Politic?: Medical Aid in Dying (MAID} Maturing Into Life-Disposal Unit

"We've been working on this for quite some time."
"[No health-care professional commits an offence] if they provide information to a person on the lawful provision of medical assistance in dying."
"However, once options for all treatment options including cessation of treatment are presented to the patient, it would be appropriate to disclose the availability of MAID."
"We have to make sure that people are aware of their options. Awareness is not the same as coercing them or pushing them in that direction."
"Do you want to move to a nursing home? Do you want to be resuscitated? Do you want CPR?"
"Do you want to be in the intensive care unit?' And within that, 'Is assistance to die something that is ethically abhorrent to you or acceptable to you? Is that something you want to explore more, or not'?"
Dr. Konia Trouton, vice-president, Canadian Association of MAID Assessors and Providers (CAMAP)

""[Within the mental illness context], imagine what this means."
"You have a person who is severely depressed where the nature of the illness is often accompanied by a desire to die."
"The person takes a step to go and see a mental health counsellor to get help, and is being told, as part of the informed consent procedure, we can have treatment, a, b, c or MAID."
Dr. Trudo Lemmens, professor of health law and policy, University of Toronto

Worries are growing that inadequate housing or food, or inability to pay for medication are driving MAID requests. Photo by Getty Images

The initial request in most global jurisdictions with legalized euthanasia for assisted suicide must come directly from the patient. In those areas, doctors are strongly discouraged, even explicitly prohibited from raising the issue of assisted death with a patient. In Canada, a guidance document has been produced by providers of medically assisted death which states that doctors have a professional obligation to raise the issue of MAID with patients. In Canada there is no prohibition in the law to stop clinicians from initiating such a discussion.

No health-care professional commits an offence 'if they provide information to a person on the lawful provision of medical assistance in dying, according to Canada's assisted dying law. MAID providers and assessors assess that no provision in the law exists that prohibits clinicians from initiating the discussions and raising the possibility of the use of ,MAID. It remains illegal to counsel someone to die by suicide, to "counsel" from a doctor-patient perspective, interpreted as to "inform and discuss",

No legal restrictions exist on who can raise the subject of MAID to an individual with a grievous and irremediable illness, disease or disability as long as the intention is not to induce, persuade or convince an individual to request assisted death, according to the Canadian Association of MAID Assessors and Providers. Ethicists, on the other hand, argue that the introduction of death as a "treatment option" in place of the patient first suggesting it themself is hugely problematic. All the more so given the expanding realm of MAID.

Given the traditional dynamics between patient and doctor, any 'suggestion' by a doctor to a patient to consider MAID as a last resort, influences the patient that hope is lost and they might just as well hasten the process. The document now under question was produced by CAMAP early in 2019, at a time when MAID was restricted to patients whose natural death was seen to be foreseeable, to qualify for assistance in dying.

MAID, says CAMAP's vice-president, Dr. Konia Trouton, would never be raised solely in and of itself, but within the context of discussing "goals of care" and "values clarifications". By not providing the information surrounding MAID in a "timely manner" to anyone who may be eligible for assisted dying, harm could be the result, rationalizes CAMAP. There was a well publicized case of a Veterans Affairs caseworker suggesting to a combat veteran suffering from PTSD that MAID was a superior option to "blowing your brains out against the wall". The veteran was aghast.

Expanded MAID eligibility potentially increases exposure for assessing physicians

"Some people, no matter how well-handled your conversation, may infer that it's essentially a suggestion."
"They would also definitely infer that they have the strong potential to meet eligibility criteria, or you wouldn't be offering it."
"Knowing that someone could interpret their conversation as encouraging suicidality is enough to stop a lot of people from even bringing it up. Because that is clearly illegal."
"I also see it as very problematic when we bring [MAID] up to people who can't pay the rent, or people who are living with disability who don't have adequate access to the things that they need."
Dr. Kerry Bowman, bioethicist, University of Toronto