Thank you for this excellent submission. A few points from my experience as as a family witness to a Canadian MAID death and academic now writing about the issue:
- Proactive offers are not just reported in Canada, they are recommended by the main MAID provider association and are policy in many healthcare facilities and jurisdictions. Patients even remotely prospectively eligible may be asked multiple times by different staff, not just by doctors, if they want AD. The rationale is that it is wrong and unethical not to mention treatments for which they may be eligible. Because AD is regarded as a medical therapy, it should be mentioned so every new clinician they encounter, from the triage nurse to new staff on shift changes, ask them. I've heard an account of an oncology ward with a dedicated non-clinician whose main task is to tell the patients about MAID. Often, the materials they provide come from DwD.
- Capacity assessments around AD are not done often in Canada. And there is some limited research that suggests some AD clinicians consider them a waste of time. There are also recordings of AD clinicians discussing the merits of lowering capacity with sedation to lower resistance to AD. And there are indications of an increasing ritualisation of the practice or the view that AD is a kind of party, so patients (incl. my father) are permitted to drink alcohol on top of whatever possibly incapacitating medication they may be taking before they are asked to give their final consent.
An excellent summary of the likely outcomes should this bill pass.
A slightly wider non-medical perspective - the purpose of law-making (in general) is to protect the vulnerable from the strong - not sure this legislation will achieve that, possibly quite the opposite.
What a well articulated piece. I hope that decisions on this bill will be made using this kind of evidenced-based approach rather than the very emotionally driven arguments I have seen put forward by proponents. I understand the emotion, especially where it reflects personal experience, but it inevitably clouds attempts towards a more objective assessment.
There are many parallels in the discussion with end-of-life decisions I faced in my career as a Paediatric Intensivist. My learning from those experiences includes three points:
1. Courts do not want to be involved in such decisions, and when they are it is always a dreadful experience for all concerned.
2. There is an important need for early conversations about what supportive and non-curative interventions are available, (and also what the burdens of some treatment interventions are). These discussions are not necessarily helped by Advance Care Plans, as they can become abstract check-list conversations enabling a more difficult, but important conversation to be avoided.
3. Without 2, trenches start to be constructed, and 1 becomes difficult to avoid.
The irony is that for cases in this context, it is often the multi-professional clinical teams who are seeking to allow life to end while maintaining comfort and dignity, and families arguing for the preservation of life at all costs.
I find it curious that the category "the most vulnerable in society" does not here seem to include those facing death from degenerative disease and other dehumanising illness. The risks to those should surely be balanced with the risks to others whose mental capacity is difficult to assess?
Thank you for this excellent submission. A few points from my experience as as a family witness to a Canadian MAID death and academic now writing about the issue:
- Proactive offers are not just reported in Canada, they are recommended by the main MAID provider association and are policy in many healthcare facilities and jurisdictions. Patients even remotely prospectively eligible may be asked multiple times by different staff, not just by doctors, if they want AD. The rationale is that it is wrong and unethical not to mention treatments for which they may be eligible. Because AD is regarded as a medical therapy, it should be mentioned so every new clinician they encounter, from the triage nurse to new staff on shift changes, ask them. I've heard an account of an oncology ward with a dedicated non-clinician whose main task is to tell the patients about MAID. Often, the materials they provide come from DwD.
- Capacity assessments around AD are not done often in Canada. And there is some limited research that suggests some AD clinicians consider them a waste of time. There are also recordings of AD clinicians discussing the merits of lowering capacity with sedation to lower resistance to AD. And there are indications of an increasing ritualisation of the practice or the view that AD is a kind of party, so patients (incl. my father) are permitted to drink alcohol on top of whatever possibly incapacitating medication they may be taking before they are asked to give their final consent.
.
An excellent summary of the likely outcomes should this bill pass.
A slightly wider non-medical perspective - the purpose of law-making (in general) is to protect the vulnerable from the strong - not sure this legislation will achieve that, possibly quite the opposite.
What a well articulated piece. I hope that decisions on this bill will be made using this kind of evidenced-based approach rather than the very emotionally driven arguments I have seen put forward by proponents. I understand the emotion, especially where it reflects personal experience, but it inevitably clouds attempts towards a more objective assessment.
There are many parallels in the discussion with end-of-life decisions I faced in my career as a Paediatric Intensivist. My learning from those experiences includes three points:
1. Courts do not want to be involved in such decisions, and when they are it is always a dreadful experience for all concerned.
2. There is an important need for early conversations about what supportive and non-curative interventions are available, (and also what the burdens of some treatment interventions are). These discussions are not necessarily helped by Advance Care Plans, as they can become abstract check-list conversations enabling a more difficult, but important conversation to be avoided.
3. Without 2, trenches start to be constructed, and 1 becomes difficult to avoid.
The irony is that for cases in this context, it is often the multi-professional clinical teams who are seeking to allow life to end while maintaining comfort and dignity, and families arguing for the preservation of life at all costs.
I find it curious that the category "the most vulnerable in society" does not here seem to include those facing death from degenerative disease and other dehumanising illness. The risks to those should surely be balanced with the risks to others whose mental capacity is difficult to assess?
This is great. Nikki Da Costa talks about your evidence in our latest podcast https://open.substack.com/pub/otherhalforg/p/this-is-not-how-you-legislate-assisted?