Dr. David Amies: Why do we need 'independent witnesses' for assisted dying?

Using his personal experiences as a volunteer in DWDC's independent-witness program as a jumping-off point, Dr. David Amies questions the value of requiring patients to get their assisted dying requests signed by two people who aren't involved in their care. Though well-intentioned, this rule in federal assisted dying law, he argues, is unnecessary and it imposes a harmful burden upon suffering Canadians who are trying to exercise their right to choice.

A few days ago, I attended the bedside of a tired, exhausted parson, wracked with pain and obviously one who had reached the end of their tether. Along with a friend, I had come to witness a signature on an application for medical assistance in dying (MAID).

I belong to a small group of people, here in Lethbridge, who have volunteered to stand as witnesses for those who have chosen MAID but who have no one else to perform that task for whatever reason. To join this group, it is necessary to undergo some very simple training and to be willing to act at short notice. Since the law on MAID came in to effect, two years ago, I have acted in this capacity about a half a dozen times. On each occasion, I have seen gravely ill people who had had enough and wanted relief from their suffering and that caused me to reflect that we were lucky to have the legislation in place, however imperfect it may be.

It is necessary to point out that Dying With Dignity Canada has set up a cross country independent-witnessing programme and the Lethbridge group is part of that effort.

The purpose of this piece is to ask why it is deemed necessary for third parties to witness the signatures of those who wish to die by means of MAID.

Since June 17, 2016, MAID has been a legal process in Canada. People, who are of legal age, eligible for health care and with full mental capacity can choose medical aid in dying if they are in the grip of a grievous and irremediable condition for which there is no acceptable treatment and whose natural death has become “reasonably foreseeable.” In other words, MAID is a legitimate health care process. It is unique in that it is the only one such process, out of thousands, for which a written application is necessary and one which must be witnessed by two independent third parties, who must certify that they are not part of the applicant’s medical team, not part of the proprietorship of any health care facility in which the applicant is residing and not the beneficiary of any will the latter may have made.

Rules should be revised

Whereas I have no objection to acting as a witness and am happy to be of service in this regard, I do wonder why those, who framed the law, considered it necessary to encumber the grievously ill with this extra, intrusive and bothersome administrative burden. Why is it not sufficient for an applicant for MAID to discuss the matter with their personal, preferred, health care practitioners and sign a consent form?

The matter does not end with the completion of the paperwork, for an arbitrary, 10-day wait then ensues — a so-called cooling-off period. This also seems to be superfluous, for I would reckon that few people apply for MAID on a whim. The overwhelming majority have surely considered this course of action in some detail, discussed it with their health team and family and then set the process in train. The fact that the waiting period can be dispensed with if the attending medical team considers that the applicant might lose capacity during the 10 days is testimony to its pointlessness.

In summary, I welcome Canada’s law that enables those suffering from diseases from which there is no relief to bring their lives to a close with medical help. I have remarked earlier that the law is not perfect and lacks certain provisions and contains certain restrictions that I would like to see remedied. I think I understand — without agreeing — why the “reasonably foreseeable” clause was inserted and why an advance directive is not acceptable as a trigger for MAID and why those with purely psychiatric illnesses cannot qualify, but I fail to comprehend the need for elaborate and tiresome witnessing procedures and waiting periods are required. There would be much to be gained by dropping those requirements when and if the law is revised.

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWDC's Physicians Advisory Council.

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