Editorial: Medical Assistance in Dying
By Sara Golling
The Rossland Telegraph interviewed a local doctor (let's call this person "Dr. X") to learn what people in our area suffering from "grievous and irremediable" conditions that result in enduring and intolerable suffering can expect if they conclude that they want to have medical assistance in dying (MAID).
The good news is that MAID is available locally for those who qualify and who really, really want it. More good news? There are strict safeguards against any form of abuse of MAID. The bad news is that some people who ought to qualify, according to the wording of the Supreme Court of Canada (SCC) reasons for judgment in the landmark case of Carter v. Canada, do not.
The process: Dr. X explained that a patient who wants MAID will talk to his or her family doctor or specialist. The doctor may, for reasons of personal conscience or belief, not wish to take any part in the MAID process, in which case he or she will explain that to the patient, and put the patient in touch with the Interior Health Authority (IHA).
No doctor, nurse practitioner or pharmacist is forced to have any part in MAID against their wishes, so IHA has sent a questionnaire out to all doctors in the region, asking whether or not they are willing to provide MAID, or to assist only by being "assessors" to help determine whether or not the patient qualifies for MAID. Dr. X said, "I wrestled with this issue. I prayed over it for a long time before deciding what I could do. And I think all doctors have wrestled with the questions involved before making their own decisions."
The patient who seeks MAID must be assessed by two independent assessors. One of those may be the patient's doctor, or the provider of MAID. If the patient meets the list of stringent criteria imposed by Bill C-14, and also the even more stringent criteria dictated by the BC College of Physicians and Surgeons, then the patient must sign documents in front of independent witnesses who understand what is being signed, are not involved in the patient's care and do not stand to gain anything from the patient's death. The patient will then endure a further waiting period of at least ten days. After the 10-day wait, the patient may be prepared to receive MAID, but must be given every opportunity to withdraw the request for MAID, and must again express a positive determination to have MAID.
Dr. X stressed the importance of respecting the experience and wishes of the patient, without being judgmental; and also of respecting the experience and conscience of each individual doctor, whether they are willing to be part of MAID or not. We discussed, as did the SCC, the sanctity of life, and whether that means not just a right to live, but also a duty to endure a life that has become unendurable until the heart stops beating of its own accord -- or until all possible measures to extend life have failed. The SCC concluded that it does not.
Dr. X freely acknowledged that Bill C-14 does not meet the simple criteria for MAID set out by the Supreme Court of Canada in its reasons for judgement on the Carter v. Canada case. In fact, the very sufferers in that case would not qualify for MAID under Bill C-14.
How so? Kay Carter, who travelled to Switzerland for "death with dignity" at a clinic there, suffered from a condition which would not kill her in the reasonably foreseeable future, but caused her unbearable agony and increasingly restricted her ability to move. Kay wanted out, but she had to go to Switzerland to achieve that, and her family members who helped her get there could have faced criminal charges here in Canada for doing that.
So Kay Carter, were she still alive and suffering in Canada, would still not be eligible for MAID and would have to continue suffering, possibly for years, if she couldn't get to Switzerland or take matters into her own hands, even though she was one of the people whose case went to the SCC to change the law.
Bill C-14 requires that a patient's illness or condition will result in a "reasonably foreseeable" death, "without a prognosis necessarily having been made as to the specific length of time they have remaining." But the various provinces' Colleges of Physicians and Surgeons, who provide medical malpractice insurance for their members, have also imposed additional restrictions. They have consulted lawyers, and in BC those lawyers -- in what many consider an excess of caution -- have dictated that doctors must not provide MAID unless they can say with assurance that the patient would otherwise die a natural death within six months. That's pretty specific.
Dr. X told us that, if anyone were to be charged for wrongful death by providing MAID, it could only be the provider of MAID, not any of the others involved in the process: not the other assessor, not the pharmacist providing the drugs, just the provider; and that the provider could be sentenced to five years in prison. That would be time in a federal penitentiary. "So you really want to be sure about why you're doing what you're doing," Dr. X commented.
The BC Civil Liberties Association says, "The new federal law will trap many Canadians in unbearable suffering. Canadians with diseases like spinal muscular atrophy, multiple sclerosis, spinal stenosis, locked‑in syndrome, traumatic spinal injury, Parkinson’s disease and Huntingdon’s disease will not be eligible for medical assistance in dying under the new law."
Bill C-14 appears to be unconstitutional in the same way as the original complete prohibition against MAID. The SCC judgement in Carter noted that the former absolute prohibition against MAID " imposes unnecessary suffering on affected individuals, deprives them of the ability to determine what to do with their bodies and how those bodies will be treated, and may cause those affected to take their own lives sooner than they would were they able to obtain a physician’s assistance in dying." Those same things can accurately be said of the restrictions imposed by Bill C-14 and the additional restrictions imposed by the College of Physicians and Surgeons.
On June 27th, 2016, the case of Lamb v. Canada was filed to challenge Bill C-14. It may not need to go to the SCC. Time will tell, and that time will pass very slowly for some people.