Myths and Facts

Medical assistance in dying (MAID) in Canada

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Canada’s assisted dying law is currently under review by the Parliament of Canada’s Special Joint Committee on Medical Assistance in Dying (MAID). The Committee is considering five issues, including advance requests, MAID for mature minors and those whose sole condition is a mental illness, the state of palliative care, and the protection of people with disabilities. Dying With Dignity Canada (DWDC) would like to clear up some misinformation surrounding MAID, the criteria and safeguards, and its application that we have been reading in recent media. 

Fact: Suffering from a lack of social supports does not qualify a person for MAID. No one can receive MAID on the basis of inadequate housing, disability supports, or home care. 

To be eligible for an assisted death, a patient must have a serious illness, disease or disability, be in an advanced state of decline that cannot be reversed, and experience unbearable physical or mental suffering from an illness, disease, disability or state of decline that cannot be relieved under conditions that person considers acceptable. A person must be approved by two independent assessors, each of whom work within the parameters of the law; they are careful and thoughtful in their work.  

In Truchon v. Quebec, a Canadian Charter of Rights challenge, it was established that denying access to MAID to people with disabilities, like Jean Truchon and Nicole Gladu, was discriminatory and violated the constitutional right to security of the person. 

For Track 2 patients (those who do not have a reasonably foreseeable death) they must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care, and must be offered consultations with professionals who provide those services. The patient and their practitioners must all agree that they have seriously considered alternative means to relieve suffering. The 90-day assessment for track 2 patients can be difficult and stressful for patients who are suffering. 

Fact: This is not true. The most important criteria in Bill C-7 is that an individual must have made a voluntary request for MAID that was not a result of external pressure and must give informed consent to receive MAID after having received all information needed to make this decision, including a medical diagnosis, available forms of treatment, and options to relieve suffering (including palliative care). 

Fact: Palliative care and MAID both provide quality options for care at the end of life.  

According to Health Canada, 80% of Canadians that seek an assisted death have also accessed palliative care. In the situations where palliative care was not accessed prior to MAID, it was available to the patient 88.5% of the time. 

“When palliative care is involved, it’s often involved for quite a substantial amount of time before MAID requests go in and before MAID is provided.” – James Downar, palliative care physician.

Fact: This is not true. Dr. Justine Dembo, a psychiatrist, stated that “Individuals would likely have endured many years, perhaps decades, of persistent, unbearable psychiatric suffering related to their mental illness, that has not improved despite numerous attempts at different interventions.”

All MAID assessments are done on a case-by-case basis, and individuals must meet the rigorous criteria to be eligible for an assisted death; the same rigour would be applied to those whose sole condition is a mental illness.  

The current exclusion of those with a mental illness is stigmatizing and discriminatory. Having a mental illness does not mean that a person is incapable of making free and informed decisions about their care. “People with psychiatric illness suffer the same as those with other diseases, and we should not deprive these citizens of their rights. There is no doubt that some forms of psychiatric illness are intractable and incurable.” – Dr. Derryck Smith, a Vancouver-based psychiatrist. 

“The vulnerability of a person requesting medical assistance in dying must be assessed…according to the characteristics of the person and not based on a reference group of so-called ‘vulnerable persons.’” — Madam Justice Christine Bauduoin.  

In the Netherlands, where assisted dying for mental illness has been available for 20 years, only 1% of assisted deaths have been approved for those suffering from mental illness. 

The Expert Panel on MAID and Mental Illness has presented a report to inform protocols and safeguards that will be in place when the exclusion of MAID for mental illnesses ends in March 2023. 

Fact: MAID is not about cost savings; it is about compassion and choice to end suffering that is intolerable to the individual. 

As part of its mandate and activities, the Parliamentary Budget Office (PBO) is expected to provide “independent economic and financial analysis to the Senate and House of Commons, of any proposal over which Parliament has jurisdiction.” 

A 2020 report by the Parliamentary Budget Office has stated that the “net reduction in health care costs for the provincial governments only “represent[s] a negligible portion of the health care budgets of provinces. The cost savings presented in the PBO report do not provide a complete picture of what is happening across Canada as data was only collected in Quebec and does not exist for the twelve remaining provinces and territories.  

Fact: “Neither the national data in Canada or Quebec nor the foreign data indicate any abuse, slippery slope or even heightened risks for vulnerable people when imminent end of life is not an eligibility criterion for medical assistance in dying,” as concluded by Madam Justice Christine Bauduoin in Truchon v. Quebec 

The criteria for eligibility for MAID are clear: a person’s suffering has to be caused by a serious and incurable illness, disease or disability, and the person has to be in an advanced state of irreversible decline in capability, and their suffering had to be caused by the illness, disease or disability or state of decline. 

Poverty, short intervals of depression, or feelings of being a burden do not qualify a person for MAID. 

No one can be forced into accessing MAID. It is a decision made by free and informed individuals after having been offered alternative means to relieve their suffering. Suffering caused by social or financial factors may contribute to someone applying for medical assistance in dying, but that application would not be approved on the basis of those factors. MAID assessors carefully assess a person’s reasons for applying for MAID to ensure there are no signs of coercion. 

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