medical assistance in dying (MAiD)

This topic may not be your cup of tea but a dear-one’s devastating diagnosis could change all that. The purpose of today’s post is to present the basics of medical assistance in dying (MAiD). It’s been legal in Canada since 2016 (brief history here and here). Belgium, Luxembourg, the Netherlands, New Zealand, Spain, Switzerland, and parts of the United States also allow what’s sometimes referred to as physician-assisted suicide, euthanasia (active/passive), and assisted suicide.

I’m not advocating for or against but offer this for your information only. As for myself: should the situation arise I’d want to avail myself of MAiD. While this cannot be part of advance care planning I have discussed my wish with a group of friends who have offered to act as my future care team.

If you’d like to share your thoughts or alert me to errors on this page, kindly COMMENT below.

Oregon’s 1997 Death with Dignity Act appears to be the oldest in North America. It was voted on by the state’s citizens and challenged in the courts by the Federal Government over the next nine years. In Canada, medical assistance in dying was prohibited under the Criminal Code until 2015 when the Supreme Court directed Parliament to make changes in accord with the Charter of Rights and Freedoms. Over time, a handful of terminally-ill Canadians fought courageously before provincial and federal courts for their right to die on their terms: they include Sue Rodriguez, Lee & Kay Carter, Gloria Taylor, Elayne Shapray, Jean Truchon & Nicole Glady. May they be remembered.

The current eligibility criteria require an applicant to –

be 18 years of age or older and have decision-making capacity
be eligible for publicly funded health care services (such as Canadian citizens and landed immigrants)
make a voluntary request that is not the result of external pressure
give informed consent to receive MAID, meaning that the person has consented to receiving MAID after they have received all information needed to make this decision
have a serious and incurable illness, disease or disability — excluding a mental illness (see next paragraph)
be in an advanced state of irreversible decline in capability.

Mental illness. Canadians whose only medical condition is a mental illness, and who otherwise meet all eligibility criteria, will be eligible for MAID after March 2023. This includes conditions that are primarily within the domain of psychiatry, such as depression and personality disorders. It does not include neurocognitive and neurodevelopmental disorders, or other conditions that may affect cognitive abilities (source).

Dementia. A person in an early stage of dementia may request access to MAiD for when they reach a later stage of the disease. Request may be withdrawn at any time. Cannot be included in Advance Directive (source). Dying with Dignity (Canada) is offering a free webinar, “At the intersection of MAID and dementia”, on Wednesday, March 16, 2022 at 3:00 pm Pacific Time (Time Zone Converter). A family physician, a lawyer, and a person who’s had two MAiD death in their family will explain the law and manner in which practitioners can work with a person diagnosed with dementia and meets the strict criteria associated and the medical protocol known as “5 minutes to midnight”. Registration is now open.

Safeguards. Federal law includes safeguards to ensure vulnerable people are protected. In the Province of British Columbia, for instance, “Medical assistance in dying provides people, who are experiencing intolerable suffering due to a grievous and irremediable (incurable) medical condition, the option to end their life with the assistance of a doctor or nurse practitioner. Medical assistance in dying is provided only to legally eligible persons. To ensure this service is provided in a safe manner, a system of safeguards has been designed to protect vulnerable people and support all people to make an informed decision. British Columbians seeking medical assistance in dying should speak with their doctor, nurse practitioner or local health authority’s care co-ordination service for medical assistance in dying” (source).

What is medical assistance in dying? In this 5-min video Dr. Stephanie Green lays out the basic criteria and standard procedures. Dr. Green works as a Victoria physician and medical advisor to the BC Ministry of Health MAiD oversight committee. Please note one change to her list: in 2016 the law was amended so that natural death no longer needs to be “reasonably foreseeable”.