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May 23, 2018

Wanting a good death?

Reuel S. Amdur

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People may make application for medically-assisted death. Yet, we attempt to prevent people from committing suicide. Let's imagine the case of someone turned down for medically-assisted death. The person then commits suicide.

Nikolja Lukich, ethicist for the Champlain Health Region, was not able to untangle that apparent inconsistency.  She was addressing a meeting of SWAG (Social Workers in Aging and Gerontology) in Ottawa on May 16. 

Lukich spoke of different forms that MAID (Medical aid in dying) may take. 

There is the direct provision of products that cause death.  Health providers might instead withhold or withdraw life-sustaining treatment but this is not clearly supported in guidelines.  Then there is the Oregon model, wherein the poison is provided to the person to self-administer.  While not common, there is at least one instance in which the Oregon practice has taken place in Canada.

To be eligible for MAID, a person must be mentally capable, over 18, and suffering from a “grievous and irremediable medical condition.”  The person, said Lukich, must “be at a point where your natural death has become reasonably foreseeable.” 

A request for MAID must be in writing, witnessed by two persons.  Then two health care providers, physician and/or nurse practitioner, review the case.  All this is to be certain that MAID is genuinely desired and that he is psychologically capable of seeking it. 

Just as requesting MAID is entirely voluntary, so too care providers (physicians and nurses), have, on the basis of conscience, the right to opt out.  However, they must make referrals to physicians who are prepared to provide the service.  They are not permitted to impede the process.

The right of a physician to opt out has presented some challenges to the program, for example, in remote areas or in the case of a single local hospital which is Catholic and does not permit MAID on its premises.

Cases, in which a patient’s request for MAID is denied, confront social workers and others assigned to provide care the difficult task of helping the patient deal with the denial, along with other matters. 

Lukich reported that the federal government is studying three major issues related to MAID: advance directives, mature minors, and access in case of mental illness. 

The case for a right to make an advance directive is based on the fact that someone with dementia may become incapable of giving consent as the dementia progresses.  As for the mentally ill, some may qualify on the basis of physical problems, but solely psychological distress may or may not qualify.  Clearly, this aspect of the question needs further reflection. 

Some have urged that the right to MAID should not be limited to those over 18.  It is argued that some minors are sufficiently mature to make such a choice.  If, it is held, they suffer from a requisite condition, then they should also have the right. 

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