“Hearing about medical assistance in dying (MAID) and knowing that she had control over her end of life was literally like the [oncologist] had said: ‘You two are going to Tuscany,’” says Kim King. “We were just so excited! Fast forward to when we realized, ‘Uh oh, wait! Audrey, you have to keep in touch. If you start to lose mental capacity you will lose this opportunity.’ It was like someone gave her a present and then took it away.”
Audrey Parker, King’s close friend, had late stage breast cancer, with metastases encroaching on her brain. She chose to die earlier than she wanted for fear of losing her capacity to consent and thus be eligible to receive MAID. Currently, MAID requires a person to provide consent during the initial assessment and then to consent again on the day of the procedure. If a person loses the capacity to consent before the date of the procedure, the procedure cannot go forward.
With an advance request, however, a person could make their wish for MAID clear prior to a loss of decision-making capacity and have that wish acted upon even after they lose capacity. Although advance requests for MAID are not currently allowed in Canada, the majority of the Canadian public believes they should be (Forum, Ipsos).
Parker was hoping that the requirement for repeated consent could be withheld, but in the end she opted not to risk losing control over having access to MAID. “Audrey had wanted to make it to Christmas and New Year’s Eve, her favourite time of the year,” says King. “But she lost that opportunity because of a poorly thought out federal law.” Parker died by MAID on November 1, 2018, surrounded by friends and family.
Where does Canada stand on advance requests for MAID?
In 2015, the Supreme Court of Canada ruled unanimously that the law prohibiting medically assisted suicide violated the Canadian Charter of Rights and Freedoms. The government then commissioned two reports on MAID (The Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying and The Special Joint Committee on Physician-Assisted Dying). Both specifically supported some form of advance request for MAID.
In 2016, Bill C-14 was passed by Parliament to regulate and legalize MAID in Canada. However, the bill denied advance requests for MAID and inserted a stipulation that the applicant must have capacity to provide informed consent immediately prior to the procedure, as a safeguard. This requirement has led to significant controversy.
Joshua Wales, a palliative care doctor in Toronto, is frequently asked by his patients about whether they are eligible to get MAID. “They want to know they have a way out,” he says. He had a patient who spent a significant portion of his last days suffering, worrying that he might become confused or lose consciousness on the morning of the procedure, and thus not be able to have it done.
To help explore this issue, the government requested an independent report from the Canadian Council of Academies (CCA) on the state of knowledge in this area (as well as in the use of MAID in mature minors and in people for whom mental health disorders are the primary reason). The CCA gathered topic experts from multiple fields and backgrounds, and many groups and organizations across Canada affected by MAID responded to a call for input. Their 244-page report is a synthesis of knowledge on advance requests and outlines concerns, evidence from other countries, specific examples and potential safeguards. The mandate from the government was to gather evidence, not make recommendations.
Who might make advance requests for MAID?
The report identified three different groups of people that advance requests for MAID might apply to, each involving different levels of uncertainty for those responsible for following the request.
1) Advance requests made when a patient is eligible for MAID: This would apply to a patient such as Audrey Parker, who had advanced breast cancer with brain metastasis, but wanted to live through one more Christmas. There was a significant chance her disease would affect her cognitive capacity to consent prior to the date she wanted for her MAID procedure.
2) Advance requests made after diagnosis but before MAID eligibility: This might include patients in the early stages of Alzheimer’s dementia who want to declare in advance what stage of their disease they would deem as “intolerable suffering,” and at which point in time they would want MAID, even if they have lost capacity at that future point.
3) Advance requests made before any diagnosis: This might include healthy adults who want assurance that they can set out criteria to access MAID if they were to have a sudden medical condition that left them unable to consent, like a car accident or stroke.
By dividing advance requests for MAID into these three groups, the report begins to separate specific concerns and form potential solutions for these different types of patients. This break down might serve as a basis for considering how advance requests for MAID might be introduced in Canada.
Jennifer Gibson, professor of bioethics at the University of Toronto and chair of the CCA’s working group on advance requests, worries that most of the public debate about advance requests has been simplified and focused on Alzheimer’s dementia (the second group), which itself is varied and has many stages that affect suffering and ability to consent differently. She asserts that there are significant differences in the issues and uncertainties that should be considered for each of the three groups, especially as they relate to the length of time between creation and implementation of a request. Jocelyn Downie, professor of law and medicine at Dalhousie University, who served on the CCA MAID working group for mental health as the primary condition, agrees that advance requests for MAID fall on a spectrum, and that arguments for allowing advance requests are more compelling the closer people get to the end of life, or as they move from the third to first group.
What framework can be used to introduce advance requests for MAID?
The data surrounding advance requests for MAID is limited and controversial. Only Belgium, Colombia, Luxembourg, and the Netherlands permit some form of them, though the use is rare (0.5–4% of all people dying from MAID) and reporting and analyses are inconsistent. Colombia allows advanced requests only in the context of imminent death; Belgium and Luxembourg only when a person is irreversibly unconscious. In the Netherlands, advance requests are only allowed for patients with some level of consciousness, because in order to qualify there, the patient must have ongoing suffering. As of 2005, an estimated seven percent of adults had an advance request in the Netherlands, but data on their actual use is limited. Thus, experience from other jurisdictions provides limited guidance for how to provide and safeguard advance requests for MAID.
How would an advance request for MAID be dealt with?
How would those responsible for acting upon the request for MAID determine the exact timing and confirm that the criteria set out by the applicant have been met? Trudo Lemmens, professor of health law and policy at the University of Toronto and a member of the CCA report panel, advises significant caution. He worries that at the time of creating advance requests for MAID, patients may not be able to appreciate their future state, or to determine all possible outcomes, which would leave those providing MAID with ambiguity for a life-ending decision. He shares an example from the Netherlands of a patient who had made a clear advance request for MAID early in the course of his Alzheimer’s dementia. However, as the disease progressed, and he reached the point in time where he had wanted to have MAID, his desire to proceed with MAID became ambiguous, complicated by the nature of his disease, leaving his family and doctors at an impasse.
Advocates of advance requests argue that criteria to trigger MAID must be objective and clear. Downie suggests, “When I lose capacity to choose MAID, that is when I want MAID.” She indicates that doctors are certified and entrusted to assess capacity, and that they use this ability currently when assessing for MAID in the first place. Downie points to other potential specific criteria, such as, “When I am in stage 7 of dementia [on the Global Deterioration Scale/Reisberg Scale]” or a “When I am in a persistent vegetative status as confirmed by two people for one month post-diagnosis.” King says she would have known “with every fibre of my being” exactly when Audrey Parker would have wanted MAID. They had talked about the details repeatedly, with multiple formal and informal witnesses.
Gibson says there will “always will be an amount of uncertainty, like anything in medicine… We can try for greater assurance, greater burden of proof, but the risk will never be zero.” The CCA report identifies a number of potential safeguards, such as formal counselling for people who wish to draft an advance request for MAID, mandatory updating, or a registry of advance requests for MAID.
How are other advance health care decisions managed?
Discussions around frameworks for advance requests for MAID inevitably involve terms such as advanced directives or advance consent for medical decisions. The legal application of these varies considerably across the country, but in general it is left up to the person who has the power of attorney or who is the legal substitute decision maker to consent to any medical decisions on behalf of the patient. Ideally they know the wishes of those they’re caring for and relay them to health care providers.
Downie argues that a regulatory process for advance requests for MAID must be separated from provincial advance directives legislation. She insists that advance requests for MAID should not be decisions put off for substitute decision makers at a later date, but rather clear and objective “decisions already made by the patient, being enforced at a later date.” She says that a standardized, consistent federal policy will serve as a safeguard and avoid the complications of the different advance directive laws across the provinces and territories.
Where do we go from here?
As a first step, some advocates are pushing for urgent change for patients who have already been assessed and deemed eligible for MAID. King is working with Dying with Dignity Canada on a campaign to remove late-stage consent, as part of Audrey Parker’s dying wishes. “We know there is an election looming, but this could be a win [for the government]… There are a lot of people pushing for it,” she says. Shanaaz Gokool, CEO of Dying with Dignity, argues that advance requests can be legalized first for this group, and then the discussion around other advance requests for MAID can continue.
Newly appointed Minister of Justice David Lametti was quoted in January 2019 by the National Post saying, “I’m interested in watching what happens and what is proposed, but I won’t commit the government to doing anything more than that.” If the government does not take any new initiative, the next step would be a five-year review of the current MAID legislation.
There is also the possibility of court challenges. However, “kicking it to the courts, you are kicking those people down… putting it on the backs of those grieving and suffering,” says Gokool. Although there are many ongoing court challenges related to MAID, none are currently specific to advance requests.
Most important, some say, is the continued public debate. Susan MacDonald, a palliative care doctor with the CSPCP and a working group member of the CCA, believes that the next step is a deeper systematic and detailed review of all possible safeguards by the CCA, with recommendations for stakeholders, including the public. Gibson agrees, and adds that, “The CCA report provides the synthesis of evidence and knowledge to inform Parliament, but more importantly serves to foster continuing conversation and debate in Canada around how we die.”
Ultimately, ending someone’s life who cannot actively consent to it at that moment, says Wales, “is something to think about very seriously.” He reinforces the importance of spending time listening to those who disagree with advance directives to make sure we’re hearing all sides. This, he says, will “make us all better and more thoughtful.”
The comments section is closed.
Yes, as soon as possible!
All Canadians, particularly those who’ve lived experience in dementia, Alzheimer’s and/or any other form of familial degenerative neurocognitive disease, have an essential need for assurance from all levels of our compassionate government that, in the event they too are diagnosed or become afflicted with any such grievous and irremediable condition, they’ll have time to explore other options for end-of-life care prior to the time when the risk of losing capacity in decision making is reduced to a state on non-eligibility for MAID. The option to exercise our right to a fully respected, implementable assisted death on their own terms is long overdue’ particularly under these circumstances.
to avoid/end their own suffering
My husband asked his doctor for MAID, but unfortunately he had already been diagnosed with dementia. He is in really bad shape I have power of attorney for him. May I ask for MAID on his behalf? He does not want to live like this. I would also like to talk to someone regarding MAID. We live in Alberta.
I live in fear that if I have a car accident, or a stroke, and am unable to speak up in defense of my right to life, I’ll just be summarily executed as an undesirable weight on the system. Given what happens in emergency rooms here in Canada, it is an entirely justifiable fear.
It is utterly insane that a person has to choose to take their own life while they are still living AND enjoying their life yet knowing that they will end up in a place where they so wish to be dead but are unable to be granted that dignity of choice. This just simply makes no sense. A person should have this choice and they should not have to lose their life at a time while still living it because the only other option is worse. That is forced suicide not assisted dying and defeats the whole purpose. Canada you can do better!
I hope Canada can do better. I never want to be “cared” for in a nursing home. Do you suppose that most of the helpless souls in those homes wouldn’t have signed an advance directive, ahead of being doomed to live there, spending day after boring day.
I watched my Mom wither away in a home. It will not happen to me.
Let me see…a person is able to make known a “no heroic measure” or a “Do Not Resusitate” as how they want care to be delivered. This directive is acted upon when a person usually totally incapacitated either physically or mentally. In some cases a designate such as guardian or family member will make the decision. The result is death. I can see no difference between this scenario and a person right to make a decision about their end of life decision using the MAID law.
I agree. My thought exactly. Bottom line: we should be allowed to die with dignity if that is our wish. I acknowledge though that it will not be easy for our proxy. A lot of honest discussions must happen
I believe in an Advanced Personal Directive indicating that if and when I develop Dementia I would like to have MAID. I want to have a directive that states that unequivocally that I be given MAID
Totally with you on this Lucille. Shouldn’t humans be treated as humanely as our pets.
Our sweet dog was surrounded by love as our vet injected him, closed his eyes and listened for a heart beat. It was over in seconds…. I’m hoping for such a peaceful passing for myself.
I do not see why so many people beyond the concerned individual need to have input to a request for MAID. I am 84 years of age.Seeing stories of lack of care in nursing homes makes me shudder when we know that aging population will only see things worsen.
I agree totally. I am going to be 83 soon and am a retired RN. The long term care facilities do not have the staff to adequately care for all the needs of the residents Having worked and seen first hand what happens to Demented patients it scares me. When you are in a state that you do not know who you are, where you are and cannot identify family what is the quality of life?
The future of patients in care facilities is dubious at best as having enough staff who are dedicated to looking after people who do not want to be there. Families who are spread over the world cannot give
the time and attention to their loved ones. I beg whoever can please pass legislation that allows people to die with dignity and family around.
I am very interested in this subject as I am currently making my living will. I am generally healthy and active and of sound mind but because of my atrial fibrillation history am constantly told I am a high risk for stroke. I want to make an advance request for MAID if in the future, I suffer a major stroke, that renders me aphasic, incontinent and dependent on being fed and in a wheelchair for the rest of my life, I would find this state of helplessness absolutely intolerable and feel the Canadian government should revisit this.
I agree I had a relative who suffered a major stroke and was bed ridden could not speak and had total care for 10 years before she passed away. If I suffer a major stroke I want to to make a request for maid so I know I will not go down the same road which is a burden to our health care system and hard on the family to watch be a part of. We were relieved when she finally died.
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.
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.
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.
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’.
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).
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).
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 :-).
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.
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.
I believe you misunderstood Renee Fine’s comment, Sue. (Sorry for coming into this conversation so late in the game.) She did NOT say that MAID should be allowed because it’s hard on “someone else” but on the *person who is dying* if they want to die but are not allowed to do so; and that it’s cruel of “someone else”/the rest of society to stand by watching a person with a terminal disease in physical and mental torment and deny their wishes for a more swift and humane death. From your description of your husband, he doesn’t sound like he has any need or wish for MAID, and so I’m happy for you both. That is not the situation for all patients, however, many of whom do not have anywhere near his quality of life. For your own family and other commentators on this board against MAID, the solution is simple: do not choose MAID.
YES! definitely!
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.
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.
Agree– God is our Creator and the one who should make the decision
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.
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.
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.
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.
Right is right, wrong is wrong, no matter how much the nihilists try to twist things, and you are right.
Our society murders preborn babies and now depressed grandmas and grandpas and soon to be depressed teens.
Sick!!!!!!!!
Yes we do have that right Margaret…we own our own bodies and minds. I want total control over my life. I do not want anyone to care for me. The indignity of having to be assisted to do any of my daily personal habits, and you know what I’m talking about, would in itself give me the incentive to end my life. Hopefully legally.
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
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.
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.
I TOTALLY AGREE
totally agree !
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.
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).
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.
This is so incredibly thought provoking. Thank you for these insights and the thoughts to consider.
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.
I so support this initiative and Audrey’s video on the DWD website is so poignant!
https://www.dyingwithdignity.ca/audrey_parker
Totally Agree..