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June 28th, 2018
Third Interim Report on Medical Assistance in Dying in Canada Yields no Insights about Protections from Abuse
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The Government of Canada has released what it describes as "the most comprehensive profile of medical assistance in dying in Canada to-date". The third interim report on MAiD across Canada compiles the number of medically assisted deaths in Canada, along with some basic demographic and diagnostic information about who has received MAiD and where it was administered.
What is most telling about the report, however, may be its omissions. For example, while the report acknowledges a number of specific "challenges encountered in obtaining medical assistance in dying", no mention is made of documented reports of inducement, where patients have reported being cornered or pressured to request MAiD.
The Government's latest report, like its earlier reports, provides no information with which to assess whether safeguards to protect vulnerable persons from harm or abuse are being respected, or whether those safeguards are adequate to prevent persons from being induced, as the Supreme Court cautioned, "to commit suicide at a time of weakness".
This critical deficiency in Canada's MAiD regime was authoritatively addressed in a recent blog post in the VPS special series, "Why Monitoring Matters". Information management specialist and VPS Advisor, Adele Furrie, calls for a "vulnerable persons lens" in monitoring the practice of MAiD:
"Any photographer knows that the lens you select has a profound effect on the picture you create. I would argue that the same is true for data. Data can be analyzed in many ways and can be used to create many pictures. I think now is the time for the government to listen to us to ensure that the right data are collected as part of the MAiD monitoring system and that those data afford the opportunity for analysis using a 'vulnerable persons lens'."
Furrie's essay, titled "Data Can Help Create a Powerful Picture", underscores the importance of gathering information about patients' "living conditions and circumstances, as well as treatment and intervention options, along with the gathering of other perspectives on the individual's circumstances" in order to come to a clearer understanding of the role that human vulnerability plays in the MAiD dynamic.
The Supreme Court's decision in Carter and Canada's MAiD law both make explicit and unequivocal reference to the necessity to protect persons in vulnerable circumstances from harm. Introducing a "vulnerable persons lens" to the design of Canada's MAiD monitoring system will be critical to determining whether safeguards are providing adequate protection, or if vulnerable persons are overrepresented in the MAiD population. As Furrie concludes,
"The Vulnerable Persons Standard lays out evidence-based safeguards and requirements to protect vulnerable persons from coercion or abuse as a result of MAiD. But... to truly help us create the picture that is required, we need the data that will identify these vulnerable persons. This is the gap the proposed MAiD monitoring system - if it is expanded as per the VPS's suggestions - could fill."
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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.
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Vulnerable Persons Secretariat
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