Rather than rushing to amend our Medical Assistance in Dying (MAiD) law, Parliament should be focused on expanding access to social services. Bill C-7, which must be passed by Feb. 26 to meet a Quebec court-imposed deadline, exists in a vacuum and ignores lessons from the COVID-19 pandemic, namely that we are failing our most vulnerable.
To be eligible for MAiD under the existing law, individuals must have a “grievous and irremediable medical condition.” This includes individuals whose natural death has become reasonably foreseeable.
In 2019, Quebec’s Superior Court declared that the provision limiting MAiD to a “reasonably foreseeable” death was contrary to a person’s rights to life, liberty and security within Section 7 of the Canadian Charter of Rights and Freedoms.
Bill C-7 is the federal government’s response to that ruling, yet the bill now goes beyond expanding the “reasonably foreseeable” death criterion. The Senate has approved an amendment that would allow access to those whose sole underlying condition is a mental illness. Another amendment would allow MAiD in certain cases without final consent, such as for individuals with dementia.
The House of Commons is debating the amendments.
Numerous disability rights organizations as well as the United Nations Human Rights Council special rapporteur have criticized Bill C-7, arguing that eliminating the “reasonably foreseeable” condition devalues the lives of persons with disabilities and guides them toward choosing death, especially when few social supports are available to relieve their suffering.
These perspectives cannot be ignored at a time when Canada has repeatedly failed to protect its most vulnerable throughout the pandemic.
Many of Canada’s older adults and individuals with disabilities live in long-term care (LTC) homes, where more than 80 per cent of COVID-19 deaths have occurred. By June 2020, although Canada’s COVID-19 death rate was low in comparison to OECD countries, its death rate in LTC homes was double the average of other countries.
Thankfully, Canada has prioritized vaccinating those in LTC homes. However, this has left older adults living at home and persons with disabilities unclear about when they will be vaccinated and fearing for their lives. Not only are those with disabilities potentially at increased risk of catching COVID-19 because of their dependence on others for assistance, many also fear that admission to hospital during COVID-19 could be fatal due to resource allocation protocols.
While doctors fortunately have yet to be faced with such decisions, Ontario’s Ministry of Health, for example, endorsed a protocol that would assign values based on the person’s likelihood of survival one year after the critical illness.
Sadly, we know that society tends to believe that people with disabilities have inferior qualities of life – a belief that is not shared by those with disabilities. It is unclear how physicians, who have their own preconceptions of persons with disabilities, would make decisions during a COVID-19 surge. As Canadians living with disabilities remain unvaccinated, they are rightfully concerned that these decisions would not be in their favour.
Now is not the time for the government to be passing a law that will send its vulnerable citizens yet another message about how little it values their lives. The rush to meet the thrice-extended court deadline is manufactured since the bill could theoretically go back and forth between the House and the Senate.
Rather than expanding MAiD eligibility, the government’s efforts should focus on proving that it values its most vulnerable and is willing to invest in social services that will alleviate as much of their suffering as possible.
Perhaps fewer people would seek MAiD for their medical conditions if they knew that living in a LTC home could be dignified, rather than neglectful. We must reimagine the future of LTC and continue to expand access to services for those with disabilities. We should only return to amending MAiD once we can show our most vulnerable that we truly value and are willing to support them in life, rather than just in death.
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Everyone is entitled to their opinion, of course. But you don’t even mention the Supreme Court of Canada Carter decision, which decided that Canadians who meet the eligibility criteria have a right to an assisted death. These are our rights, according to the Charter. The federal government’s attempts at legislation simply have not meet the Carter decision, and so individual Canadians have had to go to court at every turn to fight for rights THEY HAVE ALREADY WON. Those of us who have advocated for MAID for years are also advocates for quality palliative care, support for the disabled and vulnerable, and, most importantly, choice in how and when individuals choose to die. I just really cannot conceive of how you are trying to relate COVID deaths in LTC homes to access to MAID for people who are suffering intolerably but are not terminally ill. I see you are a third year medical student. I hope that once you are a practising physician, you will respect the wishes of your patients of want to explore the option of MAID, even if this is something you wouldn’t choose for yourself.
You seem to be missing the point of the article. It is not against the expansion of MAiD—just along with it, there should be more supports for the disabled in living. The COVID deaths in LTC homes comparison was showing how currently the sick and frail elderly and disabled have been left in horrid conditions and neglected, which is why outbreaks and deaths have been so high in LTC homes. This shows how the government seems to view the elderly and disabled. We need to do better because disabled folks (I am one) live in poverty and cannot get the services we need (especially since a lot of health care is private, not public, and there are massive limits to what is publicly funded) to improve our QoL because of government neglect and indifference. This will lead many to choose MAiD when they otherwise wouldn’t have. Disabled people with means can get the care they need to improve their QoL, but those of us in poverty cannot access that help, but will now be able to access MAiD, when they otherwise wouldn’t have.
As for another issue, that the legislation is ableist in allowing disabled people to die while trying to prevent death/suicide in other populations, see:
‘Cold comfort to be offered the choice to die’ when not offered support to live, says disability advocate
https://www.cbc.ca/radio/thecurrent/the-current-for-nov-19-2020-1.5807944/cold-comfort-to-be-offered-the-choice-to-die-when-not-offered-support-to-live-says-disability-advocate-1.5808541