Coelho: Medical assistance in dying overused in Canada even before its expansion

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Canada’s medical assistance in dying (MAID) law is the most permissive legislation on euthanasia and assisted suicide in the world.

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Canada’s medical assistance in dying (MAID) law is the most permissive legislation on euthanasia and assisted suicide in the world. The United Nations Special Rapporteur on the rights of persons with disabilities, the United Nations Independent Expert on the enjoyment of all human rights by older persons and the United Nations Special Rapporteur on extreme poverty and the person have all warned our Canadian government that our MAID law results in human rights abuses.

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Still, the Federal Special Joint Committee on MAID is studying and making recommendations to the government on expanding the system which was created in 2016 and expanded in 2021.

Here are some recent examples of MAID abuse under current law, based on information provided by physicians, a patient, and family members:

A man has been admitted to hospital after suffering a small stroke affecting his balance and swallowing. He felt depressed and isolated due to an outbreak of COVID-19 on his ward. The stroke neurologist anticipated that he would be able to eat normally and regain most of his balance. The psychiatrist diagnosed adjustment disorder but noted that her prognosis was very good. The patient then requested MAID. None of its MA evaluators had expertise in stroke rehabilitation and recovery. Because he was temporarily eating less, the MA evaluators decided he could die right away instead of waiting the required 90 days for the disabled despite having no terminal comorbidities. He received MAID the following week. This man died alone and depressed and before he tried proper therapy or reached maximum recovery.

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A 71-year-old widower has been admitted to a southwestern Ontario hospital after a fall. According to his family, upon admission he contracted an infectious diarrheal disease. He was humiliated by staff for the smell in his room, his family said. He developed new shortness of breath which was not fully assessed. In this context, a member of the hospital team suggested that he would qualify for MAID. The team said he had end-stage chronic obstructive pulmonary disease and was terminally ill. The patient was surprised by the diagnosis but trusted the team. Within 48 hours of his first evaluation, he received a medically assisted death. Post-mortem tests showed he did not have end-stage COPD. His family doctor, when informed of his death, also said he did not have end-stage COPD, but the team failed to contact her when assessing his antecedents.

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Was MAID brought up as an option because the man’s admission was taking too long or his room smelled bad or because he was a victim of ageism? Did he choose death because his healthcare team made him feel terrible, or did he make his decision based on inaccurate information? His family thinks that is the case. There are no safeguards in legislation that protect marginalized Canadians (victims of ageism, racism or ableism) from MAID as a “treatment option”.

CTV ran a story on W5 showing a man delivering MAID and a patient let me know that the story was very appealing and that MAID would be a good option for her. This patient is in her 40s and recently suffered a mild spinal cord injury from which she has not had time to adjust, receive peer support or adequate symptom control. She would rather die than be poor and she is aware that the government will not provide her with what she needs to live with her new disability.

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The legislation is written so that she can access MAID before she can get better, heal as much as she can, and adapt. Equally troubling, the government has ignored the well-documented phenomenon that messages promoting suicide increase suicide rates. Have we considered how MAID offered by the government might affect a person’s decision to choose death?

Despite these and many other cases in the media spotlight that should make us think and consider the evidence, some are pushing for the expansion of MAID. The Federal Expert Panel on MAID for Mental Illness recommended that mental illness be grafted onto the MAID framework without any legislative changes in March 2023.

Disturbingly, Canadian bioethicist Udo Schuklenk dismisses fears that suffering caused by societal injustice could lead to choosing death. Schuklenk asserts that limiting MAID for psychosocial suffering “would result in the removal of the agency from patients capable of making decisions without offering them a way out of their predicament.”

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Schuklenk talks about agency but shows no regard for how societal structures, such as governments, create and sustain the predicaments that can make death an attractive choice for those who would have instead benefited from more resources and care.

Dr Jeff Kirby, a member of the expert panel on MAID for mental illness, writes that he had to resign before the report was published because the recommendations were “soft” and “inadequate”. He also stated that there were procedural issues, including discouragement of members bringing relevant issues for deliberation and a lack of transparency in reporting.

Ellen Cohen, representing a national mental health advocacy organization, also resigned citing the same concerns. Canada should be extremely cautious about the recommendations of an expert panel, two of whose 12 appointed members have resigned in good conscience.

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Canada’s MAID Act currently allows facilitation of suicide for people with disabilities and is set to expand in March 2023 to people living with mental illness. The first report of the Federal Special Joint Committee on MAID suggests that it will not only ignore all problems caused by MAID, but will also entrench and expand MAID in Canada.

Ramona Coelho is a family physician in London whose practice includes caring for marginalized patients and people living with mental illness and disability. She has served as an expert witness before House and Senate committees examining the bill to extend MAID and has appeared as an expert witness before the Federal Special Joint Committee on MAID. She is a founding member of Physicians Together With Vulnerable Canadians.

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