Should Canada introduce advance requests for MAID?


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29 comments

  1. Carmen Allan

    I Also support,this Fully.
    I know I have,Spoken on this to a Few Ppl. In the end,it should be patients first signature on Form that stays as such.

  2. Susan Greenfield

    This is so incredibly thought provoking. Thank you for these insights and the thoughts to consider.

  3. Sandy Buchman

    There is another viewpoint to consider here – and that is the perspective of the physician or nurse practitioner who is administering MAID. I completely understand, am sympathetic and totally supportive of the reasons for wanting advance requests. But I do not think that I, as a MAID provider, would be able to administer MAID to a patient with advanced dementia who could not tell me (with capacity) at the very last moment that they wanted to receive MAID. I need certainty in the moment to do this. To me, it is qualitatively different from other medical procedures where a substitute decision maker can make the decision to proceed. I also know that many other providers (although not all for sure) feel the way I do. Therefore fewer providers will be available to provide MAID in the context of advance requests, and this sadly further limits the already limited access to MAID.

    • Maureen Taylor

      Sandy, thanks for your comments, and obviously we have discussed this together before and I agree that the willingness of providers to provide MAID for patients with dementia is going to be a huge barrier. But why do you say fewer providers would be available to provide MAID if advance requests were permitted? Wouldn’t you continue to provide those that you were comfortable with in the context of your own morality, and refuse those requests you felt you couldn’t fulfill?

      On the subject of advance requests for MAID in cases of dementia, I am of course a supporter, but then I am not a healthcare provider legally allowed to provide MAID. All I know, is that if I ever get a diagnosis of dementia, I will have to hope the “reasonably foreseeable death” clause has been struck from the law so that I can have MAID before my dementia takes away my capacity, as I do not want to live out my days in that manner.

    • Margaret Killin

      I agree with your opinion. One way to manage late decisions I think is through a proxy who has guardianship or power of attorney. Personally, I think there are too many contingencies that influence doctor-patient decision making to make any consent a fully reliable choice.

      • Pashta MaryMoon

        At least in BC, I think that it should be the health and personal care Representative (known as health proxy/agent/PoA — not the legal/financial PoA. Your health/personal care Representative (section 9) is the person that you have chosen to entrust with ensuring that your Advance Directive is followed (where possible), make any unforeseen decisions (but as consistent with the rest of the choices made in the Advance Directive), and to withhold or withdraw life-support. Since the third will result in death, it only makes sense for this designated person to make the final decision on when advance consent for MAiD is actually carried out (again consistent with the values and choices already in the Advance Directive, and/or specifically defined by the patient).

    • Pashta MaryMoon

      There are some people with dementia who move into a state of (what one might call) ‘grace’. They accept their lack of mental function (or no longer realize that it is impaired). Certainly, as an ACP consultant, I have seen people choose (in their Advance Directives) to keep living if they develop dementia — though usually with the caveat of ‘no heroic measures’. However, there are far too many people for whom dementia is an extreme loss of personhood: and because of their elongated age, they are likely to be suffering from several other chronic or untreatable conditions — making the suffering not only greater, but more difficult to handle, because the person with dementia can’t explain the what/why of their pain. And who is more able to tell if that is the case? I would suggest that physicians only have time to assess what is physically going on (co-morbitities/etc.) — not the degree of suffering (obvious or subtle). If I were a MAiD provider (which I am not), I would make my judgements (as to whether to approve and provide) based on those who know the person well enough to know if they are suffering.

  4. JAMES LEONARD PARK

    PROXY AFFIRMATION
    OF LIFE-ENDING DECISIONS:
    EXTENDING THE RIGHT-TO-DIE IN CANADA

    Canada is now considering expanding its right-to-die law
    to embrace three situations not originally included:

    1. Final informed consent for a patient
    already assessed and qualified for MAiD.

    2. Informed consent for life-ending decisions
    for patients who have lost mental capacity
    due to Alzheimer’s disease or other mental problems.

    3. Making life-ending decision for children.

    Read how carefully chosen PROXIES
    can solve all three of these problems:

    https://www.facebook.com/permalink.php?story_fbid=2248562628507478&id=105267556170340

  5. Margaret Piton

    I am opposed to medical assistance in dying under any conditions. I realise it is now the law, but that does not make it right. And yes, I am old enough that I have witnessed some very difficult deaths from heart disease in my own family. Just as we do not bring ourselves into existence, we do not have the right to determine when our life ends.

    • Christian

      Agree– God is our Creator and the one who should make the decision

    • AA

      Agree – I wish doctors would focus more on prevention and looking at environmental factors implicated in health. MDs only care about quick fixes and bandaid solutions instead of root causes. Obviously many are jumping on board with MAID instead of looking at ways to treat and cure patients or improve pain management at the end of life. Doctors are not some super humans, many make mistakes and have poor ethics and should not be bringing MAID up or promoting it.

      • Sue M.

        Absolutely. Almost all pain can be controlled near the end of life. Carefully titrated terminal sedation, to unconsciousness if necessary (which is not always the case) is always available as a last resort. Other things that are considered “undignified”, like incontinence, requiring assistance with activities of daily living (bathing, toileting, dressing, eating), having limited mobility or being bed-bound, are 100% subjective, and need not be seen this way. So are not wanting to be a burden on one’s loved ones or not wanting them to remember you in a weakened state. We used not feel that way. But now we are so ruggedly individualistic and “autonomous” that we see these things as shameful when they are just part of life. Very tragic and no need to end one’s life prematurely by asking a medical professional for assistance in doing so to avoid human frailty.

    • Adam Smith

      You have every right not to choose MAID. I have every right to choose that for myself if I wish that where I have such a condition that I think it is best for me in consultation with my physician and family.

    • Pashta MaryMoon

      That is your belief, and you have the right to follow it. You don’t have the right to make a determination for other people, who don’t share your beliefs. There is no evidence that anyone will be forced into a MAiD, so please allow others to make their own choices.

  6. Jeffrey Fruitman

    this is a very important issue. As medical intervention become more, and more advanced, it is feasible to think that many of these patients will be able to be kept alive for longer periods of time. Speaking, not only as a strong advocate for MAID, I have experienced the decline of one parent, who ultimately has passed away, with the consent of my family agreeing to stop any intervention. I am now dealing with an 86 year old father who has the early stages of dementia. His situation, is further complicated, because he does not speak, due to a laryngectomy performed 12 years ago for tongue cancer. He also receives his medication and food via a G-tube. At this point, he is able to write his thoughts and wishes down on paper. That is how he communicates. I am dreading the time when he may not be able to write for whatever reason, and basically, we will not know what he is thinking, or what his wishes may be at any one time. I know he would definitely be in favour of MAID.

  7. Renee Fine

    Well written paper on MAID covering all aspects of this very important issue. Common sense tells us that it is unreasonable to expect a person with Alzheimer’s to give knowledgeable consent nor is it right for anyone to have to end their life before their time because they have to be in a position to consent. Doctors can opt out of performing MAID and allow patients to access help from those doctors who are respectful of patients’ wishes. To watch a human being lose cognizance and waste away is inhumane and cruel.

    • Sue M.

      To *watch* a “human being lose cognizance and waste away is inhumane and cruel”. So because it is hard on someone else, this person should lose his or life prematurely by having a doctor “putting him or her out of his misery” (like a vet giving a very sick dog or a cat a lethal injection), perhaps many years before it might happen? Doesn’t that sort sound pretty selfish?

      Yes, it is a very, very difficult road to see a spouse, parent, or sibling live with Alzheimer’s or another form of dementia. Tell me about it. Have been dealing with it since 2011. But it’s not my place to make *my* life easier by getting rid of my husband years before his time. He is content and happy as he can be and not suffering, physically or mentally. He lives in the moment and still takes joy in simple pleasures. We walk together, hold hands, and I bring him goodies to eat. We watch music videos on my tablet. He has received very good care in his long-term care center for the past 3.5 years.

  8. Margaret Killin

    Personally, and professionally too, I think the bill should be reversed. As it stands, we have euthanasia and assisted suicide practiced in Canada without federal regulations or legislation. We don’t have enough terminal and palliative care units to offer patients a real choice. We don’t have enough, or equitable, resources for chronic and long term care patients, to offer real choices.
    In these conditions, physicians and hospitals have been, still are, and will continue to set the rules about hastening death.
    For the record, I would love to know how many hospital in-patients in general feel they control what happens to them from the emergency room, to admission to discharge and after care! I would love to know how many in patients leave with their dignity intact! I just do not believe that MAID is honestly about choice .
    Is it, for example, a real choice if the offer is 4 weeks in palliative care, but if you don’t die by then you will be discharged because we need the bed, OR a MAID can come clean your room? That is a true scenario.
    I think MAID is a consequence of the erosion of Canadian medicare.
    A good analysis can be found in the book The Cult of Efficiency. For online line research concerning patients’ motivation for hastening death you can also search the National Association of Social Workers web site. (American).

    • Pashta MaryMoon

      I just want to add that MAiD is also the result of the SUCCESS of the modern medical system. Decades ago, we usually didn’t have to make decisions about hastening our death, because we died too quickly — because of lack of medical technology and treatment that hadn’t been discovered and approved as yet. Now, modern medicine can — and does — keep us alive — sometimes long after there is any ‘quality of living’ left. And in fact, this process starts long before we reach any kind of terminal or serious ‘life-limiting’ diagnosis — it begins with antibiotics/etc. for what is now considered a non-‘life threatening’ condition, but used to be deadly. All of this new medical technology is wonderful at the time, but what it has never taken into account was the long-term results of people living beyond reasonable function-ability. In fact, we — in essence — have taken the timing of death ‘out of God’s hands’ by artificially (medically) extending our lives; and we now believe this to be our right. If this leads to a longer functional life, then wonderful: however, that is often not the case — especially with chronic illnesses. At some point, the right to extend one’s life has to be balanced with one’s right to end that life — which MAiD begins to do, but need itself to be extended to actually be a Canadian’s right (that is, for all people who have lost ‘quality of living’ — not just those who are imminently terminal).

    • Sue M.

      I cannot speak for Canadian medicine, but for the times I have been a hospital inpatient or in the ER in the US (or had to take charge of my husband’s care, since he has frontotemporal degeneration (dementia), I have always almost felt in charge and have been treated with courtesy and respect. This includes five hospitals in three cities (two major academic medical centers, two teaching hospitals, and one community hospital). One incident occurred after a serious auto accident out of state while traveling alone. I do understand medical terminology, have worked in a medical setting (although am not medically trained), and doctors do not intimidate me. I do my own research and give doctors “what for” if they deserve it. Maybe that helps :-).

  9. Adam Smith

    Yes, we should have advance directives. Sure, some practitioners may have concerns about the clarity and application of directives in particular situations or may not feel willing to carry out such a directive.

    If we really mean that we should have patient entered health care, then these directives should be allowed. They should not be banned just because some providers may have challenges with them: that’s a provider centric, provider knows best system.

    • Pashta MaryMoon

      I would agree that the MAiD system is presently biased towards being ‘provider-centric’ (good term!!), and needs to be extended (in multiple ways) to become ‘patient-centric’.

  10. Pashta MaryMoon

    Please remember that — when we are talking about ‘vulnerable’ people — those who are suffering from progressive (or untreatable) chronic illnesses are extremely vulnerable, if they are left with no access to MAiD. Not all ‘end of life’ situations are terminal (in the usual sense — they are all ultimately terminal) , but capable of producing much more suffering than someone with a more distinct terminal disease.

  11. S. Ellis

    Yes, we should allow advance directives.

    I am currently watching a parent die from dementia. She is incaple of rational thought, is paranoid, has threatened people, and wants to go home, although the home she wants to return to no longer exists.

    Her mother had Alzheimer’s as well. I do not wish to suffer the same fate. I also don’t want to die earlier than necessary for the sake of a law that doesn’t take human frailty into account.

    I have been disturbed by this aspect of the law since it was written. If I am in a persistent vegetative state,I would prefer to leave the world without further discussion, thank you. If I am wandering and terrified of everyone, if I can’t remember family…I want to die peacefully.

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