When I was in nursing school, 2008, I had an instructor who dedicated a lot of her nursing career to palliative care. Something she said really resonated with me–often cries of “I just want to die” and begging to be “put out of their misery” were the result of unimaginable pain and suffering. She went on to explain that these pleas are fleeting and in-the-moment. My bedside experience solidified her teachings that once we get our patient more comfortable, those desires to die will lessen.
Amidst a lot of opposition, Medical Assistance in Dying, also called MAiD, was put into place in June of 2016. It allows certain eligible patients to have a physician-assisted suicide or death in an effort to end their pain and suffering. Currently, there is a fight against amendments to MAiD under Bill C-7, which is what I would like to touch on in this episode.
Before I dive into this, I want to issue a disclosure: I am not an expert on this topic. I do not administer MAiD, nor witness it happening. My only role is to talk with potential recipients of MAiD and witness them signing their uncoerced application. I have seen only a few dozen patients discuss this with their doctor while in-hospital and from those discussions, a handful of them went to completion.
I think of those individuals frequently–each of them were just amazingly kind people who were suffering insurmountable pain that was increasing daily and their deaths were approaching quickly with the exception of one whose diagnosis was related to an incredibly fast progressing neurodegenerative disease. Going into this discussion, I am actively going to suppress my biased towards MAiD as I do believe that there is a place for MAiD in our health care.
I also wanted to demonstrate that where I work, doctors and other allied healthcare professionals do our best to provide our patients with as much assistance, comfort, and care as possible so that MAiD is an absolute last-resort. Where I work, it is not something we freely offer nor something we take lightly. With that said, I understand that this is not the case everywhere and as such, my frame of reference as we discuss this is painted by my personal and professional experiences.
Currently, in order to be a candidate for MAiD, one must be eligible for government-funded health care services in Canada, be 18 years of age or older and capable of making health-related decisions, must have a grievous and irremediable medical condition, the individual must have been provided with information about ways to alleviate suffering outside of MAiD, their request for MAiD must be fully voluntary and not coerced… The individual must provide informed consent.
Let’s overview what a grievous and irremediable medical condition currently is defined as, under section 241.2(2) a, b, c, and d: It is a serious and incurable illness, disease, or disability in an advanced state of irreversible decline and capability. Further, they must have endured physical or psychological suffering that is intolerable and cannot be relieved in conditions that the individual believes to be acceptable. The individual must be in a state where a natural death is imminent or is reasonably foreseeable.
Bill C-7 is intended to amend some provisions surrounding MAiD and is partially a result of a 2019 ruling in Quebec’s Superior Court that broadened access to those whose natural death was not reasonably foreseeable… so people whose prognosis was not necessarily terminal.
Bill C-7 is an Act to amend the Criminal Code pertaining to MAiD and includes four primary clauses:
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The first removes the stipulation that an individual’s death must be reasonably foreseeable.
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The second clause adds a new section to further define eligibility relating to mental illness: it states that “mental illness is not an illness, disease, or disability for the purpose of eligibility. This ensures that mental illness on its own is not enough to qualify for MAiD.
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The third clause reduces the amount of people required to witness the requesting individual signing their MAiD application from two witnesses to just one. The third clause also addresses waiting periods. Currently, there is a waiting period of 10 days between application for MAiD and the completion of services, so to speak… Bill C-7 looks to divide the waiting period into two categories — one for those whose death is reasonably foreseeable and one for those whose death is not.
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For the reasonably foreseeable, the waiting period of 10 days will be waived.
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For those whose death is not reasonably foreseeable, a 90-day waiting period will be imposed and it is required that at least one of the two practitioners assessing the patient must be an expert in the field of whatever ailment the individual is living with. As part of the informed consent, all available treatments and services must be provided and be made aware of and understood by the individual.
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The fourth and final clause revokes the necessity for same-day consent if certain criteria are met; however, consent can be withdrawn at any time.
This bill has sparked debates for and against it. Disability advocates feel that the bill will increase the stigmatization and marginalization of those living with disabilities or give off the impression that living with disability somehow makes their life not worth living. They also fear that this bill will leave vulnerable people pressured into receiving MAiD due to societal pressure or lack of supports.
On the other hand, not having MAiD accessible to persons with disabilities simply because they are disabled removes autonomy that is afforded to those without. All adults with grievous and irremediable illnesses which cause enduring and intolerable suffering resulting in an irreversible decline in capability will have access to the medical service without prejudice. Theoretically, the intent is to empower the individuals to choose if they prefer quantity over quality of life.
In laws like this, we really rely on our medical and healthcare professionals to uphold their code of ethics and provide patient-centred care. Suffering is subjective… Quality of life is subjective. Most of the definition within the bill are… subjective. And I believe this is where a lot of the uneasiness comes from.
Thank you John and Jessica for being so open and vulnerable with me about this topic. It has been a really difficult one to dive into as both those for and against this bill have harrowing experiences and real fear. It’s been humbling for me to hear messages from the hearts of people fighting for what they feel is right. MAiD was always a heavily impassioned topic of debate for many different reasons and it is of course a slippery slope.
Information has been retrieved from: https://lop.parl.ca/sites/PublicWebsite/default/en_CA/ResearchPublications/LegislativeSummaries/431C7E
https://www.tandfonline.com/doi/pdf/10.1080/17482631.2020.1744926
https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do
