Coelho, Nicholas: It is a mistake to extend medical assistance in dying to children

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The lack of evidence to support safe practice and the risk of suicidal contagion among adolescents raises the question: why the rush to make MAID available to children?

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It is highly likely that in October 2022, the Canadian government will receive its own parliamentary report recommending that children deemed fit (mature minors) be entitled to medical assistance in dying (assisted suicide and voluntary euthanasia).

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the Special Joint Committee on Physician-Assisted Dying (MAD), is currently meeting and, among other issues, is considering MAID for children. It is despite serious concerns already raised by some about the current MAID regime and the urgency of its reform.

In an increasing number of reported cases, MAID replaces medical treatment and government assistance for people with social, economic and psychiatric problems. An example is the case of Alan Nichols, who had recurrent bouts of depression. Nichols was arrested by the RCMP and admitted to hospital under the Mental Health Act. While in hospital, he received medical assistance in dying – much to the dismay of his family, who would have preferred him to receive medical treatment instead. Similarly, a recent CTV story told how “Sophie”, unable to find affordable housing compatible with his chemical sensitivities, chose MAiD.

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How can we prevent MAID from being used as a tool to absolve governments of their obligation to provide people living in poverty, with disabilities or mental illness their equal rights as citizens to health, economic and life security? This is the question the Special Joint Committee should ask itself. But instead, expanding MAID for children is the order of the day.

The Supreme Court of Canada recognize that children’s decision-making capacity must take into account the mental, emotional and physical needs of the child and their stage of development, among other factors. The courts apply a sliding scale to capacity, which means that decisions with serious consequences require a deeper examination of capacity. In some cases, a total ban is necessary to prevent future harms like marijuana, alcohol, and cigarettes. Children who consent to MAID would not be consenting to future health problems but to having no future at all.

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Current medical evidence confirms that adolescent judgment continues to develop into adulthood. The American Academy of Pediatrics states: “Although the size of the brain reaches almost its adult size in infancy…we know that much of the brain has continued dynamic changes…until the third decade of life. The prefrontal cortex , where many executive functions are coordinated… is among the last areas of the brain to mature.

What are the potential dangers of extending MA to children? One is the contagion of teenage suicide. There is evidence that messages that encourage suicideand knowing someone who committed self-harm or suicide, both increase the risk of suicide contagion in adolescents. Indigenous youth are particularly at risk due to an already high suicide rate resulting from long-standing injustices. Aboriginal stakeholders have repeatedly requested federal government support for the implementation of suicide prevention programs and mental wellness strategies in their communities. These demands have not been adequately met and, in many cases, ignored, as the federal government instead focuses on facilitating access to suicide for young people, including Indigenous youth.

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Council of Canadian Academies Expert Working Group on MAID for Mature Minors Note that there is a lack of evidence on how MAID for children will affect families. He noted that there is no strong evidence that captures the voices of young people on this issue, including the perspectives of minors with disabilities, Indigenous youth and/or those in the child welfare system. He also cites the lack of international evidence on which to draw conclusions.

Given the lack of evidence to support safe practice and the risk of suicidal contagion in adolescents, and the seriousness of MAID as an option, a valid question is: why the rush to make MAID available to children ? The federal committee on MAID should slow down, review the evidence, and not push for expansion to children.

Dr. Ramona Coelho is a family physician caring for marginalized patients. She has served as an expert witness before House and Senate committees examining Bill C-7 and is a founding member of Physicians and vulnerable Canadians. Hon. Nicholas Graydon was the 30th Lieutenant Governor of New Brunswick. He is a member of the Wolastoqiyik Nation, served as Co-Chair of the Stakeholder Advisory Council and was a member of the First Nations Advisory Council on Aboriginal Youth and Suicide Prevention in New Brunswick.

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