Why Ottawa plans to allow MAID for people incapable of consenting moments before death

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On the morning of her death, the doctor secretly slipped a sedative into the woman’s coffee. She did not tell the woman she was about to die. Despite the sedative, the woman appeared to try to get up in the middle of the procedure and “resisted physically,” the doctor initially reported to the euthanasia committee. The woman’s son-in-law laid her back down so the doctor could inject her. The doctor was eventually acquitted of breaking Dutch euthanasia laws after a judge ruled the woman’s prior written request was sufficient and that there was no legal requirement for the doctor to verify the “current death wish,” BBC reported.

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What do proponents say?

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Dying with Dignity Canada said the proposed legislation would only decriminalize advance requests in provinces and territories that also pass legislation permitting them, creating at best a patchwork system across Canada. “At worst, some people in Canada may never have access to advance requests in their province or territory,” CEO Helen Long said.

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Fraser, the federal justice minister, said advance requests would allow people at risk of losing their decision-making capacity “to live out their remaining years, rather than being put in a position where they fear they have to take that decision prematurely.”

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What do opponents say?

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While he can understand the appeal they hold for some, psychiatrist Dr. Sonu Gaind said there are several unresolved concerns, including how people, once they lose capacity, could withdraw their consent.

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“Meaning that, if they change their mind, and they’ve lost capacity, what do you do? How do you deal with it? How do you know?” It’s a concern reflected in the coffee case in the Netherlands, he said.

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Advance requests are also based on what people think they would and would not want in the future. “We’re not very good at knowing how we’ll actually deal with things and cope with things” months or years later, said Gaind, a University of Toronto professor. Studies show people who suffer spinal cord injuries, for example, adapt in ways they never thought possible, he said.

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“How do we predict that for our future selves? We don’t know how we will actually adapt and feel in the future once something happens.”

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What’s not talked about enough, he said, is what gets “projected into the decision” to end a person’s life.

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“Once the person has lost capacity, then the agency for actually fulfilling their prior wishes falls on someone else,” Gaind said. “It’s inevitable, it has to: It falls on someone else to make a judgment that, ‘OK, have the conditions now been met'” to warrant MAID.

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It would fall onto an assessor, yet the MAID literature shows the personal views and values of the assessor influences the end-of-life decisions that are made, Gaind said.

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“You risk having an illusion that, ‘Oh, we’re compassionately fulfilling patient autonomy,’ but in fact are we now, in some of these situations, allowing internalized ableism of assessors to get projected onto these assessments of patients who’ve, at this point, lost capacity?”

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Others worry about coercion.

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“A court can undo a will that was unduly influenced,” Heather Campbell Pope, a lawyer and chair of Dementia Justice Canada, said in a statement.

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“But once MAID is provided, there is no meaningful remedy if we find later that the person was pressured to make the advance request” or pressured to go along with it, she said.

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“It is simply too late.”

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National Post

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