MAID At Your Service in Canada

"To force people who are already in unjust social circumstances to have to wait until those social circumstances improve, or for the possibility of public charity that sometimes but unreliably occurs when particularly distressing cases become public is unacceptable."

"A harm reduction approach acknowledges that the recommended solution is necessarily an imperfect one; a 'lesser evil' between two or more less than ideal options."

Essay, Journal of Medical Ethics

 

"One way of responding to these cases [permissive assisted death regime] is, 'Well, clearly then, medical aid in dying should not be available to them [those living without the medical or disability supports they require, driven to choose MAID, without true voluntary, informed consent].

"We just don't think the fact that social conditions are contributing to make their lives intolerable means that they don't have the wherewithal to make that choice."

"People can make their own determination about whether their lives are worth living, and we should respect that."

[The public] may be shocked to realize that some people's lives become intolerable to them -- not simply because of their health condition, but because of something that, as Canadians, we have the power to change."

Bioethicist Amy Mullin, professor of philosophy, University of Toronto 

"All options on the table are really tragic and sad."

"But the least harmful way forward is to allow people who are competent to make decisions to have access to this choice, even if it's a terrible one."

Kayla Wiebe, PhD candidate in philosophy, University of Toronto

'You have to meet rigorous eligibility criteria. And being poor and not having a home, or a home that is suitable for you, does not make you eligible.’ Photograph: Marco VDM/Getty Images

 

A new paper produced by two University of Toronto bioethicists argues that allowing Canadians with non-terminal conditions to choose a doctor-assisted death following a failed search for better housing or proper medical care may be 'deeply tragic' but it would still be wrong to deny medical assistance in dying (MAID) to people who are driven mostly by poverty or unjust conditions; people who not only might, but have explicitly said they would prefer not to die.

There was a story seen on CTV of a 51-year-old woman with multiple chemical sensitivities who chose MAID after what she described as a failed search for an affordable apartment in Toronto where the afflicting odour of smoke or chemical cleaners would not bedevil her condition. In another instance, a 37-year-old Vancouver women made an appearance in a pro-euthanasia film who opted for doctor-assisted death after failing to receive adequate medical care for Ehlers-Danlos Syndrome, a rare, painful condition of fragile connective tissue throughout the body.

Medical Assistance in Dying was originally restricted to people whose death was considered to be reasonably foreseeable, then expanded in 2021 to include those not at imminent risk of dying, but with an illness, disability or disease causing enduring suffering intolerable to their quality of life. 

The paper in question that the professor of bioethics and her post-graduate student co-wrote was meant to address the question of whether someone facing an injustice -- like inability to acquire affordable housing -- could be recognized for a reason to deny them a request for assisted suicide. The co-authors point out their feeling that the absence of better social supports is "abhorrent", in and of itself constituting a deep injustice.

A new poll ascertained that while most Canadians support euthanasia for "grievous and irremediable" medical conditions, opinions tend to be more nuanced with assisted suicide for other reasons. An online survey by Research Co. revealed that half those questioned would agree to permit adults due to an inability to receive medical assistance to apply for medical assistance in dying. Less than three out of ten would support the expansion of assisted dying to include homelessness or poverty.

Refusing access to MAID, the two academics contend, "amounts to perpetuating their suffering, hoping that this will ultimately lead to a better, more 'just' world." They consider their recommendation as representing a harm reduction argument, that "the least harmful way forward is to allow MAID to be available."

The services proposed as an alternative to MAID, they argue, such as access to long-term care, palliative care and even basic care, is deteriorating following the COVID pandemic. The growing inability to access all services people require results in people believing their lives are intolerable yet they would be met with statements such as: "Well, sorry, we haven't made these social changes yet, but you're not going to have access" to MAID.

MAID proponents once claimed no one was choosing MAID as a result of poverty or a lack of social or medical support, points out Yuan Yi Zhu, Canadian research fellow at Harris Manchester College, University of Oxford. "It is more than tragic: it is a moral stain on our country, for which future generations will have to atone."

MAID deaths have grown in number from just over 1,000 in 2015 when assisted dying in Canada was legalized, to 31,644 in total by the end of 2021.

The Senate has passed Bill C-7, which expands access to medical assistance in dying, including, eventually, to people suffering solely from mental illnesses.  CBC

Is There Death After Life?

"[The study] reveals the underappreciated capacity for cellular recovery after prolonged whole-body warm ischemia [loss of blood circulation, and thus oxygen deprivation] in a large mammal."

"Cellular demise can be halted, and their state [can] be shifted toward recovery at molecular and cellular levels."

Yale University research team

"We could see the heart was beating. It was beating. The quality of this beating is debatable."

"The next step is that we're hoping to see complete tissue and organ recovery and, of course, eventually, to transplant these organs."

First author David Andrijevic, associate research scientist in neuroscience, Yale School of Medicine

"The implications are just so phenomenal as I see it."

"With heart attack and stroke, I say, hallelujah, because so much harm is done so quickly and if something like that is going to help, that would be wonderful."

"What hits me like a tonne of bricks is that you are really manipulating the boundary between life and death."

"If you can restore a lot of these organs, how dead is the person?"

Kerry Bowman, bioethicist, University of Toronto

Illustration of organ perfusion and cellular recovery with OrganEx technology. The cell-saving blood analog is delivered to vital organs one hour after death. Credit: Marin Balaic

 

It's not quite the fountain of youth, but it is an extraordinary development that scientists have been able to publish an experiment in the journal Nature, declaring that they met success in restoring 'life' to body cells. With the use of a system called "OrganEx" using special pumps and solutions restoring oxygen, preventing cell death throughout the body, a team of researchers at Yale University succeeded in restoring blood circulation along with allied cellular functions in the organs of pigs that had expired due to cardiac arrest.

The heart muscle contracted when electrical activity was restored. Bioethicists now have a good deal to mull over in the broad acceptance of death. The results of this experiment have, in essence, created an unexpected muddying of the understanding of when life ceases and death arrives. An earlier project three years ago led by Yale scientists involved disembodied pigs' brains with the use of a similar perfusion system called BrainEx where circulation was restored and cellular activity reawakened in the brains of pigs killed in a meat-packing plant.

 

Nova

 

The current Yale research team took inspiration from that, wondering whether a similar approach could be applied on a whole-body scale. What they succeeded in doing by expanding that research was to lay to rest the assumption that body cells and organs begin an irreversible death within minutes of the heart stopping. What the scientists envision is the potential to help reduce the damage to people's brains following a stroke, or to repair heart function following a heart attack.

 

At the very least, they felt, OrganEx could allow doctors more time to retrieve human organs after life support has been removed. That mode of approach would come with a requirement that the "obligatory" clamp of the main arteries supplying blood to the brain in prevention of blood circulating to the brain of a deceased organ donor be respected. Both BrainEX and OrganEx experiments saw cellular activity through electroencephalography monitoring in some areas of the brain.

 

With the OrganEx system, a perfusion device is connected to the pig's circulatory system with a synthetic fluid containing Hemopure, a blood-like product, along with a dozen other chemicals to suppress cell death and inflammation when it is pumped throughout the pig's body. An hour following death after the researchers anaesthetized the animals and stopped their hearts, they connected the pigs to the Organ Ex system. After treatment lasting six hours decreased cell death was noted, less swelling and restored activity in the heart, liver, kidneys and pancreas.

 

Pigs gather in their pen at a farm in Pruille-Le-Chetif, western France. (Francois Mori / AP)

"[The experiment is important for] trying to figure out what can be restored, what can be resuscitated, what can be partially restored after death."

"If you can get biological activity in cells, in muscles, and they're moving and you seem to see signs of what I'll call 'life' in a body, in an animal that's been dead for an hour, do we need to rethink how we understand cardiac death, not brain death?"

"If you could get some function back by putting in this OrganEx solution, would that mean that should be tried on people whose hearts have stopped before we pronounce them dead?"

"I think a lot of people are likely to assume that when you're dead, everything is dead all at once. This experiment suggests to me that isn't true."

Arthur Caplan, medical ethics expert, New York University