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

Assisted Death as Treatment

"For all my love of life, I do not fear death. In the early stages of the disease, I fought back hard as long as there was hope for recovery. Only when the pain became too much to bear and it became evident that there was no positive outcome did I turn my focus to managing my own death. I have a strong wish to die with dignity at the time of my choosing."
"I have become a skeleton of the man I was. My suffering is intolerable and unbearable."
Toronto man, 80, father, grandfather

Fred Dufour/AFP/Getty Images/File   Physician-assisted death should be viewed simply as a “treatment for an underlying illness,” lawyer Andrew Faith argued in a case that offers a poignant glimpse at the kind of suffering that can drive someone to plead for a premature end

 

Reduced to a shadow of the man he once was, the man, recognizing what he speaks of as a "wonderful" existence since he arrived in Canada, speaks of the agony of the blood cancer that has now spread into his spine, and that the painkillers given him are not capable of reducing his pain. And nor can he perform any of the most basic of all self-help actions of life without assistance, let alone have control of his bodily functions.

Reduced to a shell, housing an active brain suffused with memories, he knows he has not been given very long to live, a matter of mere months, but his suffering is too intense to bid him to bide his time. He has suffered enough, and at this juncture he feels it is in his best interest and the interests of those who surround and care for him, that his exit from life be accelerated to free him from the physical torment he now experiences.

He has filed an affidavit in a Toronto court supporting his request. He is entirely lucid and more than capable of making a choice of his own volition. By order of a Superior Court justice media has been banned from publishing the man's identity or that of his family, nor of his health-care team. That information has been redacted from the documents presented at court.

His decision to preempt nature's plans for his life-ending was paved by the year-ago ruling of the Supreme Court of Canada, sweeping aside the Criminal Code ban on assisted suicide, for its perceived unconstitutionality. The government has yet to officially change the law, but that process has begun and is due in June; too late for this man and any others in a like position. By appealing to the court he is able to obtain permission to proceed.

When he was diagnosed with aggressive b-cell lymphoma in July of 2012 he underwent chemotherapy. However, its severe side-effects led to hospital admissions, convincing him to put a stop to the treatment. A year later the disease's symptoms became far more aggressive, leading to palliative chemotherapy. By the fall of 2015 a dramatic increase of symptoms caused him severe pain, fatigue, nausea and "profound" weakness.

By the turn of the year in 2016 his decision was made, to choose assisted death. His daughter speaks of her father as an "inherently happy man". His Toronto-based hematologist has stated that his patient whom he has treated since 2012 has no more than three months of life left to him, and that he is himself willing to assist in the administration of the fatal injection.

The doctor has no wish to have his name made public, and that extends to his involvement in this sad case. "Nor do I intend to make providing physician-assisted death a significant part of my practice."
The man's lawyer asked the court not only to approve the aided death, but to make certain a coroner's inquest not result; that the man's death be certified that it is the cancer that was the cause of death, and not a lethal injection of barbiturates.

Lawyer Andrew Faith rendered his view that physician assisted death be considered a "treatment for an underlying illness", in which case, lymphoma should logically be recognized as the cause of death, and not that the treatment be listed as its cause.