We are psychiatrists who work with patients with advanced cancer. It’s no wonder, then, that when Canada legalized medical assistance in dying a decade ago, it quickly became a major topic of conversation in our clinics. We’ve counseled patients about the procedure and assessed whether they were eligible.
One of us has administered the drugs to end patients’ lives. We’ve also researched what leads people to choose this option. And together, we created an institutional framework that determined how one of Canada’s largest medical centers would respond to requests for assisted death.
We know that medical assistance in dying can be dignified and profoundly meaningful for everyone involved. We remember a man in his 30s in our palliative care unit who, thanks to the procedure, was able to choose to die before he became even sicker and potentially lost the ability to communicate. He said a final goodbye to everyone he loved, including his 5-year-old son, and died with his wife beside him and a music therapist singing Leonard Cohen’s “Hallelujah.” But Canada’s system for assisted death is no longer an option of last resort.
Too many people are receiving the procedure without the opportunity for careful reflection about it with a health provider. In some cases, patients are being approved who should not be. Reports have emerged of people seeking assisted death in the context of poverty or loneliness, raising concerns that they may feel they have no other options.
In other cases, including for many of our cancer patients, medical assistance in dying may be the right choice eventually, but there’s a risk of rushing into it and shortening what can be a meaningful period in patients’ lives. Canada’s medical assistance in dying program started in 2016 as an option only for patients with a “reasonably foreseeable” natural death. In 2021, Parliament removed the foreseeable death requirement.
Today, Canada’s system is one of the most permissive in the world, allowing assisted dying for almost any form of subjectively intolerable suffering that has a medical basis, or even for medically unexplained physical symptoms. This latitude may contribute to Canada having the fastest growth rate of assisted dying in the world, increasing 16-fold in the eight years since legalization. The procedure now accounts for over 5 percent of all deaths in the country.
Within the Canadian system, medical assistance in dying is the result of a decades-long campaign aimed at enshrining it as a human right — often in the face of strong pressure from groups who opposed the procedure on religious or other grounds. Activists who support the procedure are still understandably wary of anything that could make it harder to get, often warning of unnecessary “gatekeeping” that might interfere with a patient’s autonomy. These activists helped shape the laws that govern the procedure and were instrumental in supporting the first medical networks that emerged to administer it.
Perhaps as a result of this influence, many doctors have come to see their primary role to be making sure their patients meet the legal eligibility requirements to qualify for assisted dying. They must, for instance, be experiencing intolerable suffering and have the mental capacity for informed consent. The problem is that there has become far more focus on whether patients can get an assisted death and not enough on whether they should.
A study published earlier this year looked at how Canadian physicians involved in medical assistance in dying understood their role. One provider described being “just a conduit really for someone’s desires and someone’s choices.” In a separate but similar study, another provider professed to have no role in evaluating suffering — though one of the legal requirements to receive the procedure is that a clinician must confirm that the patient is experiencing intolerable suffering. Determining that degree of suffering “is entirely up to the patient — 100...
Source: New York Times Top Stories · Summarized by HeadlinesBriefing