Normalizing Medical Assistance in Dying in Canada

 "It happened again. In the list of questions about your life and  your past and how are  you treating these things was 'Hey, [MAID] is a thing that exists'."

"It was upsetting. Not because I thought they were trying to kill me. I was shocked that it happens. I was like, 'Again? This happened again'?"

"I was literally on my way into surgery [when for the second time the issue was broached by another doctor]."

"It came up in completely inappropriate places and completely inappropriate times."

"I am a very lucky woman. I have a large and supportive family. I have all the love. But I felt small and lonely and alone in that hallway before going into surgery."

"There are people who have lists of conditions like mine who don't have a big, happy, loving family, or financial or emotional support and if those words are said to them when they're lonely and alone --- if my life were like that, I may not have had the strength or courage to either pretend that that question didn't exist or just say 'No I don't want to talk about it. Let's move on'."                                                       Nova Scotia resident, 51-year-old woman

"[It was] clearly inappropriate and insensitive [for a doctor to raise Medical Assistance in Dying] as a person is being rolled into a surgical suite]. I can understand why the patient was upset. [However], there's a difference between raising the topic of discussing awareness about MAID and possible eligibility, from offering MAID. They are wildly different things that need to be disambiguated."

"The issue is the sensitivity or appropriateness of raising the question of an awareness of MAID at the time, and I can certainly understand the patient being put off by that."

"[The thrust of the college's approach to MAID and conscientious objection] is to make clear that the patient's rights are paramount [and to ensure that] the care available and provided to patients does not vary according to the belief structure of the physician providing the care."

"[Assisted death is] increasingly becoming part of the dialogue between patients and physicians, particularly when the patients have grievous and irremediable conditions."

Dr. Gus Grant, registrar, chief executive officer, College of Physicians and Surgeons of Nova Scotia

"I'm not sure that any physicians in Nova Scotia are clear on where we are on this."

"Certainly, what we're seeing in hospital is that physicians are initiating the conversation with patients."

Dr. Jeanne Ferguson, geriatric psychiatrist

A routine questionnaire in general use in the province of Nova Scotia, presented to a patient on the cusp of surgery, when she is queried through a series of pre-operative questions: What was her medical history? What medications does she regularly take? Any allergies? Was she aware of medical assistance in dying (MAID)?  Anyone in those circumstances would be taken aback, mind churning over the sinister nature of a casually asked question: You're about to have cancer surgery, so MAID? Is it possible I won't survive the operation; they're preparing me for the end...

Nova Scotia resident, 51, recounting an operating room dilemma

The head of the College of Physicians and Surgeons of Nova Scotia said he "can understand why the patient was upset" about a doctor raising MAID as she was being rolled into a surgical suite. Photo by Getty Images

"Every patient I see in my office who is suffering with a chronic medical condition -- anyone I see could potentially be eligible for MAID."

"If this ended up on a checklist, how did it get there? Did it get there because people think they have an obligation to raise this with every single patient that crosses their path?:

"And even if it sounds like it was off a checklist what she heard was, 'Does your life really have any value to you? Because we can end it for you."

"If you don't know the patient very well, if all that you have is a list of their medical issues and their external appearance, how can you, as a physician or a nurse, speak to their experiences and decide in n instant 'Oh, they must e suffering so much that maybe we should offer to help them end their lives?"

"I don't understand how that could be coming from anywhere but a place of bias."

Dr. Amy Hendricks, internal medicine specialist, Antigonish, Nova Scotia

Concerns are being raised yet again about Canada's system of assisted suicide, through its Medical Assistance in Dying protocol which when first introduced into Canadian medical circles as an approved process had strict guidelines respecting qualifications for such a process; quality of life, suffering, a severely shortened life expectancy and a condition so severe that it led inevitably to death. Those who qualified could be accommodated in their wish to leave life. 

 

The public had majority support for the process. Gradually the guidelines were loosened and it seemed as though the process was being promoted.

It has reached the point where those suffering from mental illness, from pain and demoralization from physical handicaps, children whose suffering cannot be mitigated can all now be swept into the net of ending an unbearable life and critics have been howling their indignation that the qualifications have been stretched out of proportion to their original careful selection to ensure that lives weren't being eased into death heedlessly, needlessly. Charges that medical practitioners and nurses were recommending MAID to certain of their patients went the rounds.

Now a woman undergoing cancer surgery in Nova Scotia had revealed publicly how new guidelines for the province's medical-providing community has been tasked with an obligation to mention MAID when examining their patients, or undertaking surgery. The predictable results are obvious in their context of delivery; when people are already at their most vulnerable, facing a life-changing process that could conceivably lend itself to tragedy; a condition of time and place exacerbated through a reminder of one's mortality matched with a morbid outcome.

Speaking of her experience to investigative reporters the Nova Scotia woman has emphasized the dilemma facing both patients and their physicians when the latter raise euthanasia as a perceived optionary 'solution' to pain and a hopeless outcome approaching. Even as she clarified that she had not been offered MAID, simply given a reminder that it is available, and with her numerous chronic conditions, would be eligible if she were to be interested. It was the blunt approach to the question that unsettled her at a time of deep uncertainty.

According to Dr. Grant, the province's College of Physicians and Surgeons have no intention of imposing a duty on member-physicians to initiate discussion relating to MAID eligibility. A group of provincial doctors professing Christianity stated that the new policy on conscientious objection by the college  relating to conscientious objection has created confusion while a "strict reading" implies a duty to raise MAID with patients.

The organization that represents Canada's MAID assessors nationally and providers, argues that doctors have a professional obligation to raise MAID as a 'clinical 'option' should a patient be eligible, as long as the intention is to draw attention; the issue is not to induce, persuade or convince the person to request assisted death. 

 

Calgary palliative medicine specialist Dr Leonie Herx wrote that patients reported to her feeling "badgered and harassed" to consider MAID. Doctors, the Nova Scotia policy reads, "must discuss all available treatment options" relevant to a patient's condition and doctors must not "withhold information regarding a procedure of treatment", even should providing such information conflict with the doctor's conscience.

The Telegraph