Medical Assistance in Dying

Canada’s medical assistance in dying (MAiD) first came into effect in June 2016. It continues to evolve, with the latest changes coming into effect in March 2021, and more expected in March 2023. The law “seeks to respect personal autonomy for those seeking access to MAiD, while at the same time protecting vulnerable people and the equality rights of all Canadians”.

In BC, physicians and nurse practitioners can be trained to provide MAiD, if they choose to do so. To be eligible to receive MAiD, a person must qualify for government funded health services in their area (visitors to Canada not eligible), be at least 18 and mentally competent, have a grievous and irremediable medical condition, request the service of their own free will, and give informed consent.

To be considered as having a grievous and irremediable medical condition, a person must have a serious illness, disease or disability (excluding a mental illness), be in an advanced state of decline that cannot be reversed, and must experience unbearable physical or mental suffering from their illness, disease, disability or state of decline that cannot be relieved under conditions that he or she considers acceptable.

The person seeking MAiD does not need to have a fatal or terminal condition to be eligible. He or she must have received all of the information needed to make the decision, including a medical diagnosis, available forms of treatment, and available options to relieve suffering, including palliative care. For those whose natural death is not reasonably foreseeable, more safeguards are put in place, including an assessment period that must take a minimum of 90 days, though this could be shortened, if necessary.

If a mental illness is the only medical condition leading a person to consider MAiD, they are not eligible at this time. This exclusion will remain in effect until March 2023.

MAiD is “a complex and deeply personal issue.” There was heated debate before legalization which continues today over the expansion of MAiD to include youth, those with mental illnesses and disabilities, and whether it can be part of an advance care plan.

Some believe all Canadians should have the right to have autonomy and control over their own death, for which MAiD is essential. Many who consent to MAiD choose to die naturally; just knowing their suffering can be relieved, if it becomes unbearable, provides peace of mind. Others, with no access to MAiD, may end their life prematurely while it is still possible for them to do so. For some, the ability to die without prolonged decline and suffering and with loved ones present, provides for a meaningful and rich experience, a heartwarming memory for those left behind.

Others argue we do not provide adequate palliative care to those facing death, in which case MAiD becomes the only option to relieve suffering. There is concern that it is premature to begin providing MAiD for those with mental illness when there is simply so much work for Canada to do when it comes to improving mental health care. In a health care system burdened by resource constraints and burn-out, especially during the pandemic, there is concern that MAiD becomes motivated by economy and convenience, rather than care.

In Canada 2.5% of all deaths are by MAiD, and in Belgium and the Netherlands, which have been providing assisted dying for decades, 4%. Here on Vancouver Island the percentage is 7.5%. Clearly this is a relevant topic for each of us, and one we could learn more about.

Written by Margaret Verschuur