Canada revised its criminal code on medical assistance in dying – MAiD – in March, opening the door to individuals whose deaths are not reasonably foreseeable but who meet other eligibility criteria such as having a serious incurable “disease, illness or disability,” being in an advanced state of decline and suffering intolerably.
MAiD is assistance provided by a physician or nurse practitioner to a person, at the person’s request, that causes the person’s death. A physician or nurse practitioner can administer the drug or provide it to the patient, who can then self-administer it.
The law now requires a minimum 90-day period between when the person’s first assessment of MAiD begins and the day on which the MAiD procedure is carried out. Individuals now must undergo two MAiD eligibility assessments by two different practitioners.
Furthermore, the individual must sign the request for MAiD before an independent witness, and must be informed of the “means available to relieve suffering,” including counselling, mental health and disability support services and palliative care, and offer consultations with health-care practitioners related to those services.
Finally, the individual can withdraw the request at any time.
While the door has been opened to those seeking MAiD solely on the basis of a mental disorder, the legislation requires governments and medical bodies to come up with guidelines and safeguards within two years.
These changes should provoke reflection about our own attitudes toward death. A place to start is a thought-provoking and wise 12-minute video produced by Ronald Bayne shortly before his death on Feb. 26. At the time, he was 98 years old and received MAiD at home.
As a geriatrician, he was a physician specializing in the health, welfare, maintenance and protection of older adults. The video contains his reflections on overcoming our fears of death and suffering, his perspective on MAiD and how to plan for the end of life. He highlights the importance of coming to terms with the inevitability of death and encourages older adults to insist that their voices be heard when discussing their end-of-life care, wanting them to know they have more control over what they want than others may think.
In the late 1960s, when the new McMaster University medical school was founded to serve the Golden Horseshoe at the west end of Lake Ontario, the first dean, John Evans, recruited a stellar group of scholars including Dr. Bayne. At a time where there were very few geriatricians, Evans understood the need for Canada’s future physicians to be prepared to serve older adults with complex and long-term conditions and disabilities. As a geriatrician, Ronald Bayne was exceptional because he was also a clinical scholar. He was appointed as a professor of medicine in 1970 and retired in 1989. In this role, he had an extensive impact on students, including one of the authors of this article (Larry Chambers).
In 2006, he received an honorary degree from McMaster for his advocacy and work raising awareness of the need for better care of older adults and people living with long-term conditions.
Dr. Bayne and his wife, Barbara, made several donations to McMaster, establishing the Ronald Bayne Gerontology Award for a graduate student conducting research in aging, and the Barbara and Ronald Bayne Award to provide support for senior students in the Department of Health, Aging and Society engaged in practical learning.
Dr. Bayne founded the Hamilton-Wentworth Group on Aging, the Gerontology Research Council of Ontario (GRCO) and led the Canadian Association on Gerontology in the 1980s. His passion for the health and health care of older adults drove the infusion of provincial funding into research and training in aging.
Through Dr. Bayne’s leadership, we learned the principle that every citizen should have the right to choose where to live. Instead of deferring to outdated policies that have an ‘institutional’ mindset, a successful aging-in place philosophy is required to build the necessary infrastructure. In the video, Dr. Bayne asserts: “Take that responsibility. Let us ensure that the health-care system for long-term care is properly organized and managed and supervised.”
As someone who lived to the age of 98, he truly was a specialist in aging.