cardus Health said some professionals in the field are being tasked with managing and providing MAID rather than palliative care. Palliative care supports a person at the end of their life but does not end it.
And professionals who do recommend palliative care over MAID are sometimes seen as obstructive, she says.
She knows of palliative care workers who are leaving the profession because they are uncomfortable with participating in or providing MAID.
“I know many patients ask for MAID because their family doctor recommended it,” said Herx.
Editor’s Note: This piece has been updated to note that Cardus hosted the launch event for the book and that the comments by experts at the event were all based on their contributions to the book.
“In March 2024, the law is set to further extend to adults whose sole medical condition is mental illness.” — This is a concerning statement, considering MAID is a government funded service and most counselling and professional mental health services are not publicly funded. It is a concerning thought that death could be more accessible than services aimed to restore hope and life.