Monday, November 25th , 2019

SOBER SECOND THOUGHT: CANADIAN PHYSICIANS URGE CAUTION WHEN CONTEMPLATING CHANGES TO CANADA'S MEDICAL ASSISTANCE IN DYING LAW
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Medical professionals on the front lines of Canada's health care system have spoken out against a recent court ruling that makes medically assisted death available to people who are not otherwise dying.

Over 300 Canadian physicians representing a broad range of specialties and geographic regions signed an open letter urging the Honourable David Lametti, Attorney General of Canada, to honour our national commitments to the values of inclusion and compassion. Expressing unanimous support for an end-of-life requirement for MAID, they emphasized the important legislative history of Canada's law:
"When the original medical assistance in dying legislation was debated in Parliament, there was a clear understanding that MAiD must have limits; that individual rights must be balanced with protections not only for our most vulnerable citizens, but for our society as well."

Physicians have a distinct perspective on the social conditions in which vulnerability is rooted, and the inherent risks for vulnerable persons when access to assisted death is expansive and unlimited. Drawing from their own experience in caring for vulnerable Canadians, they explained:

"Day after day, we participate in a healthcare system and a social support system that do not come close to meeting the basic needs of our most vulnerable patients. Many physicians experience significant distress due to these disheartening interactions with those whom we are pledged to help, but to whom we have only paltry resources to offer. We are aware of numerous patients across Canada who have chosen medical assistance in dying (MAiD) due to the suffering caused by a lack of proper supports."

As an example of this kind of suffering, the physicians' letter cites the story of Sean Tagert , a BC man with ALS who received an assisted death in August of this year. Mr. Tagert had struggled for years, without success, to secure adequate funding for the in-home care that would permit him to maintain a close relationship with his eleven-year-old son. Mr. Tagert's personal Facebook page chronicles the insidious erosion of his autonomy in the face of ableist policies and persistent denials of support. The page concludes with a posthumous tribute that lays out the stark 'option' of institutional placement that lay ahead for him - an arrangement that would have offered "vastly inferior care while separating him from his family, and likely would have hastened his death".

Accounts like Mr. Tagert's make clear the subtle ways in which true autonomous choice can be radically undermined by one's resources and social condition. As Dr. Ewan Goligher, one of the signatories to the open letter, wrote last month for the Lethbridge Herald:

"A decision expresses your autonomy insofar as you "own" the decision: it reflects your wishes and values and is not imposed upon you in any way. This notion of autonomy assumes that all of us can rise above the forces acting upon us from without, and here we detect a grave possibility of error. Overt efforts at coercion may be easily detected and resisted, but the subtle influences of societal valuation are harder to appreciate and far more irresistible."

For Canada's newly elected parliament - and cabinet in particular - now charged with detecting those subtle influences of social valuation in the context of amending the legal framework for medical assistance in dying, the stakes are very high.
It would be a grave mistake to make medically assisted death available to every citizen who wishes to die without regard to the source of their suffering.
DID YOU KNOW

According to data published in 2018 by the Canadian Association for Health Information (CIHI) and reported in the Globe and Mail by Andre Picard, an estimated 89% of Canadians could benefit from palliative care in the last year of life, but only 15% are actually getting it.
IN THE NEWS 

" Liberty or Inequality? Unrestricted Access to Medically Assisted Death Endangers Vulnerable People " CBC, October 12, 2019. Ruth Enns argues that the court's ruling in Truchon & Gladu "leaves everyone more vulnerable than ever". She pointedly asks, "If people don't start out equal, how does removing safeguards equalize them?"
GET INVOLVED
  • Invite others to support the Vulnerable Persons Standard and subscribe to this newsletter.
  • Discuss with friends and colleagues why the end-of-life provision in the current law is an essential requirement, and what risks its removal would present for persons who are vulnerable.

  • Write to your local Member of Parliament explaining how abandoning the end-of-life requirement would have negative consequences for individuals and for society as a whole.
The Vulnerable Persons Standard was developed by a group of more than forty advisors with expertise in medicine, ethics, law, public policy and needs of vulnerable persons. The Standard is a series of evidence-based safeguards intended to help ensure that Canadians requesting assistance from physicians to end their life can do so without jeopardizing the lives of vulnerable persons who may be subject to coercion and abuse. 

To learn more about the Standard and the many Canadians and organizations endorsing the Standard, please visit us at www.vps-npv.ca.
Vulnerable Persons Secretariat
www.vps-npv.ca

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