The waiver of final consent: In recognition of the anniversary of Bill C-7
News & Updates | March 17, 2022 | Dying With Dignity Canada
One year ago, the legislation with respect to medical assistance in dying (MAID) changed and broadened eligibility with the passage of Bill C-7. There was strong support for the changes in the law, and Canadians advocated passionately for them. The three main changes in Bill C-7 included:
- A person’s death does not have to be reasonably foreseeable to be eligible for MAID
- A person only needs one witness to sign their request for MAID, down from two, and,
- The waiver of final consent for those whose death is reasonably foreseeable
Audrey Parker advocated for the waiver of final consent after her diagnosis with an incurable cancer. Audrey chose to die earlier than she would have otherwise wanted because of a flaw in Canada’s assisted dying law; the requirement that the suffering person be competent immediately before their MAID provision. The proposed change was named, “Audrey’s Amendment” in honour of her advocacy.
“What a tremendous relief it was to see Audrey’s Amendment included in the passage of Bill C-7. We will never know how much extra time we would have had with Audrey. Without the waiver of final consent, she was forced her to choose her death earlier than she wanted. One of her greatest fears was losing mental capacity before she could invoke MAID. Her advocacy, before her own assisted death, led to this very important change for Canadians and their families” said Kim King, Audrey’s close friend.
According to Dr. Chantal Perrot, “The waiver of final consent was a welcomed change to the legislation governing MAID when Bill C-7 received royal assent last year. It was a terrific idea in that it allows people who have been assessed and approved for MAID to receive MAID in the event that they lose the capacity to provide consent on the day of their provision.”
Since March 2021, when the change in the law came into effect, 72 people in Ontario have received MAID using a waiver. More federal statistics will be available in the summer when Health Canada publishes their annual MAID report.
Dr. Perrot goes on to say, “In my own practice, I discuss the waiver with most of the patients I see whom I find eligible for MAID and whom I believe are at risk of loss of capacity in the near future. Having a waiver in place gives them and their loved ones the assurance that they may receive MAID if they lose capacity, and thus will not have to languish in a state of suffering and incapacity for days, weeks, or even months while waiting for a natural death. I discuss the waiver with both the patient and their loved ones, as the loved ones will have to be more involved in facilitating on the day of the provision if the patient no longer has capacity. I encourage the patient to help me and their loved ones by telling us at what point after the loss of capacity, or under what conditions, they would want to proceed with MAID. I include this detailed information in the agreements that I make with them.”
Like any new legislation or process, there have been challenges with the application of the waiver that continue to be worked out. Dr. Perrot believes that some of the difficulties with the waiver of final consent provision will be alleviated if and when advance directives for MAID become legal.
“Many people look forward to this day. In the meantime, we will continue to try to help our patients understand the use of the waiver so that they can have this added assurance and relief of suffering at the end of their lives.”
The Special Joint Committee and the parliamentary review of MAID have yet to be reinitiated since the 2021 election. The review is critical to creating legislation and safeguards that will allow for advance requests and for people with a mental illness to safely access MAID, while also providing a forum for addressing the protection of Canadians living with disabilities and for Parliament to gain a better understanding of the state of palliative care in Canada.