 |
| Yuriko Ryan |
A new article published on January 10, 2025 in The American Journal of Bioethics examines the rapid increase in Medical Assistance in Dying (MAID) deaths in Canada.
Dr. Lyon, the lead author witnessed a MAID death in BC; Dr. Lemmens is a member of the MAID Death Review Panel of the Office of the Chief Coroner for Ontario, and Dr. Kim along with Dr. Lemmens, were members of the Council of Canadian Academies Expert Panel on Medical Assistance in Dying.
The authors describe the rise of MAID deaths in Canada, suggesting it is influenced by policy rather than widespread societal acceptance. They argue that organizations such as the Canadian Association of MAID Assessors and Providers (CAMAP) and Dying with Dignity Canada (DWDC) have significantly influenced MAID policy, emphasizing access over patient safety and protection against premature death. This, according to the authors, has resulted in concerning cases and potential legal violations. They call for substantial reform, advocating for more transparent, evidence-based, and multi-perspective policymaking to ensure a safer and more ethical MAID system in Canada.
The key issues discussed in this article include:
Drivers for the Exponential increase in MAID deaths
Provider Concentration: A small group of clinicians are responsible for the majority of MAID deaths. The Fifth Annual Report on MAID 2023 (Canada, 2024) shows that practitioners who performed MAID 11 or more times in 2023 provided 66.4% of Track 1 (a requester’s natural death is reasonably foreseeable) cases and 58.4% of Track 2 (a requester's natural death is NOT reasonably foreseeable) cases. Some clinicians have made MAID their full-time practice, and the number of cases per provider has increased from 5.1 in 2019 to 7.2 in 2022.
Problematic Cases: There have been instances where individuals sought MAID due to lack of access to other resources, non-compliance with eligibility criteria, incomplete documentation, and clinicians refusing to cooperate with oversight bodies. A concerning number of unlawful MAID deaths have been reported.
Expansion of Eligibility: There is an active movement toward further expansions in MAID eligibility, including for mature minors and those with mental disorders. There are concerns that the focus is on facilitating access to MAID rather than protecting against premature death. Some cases suggest that individuals with mental illness, poverty, or lack of adequate support have received MAID.
Lack of Safeguards: The criteria for MAID, such as "serious and irremediable" conditions, have been interpreted flexibly, with heavy reliance on self-reporting. The MAID law does not require a high level of expertise for assessments.
Influence of Advocacy Groups: CAMAP and DWDC have played a disproportionate role in influencing MAID policy. CAMAP has close ties to DWDC, an expansionist advocacy group, and this has resulted in a conflict of interest that has been disregarded by the Canadian government.
CAMAP's Role and Influence:
Activist Ideology: CAMAP promotes an activist approach to MAID and has its origins in the leading global MAID advocacy organization, DWDC. CAMAP's bylaws require that more than half of its directors must be assessors or providers who have approved or provided MAID for at least five people each year.
Policy Influence: CAMAP has been consulted by Health Canada and has received public funds ($3M CAD) to develop a national training curriculum. CAMAP members’ expertise appears to be based on informal accumulation of patient requests and deaths rather than formal training.
Guidance Documents: CAMAP's guidance documents have been geared toward expansion, with advice on how to circumvent requirements for those not approaching natural death. CAMAP advises clinicians to mention MAID to potentially eligible patients, which some consider a risk of coercion. The organization also suggests that the imminent loss of capacity can be seen as an "advanced state of irreversible decline."
Flaws in Canadian MAID Law:
Subjective Preferences: The irremediability is reduced to the subjective preference of the requester. The law allows the co-opting of the healthcare system for the delivery of ideologically driven deaths.
Lack of Medical Expertise: The majority of MAID delivery is by non-specialist family practitioners and nurse practitioners. The law allows a person with "expertise in the condition" to be consulted rather than requiring a specialist, explicitly to avoid barriers to access.
Prioritizing Access over Safety: The Canadian MAID law prioritizes access to MAID over safety measures. Some providers construct MAID in ideological terms, as ‘social justice,' 'a crusade,' or 'empowering people.'
Conclusion:
The rapid increase in MAID deaths in Canada is not solely a reflection of widespread public support but is influenced by a small group of activists. The close relationship between CAMAP and DWDC, along with the government's reliance on these organizations, has led to an expansionist approach to MAID. There is a need for substantial review of MAID policy and practice. Reforms are urgently needed to insulate policy development from the influence of minority views. The government should establish an independent and transparent public body more representative of clinical specialties and other stakeholder groups, as well as a public meta-regulator to provide oversight and standardization. Increased transparency is necessary for public accountability and patient safety.
What Can We Learn?
These findings are relevant to ongoing debates about assisted suicide and euthanasia globally. The Canadian example highlights the need for safeguards and transparent processes to prevent similar issues elsewhere. Policymakers, medical professionals, and the public should be aware of these risks when considering end-of-life options.
Dr. Yuriko Ryan is a Canadian bioethicist and gerontologist who explores emerging topics including end-of-life care, mental health and addiction, and artificial intelligence. She is an ethicist with more than 25 years experience in health policy research and healthcare administration. She has a doctorate in bioethics and a Master's degree in gerontology from Simon Fraser University.
No comments:
Post a Comment