week 5: MAID Flashcards
physician assisted death
an umbrella term for both: euthanasia and physical assisted suicide
physician assisted suicide
refers to when a physician gives a prescription, patient takes it on their own (used much less now than 20 years ago)
euthanasia (active)
physician does it themselves (ex. inserting a needle that kills them)
- permissible in canada, netherlands, beligium
- accounts for 97% deaths in canada
euthanasia (passive)
physician undertakes an action that allows the patient to die (ex. on a ventilator and tells them to turn it off)
- withdrawal of treatment
euthanasia (voluntary)
actively request it, capably
euthanasia (involuntary)
when a patient says no and you do it anyway
euthanasia (non voluntary)
when a physician does it anyway without consent
- this is not allowed anywhere
VSAD (voluntary stopping of eating and drinking)
person chooses not to eat food or water
- in countries where physician assisted death is not legal
- much slower and painful way to do so
1982-1972
suicide was illegal in canada
- assisting suicide remained a clinical offence
- prior to 1972 if you attempted to commit suicide and failed you would end up in jail
palliative sedation
providing a patient high doses of medicine to help them alleviate their pain but it could not kill them
- not intended to; it can be highly foreseeable and tolerated
- good effect must be proportionate to the bad effect - good will outweigh the bad in terms of more value
Rodriguez v British Columbia
Rodriguez suffered from ALS
- challenged prohibition on s 7, 12, 15 of charter
- appeal denied in 5-4 split
- section 7: right to life, standard practice around the world, in line with fundamental justice
final: did not allow MAID
DDE
Doctor Double Effect
an action that has both a good effect and a bad effect can be morally permissible if it meets certain conditions
- The action itself must be morally good or neutral
- The bad effect cannot be intended
- The good effect cannot be achieved through the bad effect
- There must be a proportionally serious reason for allowing the bad effect
- MAID would fail this because intent in that is to kill them
- allowing the patient to die without the ventilator they will die anyways
- allows the natural process to occur
Carter vs Canada (2015)
second constitutional challenge to prohibition of assisting suicide
- focused on s.7 charter rights
unanimous: everyone agreed that legality needs to be changed
- permissible to allow physician assisted suicide based on the 3 principles
Bill C-14: 2016
- Legislative response to Carter case
Goal: was to strike a balance between autonomy and the interests of vulnerable people
Criteria:
1. being an adult (at least 18 years old) who is mentally competent (“capable”) to make health care decisions for themselves
2. having a grievous and irremediable medical condition
3. making a voluntary request for medical assistance in dying which does not result from external pressure
4. giving informed consent to receive medical assistance in dying
5. being eligible for health services funded by a government.
Bill C-14: Grievous and Irremediable
- having a serious and incurable illness, disease or disability
- being in an advanced state of irreversible decline in capability; and,
- experiencing enduring physical or psychological suffering, due to the illness, disease, disability or state of decline, that is intolerable to the person and cannot be relieved in a manner that they consider acceptable
- where the person’s natural death has become reasonably foreseeable taking into account all of their medical circumstances, without requiring a specific prognosis as to the length of time the person has left to live
Truchon vs Procurer General Du Canada: 2019
- challenge in Quebec of the requirement of reasonably forseeable death
- argued that Bill C-14 is not reflective of Carter v Canada and same s.7 challenge as provided in Canada
Bill C-7: 2021
two track MAID system
- death is reasonably foreseeable
- death is not reasonably foreseeable
commitment to expand MAUD to include mental MD-SUMC by 2023
MD-SUMC
mental disorders as the sole underlying mental condition
eligibility concerns of the addition of mental health
are mental health conditions “grievous” (suffering criterion)
are MH “irremediable (untreated criterion)
can individuals suffering from MH freely consent to death? (autonomy criterion)
suffering criterion- MH
MAID is a treatment for intolerable suffering, is maid proportionate treatment for MH?
anxiety? depression?
irremediable criterion - MH
many people suffering from MH can respond positively to treatment
- individuals can attempt suicide survive, go on to recover
- people with MH access at low points, how can u confirm state of mind
autonomy criterion - MH
- MH conditions can impact cognitive capacity, reason, affective response
- suicidal ideation is a symptom of some MH conditions
- can be grounds for psychosocial holds under MH act
- can someone be capable of consenting to ones own death
own personal thoughts:
- They can meet all three criteria (or at least some individuals will)
- Should be some safeguards - waiting period (6 months) to determine the crisis of the individual
- Come along with increased access to mental health care, without doing this u are reinforcing the opinion that we don’t care about mental health conditions
- If u don’t allow access to MAID you reinforce medical stigma of MH
- Allowing maid can improve certain aspects - serving as a checkpoint
- Increased funding
part of the problem:
- does not affect access to care
- does not take into account social factors
- increasing safeguards but that doesn’t give people better access to healthcare
- discrimination
- stigma
- suffering
physical vs MH
