What you should know about medical assistance in dying – MAID?

Toronto Waterfront (Alia Bharwani)
Toronto Waterfront (Alia Bharwani)

“I’m not afraid of being dead. I’m just afraid of what you might have to go through to get there,” said Pamela Bone. Bone, 68, was a columnist and associate editor of the Age, one of Australia’s most respected newspapers. She died of terminal cancer. She was also a passionate campaigner on the right to die.

In Canada, following a Supreme Court ruling, medical assistance in dying became legal on June 6, 2016.

Recently (June 2018), the Canadian Medical Protective Association (CMPA) wrote, “Despite current federal and Québec legislation that makes medical assistance in dying (MAID) legal, there continues to be uncertainty among some physicians about their rights and obligations, and the processes to be followed in this area.”

A June 2016 Canadian Medical Association (CMA) survey revealed 25 per cent of responders (doctors) would be willing to provide MAID and 61 percent would not. Under the new law, Canadian doctors are not compelled to provide MAID. In these cases, the doctor is required to provide a referral to a health care professional or agency willing to carry out the patient’s wishes.

What kind of challenges physicians may face in determining eligibility for MAID? CMPA says there are several areas of concern. First, how can a doctor define and predict “reasonably foreseeable death” before enlisting an individual for MAID? Can a doctor be a conscientious objector if MAID does not agree with his/her beliefs? And there are other issues not well defined in the law.

Court challenges are underway in British Columbia and Québec in which the issue is whether the requirement that “natural death be reasonably foreseeable” is too restrictive and violates patients’ constitutional rights.

Physicians should remember that unlike most other healthcare services, MAID is governed by criminal law. Failure to ensure that the safeguards and eligibility criteria, as well as the reporting requirements for MAID are met could result in criminal charges and imprisonment of up to 14 years, in addition to College sanctions, civil legal actions, or both, says CMPA.

There are several other issues to be considered when implementing MAID:

  • Is there a risk that the law will be abused to weed out society’s undesirable people? In Canada, patients need to meet specific eligibility criteria put in place to safeguard vulnerable people. The patient must be mentally competent and give informed consent.
  • Is MAID a legal way to commit suicide? Committing suicide and going through physician-assisted dying are legally two different things. A medically assisted death is well planned and thought out, while suicide is often impulsive, violent and carried out alone.
  • Prior to Canada’s new law, it was illegal for anyone to counsel or coerce someone to die by suicide. The current Criminal Code now includes an exemption for physicians, nurse practitioners, and pharmacists – they are now allowed to counsel patients.

Alberta Health says its goal is to provide access to physician-assisted death, while protecting vulnerable Albertans and respecting the rights of physicians and other health professionals. To achieve this goal, the law should provide better clarity to protect the health care providers if they have to help those who are eligible for MAID.

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