MAiD in Canada – Public Consultation

In this article I would like to outline some of the results of a public consultation which the Government of Canada carried out and published in March 2020 regarding MAiD. The publication, with the headline, “What We Heard Report. A Public Consultation on Medical Assistance in Dying (MAID)” can be accessed at the Justice Canada site here and a copy of the pdf can be viewed here.

MAiD

MAiD – an Acronym for Medical Assistance in Dying became legally established in Canada in 2016 through the enactment of Bill C-14. “Medical assistance in dying” includes:

1. “the use of medication by a physician or nurse practitioner to directly cause a person’s death at their request”
2. “the prescription or provision of medication by a physician or nurse practitioner that a person can use to cause their own death”¹

“MAiD” is a fancy acronym for the process whereby a physician either takes the life of another human being or provides him or her with the means of doing so. It is a clear violation of the fifth commandment. The use of this term is very clever. It is in a sense very soothing as the English word the acronym mimics is “maid”. A maid is an unmarried girl or woman or a housemaid or chambermaid. But this MAiD is, metaphorically speaking, a harsh mistress who has been assigned the task of facilitating the removal of the weak, suffering and vulnerable rather than providing care and comfort…an inversion of what one would expect of a maid. This MAiD is a grim reaper.

The Report

This report is broken down into three sections: “1.0. Introduction”, “2.0. Results from the Online Questionnaire” and “3.0. Perspectives From the Roundtables”. The introduction provides context, giving the history and evolution of MAiD in Canada and the objectives of the public consultation which were stated as “In light of the Government’s decision to change Canada’s MAID regime and to inform the way forward, these consultations sought Canadians’ views on the need for additional safeguards in a regime that will no longer be limited to dying persons, and on advance requests for MAID.” However the tone of the consultation seemed to be one of advocating for the removal of existing safeguards rather than adding more. Section 2.0 included the demographics of the participants and allowed for ranking of several canned statements, as well as limited space for comments. The last section sought the input of various stakeholders such as doctors, nurses, lawyers and the disabled.

According to the public consultation report the MAiD legislation’s “core policy was to give Canadians who were suffering intolerably during the dying process, the choice to have a medically assisted death.”² Unfortunately once this bill was passed it appeared that the next step was to leverage the Charter of Rights and Freedoms to broaden the law. The report goes on to state, “Finally, since the enactment of the MAID legislation, litigation challenging the MAID regime was initiated in British Columbia, Ontario, Quebec and Saskatchewan. The British Columbia (Lamb) and Quebec (Truchon) cases challenged the MAID law on the basis that its eligibility criteria violated the Canadian Charter of Rights and Freedoms because they were too restrictive.”³ This in spite of the fact that the Charter does not enshrine a “right to die” for Canadians. (For example, in the report, see “Theme 3 – The right to die”^4a)

In 2019 the Quebec superior court ruled that for MAiD to be limited only to people nearing the end of life was unconstitutional. Thus, according to the report, “…the MAID law will change from a regime that aims to enable people to have a peaceful death rather than a painful or prolonged dying process, to a regime that offers the choice of MAID to relieve intolerable suffering, regardless of proximity to natural death.”⁴ This kind of wording in the report may lead one to believe that this public consultation was used solely as a means to justify the expansion of MAiD. And is this truly a peaceful way to die?

Although it appears, from the results of this public consultation, that a large majority of Canadians support MAiD, as mentioned above, the report itself seems to take the point of view that MAiD is a good thing and is here to stay. Indeed under the section “Theme 5 – Opposition to MAID” this was picked up on by many respondents: “Many also expressed their disappointment with the consultation questions, stating that it forced respondents to endorse MAID in order to debate its expansion.“^5a For example, in “Table 6: Additional Safeguards” under the section “Safeguards to protect against misuse or abuse of medical assistance in dying” a typical proposed safeguard involving MAiD was, “MAID should be available only when the practitioner and the patient both agree that reasonable treatments and options to relieve the person’s suffering have be entried without significantly improving the person’s situation”.⁵

Regardless, it is evident that many Canadians have ambivalent feelings about MAiD. This is evident on the responses to the safeguard “Making sure the person requesting MAID is aware of all the means available to potentially relieve their suffering, including health and social support services (for example counseling, disability support, palliative care)” were 90% on the side of respondents considering this ranging from “important” to very important.⁶ See Figure 1 below.

One observation I would like to share in reading this report is a dearth of discussion on the role of the family and support networks in the care of those to whom MAiD would be considered an option. For example, in the section “Safeguards to protect against misuse or abuse of medical assistance in dying” the role of the family was only mentioned once “An obligation for the physician and nurse practitioner to offer to discuss their patient’s situation with their family members or loved ones with the patient’s consent” and this safeguard was considered important to very important by over 75% of respondents. (See Figure 2 below.) Under the section “Theme 2 – MAID through advance requests” there is no serious consideration of any kind of the role for the family in deciding the fate of those who are no longer able to make decisions for themselves, limited to the following: “Some concerns were expressed about the role of family members—whether they should or should not be able to apply for MAID on a patient’s behalf, or to invalidate the wishes of a patient.”^6a Why is that?

Under the comments section of this public consultation it states “In the questionnaire, there were three text boxes that could be completed with up to 500 character responses.” This does not leave much room for those participating to properly express all of their concerns. Note that the above paragraph contains just over 1100 characters.

Under the section “Theme 5 – Opposition to MAID” it is interesting to note the embedded opinion “Others were of the view that religious objections to MAID have no place in secular society, and should not be pushed upon those who do not share the same religious beliefs.” It would seem to me this would not be an appropriate place in the report to insert such a comment. Is this an attempt to discredit the objections raised to the implementation of MAiD? One concern raised in this section was that “many respondents noted that it is immoral for the government to force nurses, doctors, and other health care professionals to perform MAID as it is putting them in a situation where they are forced to end someone’s life.” An important issue but one that was not raised anywhere else in this report – surprisingly not even in roundtable discussions in section 3.0.

Some of the reasons many of the respondents advocated for MAiD were: 1. “the poor quality of life for those suffering, especially those experiencing extreme chronic pain.” 2. “The majority of responses focused on the right of the individual to choose when to die, no matter the circumstances. There were many references to how we treat our pets – that we do so with more compassion than we treat our fellow human beings.” 2. “Some respondents commented on having witnessed MAID with people surrounded by friends and family and the compassion and dignity that it afforded to the patient.” 3. “…mental health conditions can result in suffering that is as painful as physical disorders and not respond to treatment, resulting in people making dangerous suicide attempts rather than ending their life in a safe way.”

This world view is perfectly understandable from a purely materialistic point of view. Nonetheless it has ominous consequences. Under “Theme 5 – Opposition to MAID” the report states “MAID was seen as a slippery slope for many respondents, who state that it opens the door to the government legalizing the act of ending someone’s life when it is deemed convenient for the state. Along the same lines, many respondents noted that it is immoral for the government to force nurses, doctors, and other health care professionals to perform MAID as it is putting them in a situation where they are forced to end someone’s life.” But this is exactly what is happening. The point of the public consultation seems to be to expand MAiD. And indeed, since MAiD was introduced in 2016 rapidly growing numbers of Canadians have opted for it.¹⁰⁵ As Canada has socialized health care all Canadians are compelled to support MAiD through their tax dollars. There is no opting out. Efforts are ongoing to force hospitals that do not practice MAiD to implement it.¹⁰⁶ How far will the expansion of who can opt for MAiD go? Traditional Western values offer a solid and reliable framework to navigate these moral dilemmas. See Can any Civil Authority Legalize Abortion or Euthanasia?

In Section 3 of the report, titled “Perspectives From the Roundtables” one question that comes to mind is why were there no participants selected to represent the concerns of the families and the impact that MAiD has on them? and why were faith communities such as the Catholic Church and other Christian denominations, who have much to say on the issue, and are the primary voice representing the well being and interests of the nuclear family, excluded? Or if they were, why does this report fail to mention their input in this section?

In addition to the online questionnaire, the Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion hosted a series of ten in-person roundtables across the country from January 13 to February 3, 2020 (in Halifax, Montreal, Toronto, Vancouver (x2), Calgary, Winnipeg, Ottawa (x2) and Quebec City). These roundtables allowed the three ministers to hear from over 125 experts and stakeholders, including doctors, nurse practitioners, health regulatory bodies, key health stakeholders, legal experts, the disability community, and civil organizations on key issues. Moreover, the Ministers hosted a separate roundtable focused on receiving specific feedback from Indigenous practitioners and community leaders…

One final thought. This Report seemed to disregard the impact that this would have on the medical profession, and family. Will nurses and doctors be coerced into providing assisted suicide, which on the face of it is the deliberate killing of another human being? And what is the impact of one family member opting for this procedure on the rest of the family, particularly the children? It is well known that marriage breakup has a detrimental effect on children. What happens when a parent or grandparent chooses assisted suicide? This has happened. Recently Lifesite news published an article on this: Disabled Canadian woman opts for assisted suicide because she struggles to receive gov’t support.