One retort to this would that this doesn't specify the exact type of palliative care patients received (and it's true that it's a limitation of the report). At the same time however, there isn't an implication that the care received was sub-standard. When you look at Belgium, Oregon, and New Zealand for example (I don't know what the percentage is for patients in the Netherlands, Switzerland, Australia, or the other various US states that legalised MAID) you also see that the great percentage of patients who received assisted-dying underwent palliative care beforehand.
I truly believe that given from all the evidence so far, that even if 99% of MAID applicants were receiving the very best palliative care most MAID requests wouldn't be rescinded. Why? Because pain isn't one of the top reasons why people request assisted-dying in the jurisdictions that have legalized it. Loss of autonomy, loss of dignity, and inability to engage in the activities they find to be enjoyable are by far and large the most common reasons. Palliative care is primarily about symptom management, which doesn't target this.
Thank you for this piece. The offer of MAiD by your oncologist reminded me of what appeared to be an approval based on a very limited and in some significant ways, completely wrong, knowledge of my father. I wrote the experience here. https://christopherlyon.substack.com/p/dying-indignity
I'm also concerned about who is attracted to providing MAiD. It's one thing to feel that ending the life of someone in extremis is perhaps a benefit to them, but quite another to want to involve themselves in ending the lives of people who are not dying and/or children, and who express personal gratification as a result. If we propose screening patients of suicidality and mental illness, we should do likewise for clinicians wishing to involve themselves in MAiD.
Thank you for this helpful article on MAID including comments from your personal and medical experience. I was horrified that your surgeon suggested assisted-suicide based on his calculation of your life span (which was off by more than a few years!). Medical ethics need to be discussed and laws/ policies constantly reviewed, especially when they have life-changing consequences.
I came to your substack after reading "Eucharist ,Cancer, Love", your beautiful, poignant and insightful article in Comment Magazine, Winter 2023. May the Lord bless you for teaching us how to use each precious day of life well, in the centre of God's love.
Great article. In addition to personal awful circumstances (homelessness, poverty) I think I would add sense of being burden to family would prompt suicide. Offering by physicians legitimizes the choice when people are very vulnerable.
Insightful reflections. It rejoins a piece we wrote when Bill C7 was being debated. Canada's MAID system is unique in that respect. No other regulatory regime treats MAID as first line therapy available to be put on the table for any seriously ill or disabled person (i.e. everyone with serious illness, disease, or disability and has irreversible decline of capability (quite an ableist/ageist concept, in fact: who doesn't have that?) and who may be suffering intolerably. It's CAMAP's recommendation to explicitly introduce it to everyone who 'might qualify;, and the law doesn't prevent that and also doesn't require that all other options be made available and attempted first. In B & Nl, until recently the most liberal regimes, doctors have to agree that no other reasonable options other than euthanasia are available. In practice, this may sometimes come to the same, when you combine that with the right to refuse treatment, but as you discuss and know as a physician, an expert opinion about 'reasonable options' has an impact on what patients see as reasonable choices...
It should be noted that 80% who received MAID in Canada had received palliative care beforehand: https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2021.html#table_4.4
One retort to this would that this doesn't specify the exact type of palliative care patients received (and it's true that it's a limitation of the report). At the same time however, there isn't an implication that the care received was sub-standard. When you look at Belgium, Oregon, and New Zealand for example (I don't know what the percentage is for patients in the Netherlands, Switzerland, Australia, or the other various US states that legalised MAID) you also see that the great percentage of patients who received assisted-dying underwent palliative care beforehand.
In Belgium approx 71%: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758933/
In New Zealand approx 74%: https://www.health.govt.nz/our-work/life-stages/assisted-dying-service/assisted-dying-service-data-and-reporting
In Oregon approx 90%: https://journals.sagepub.com/doi/abs/10.1177/1049909111418637
I truly believe that given from all the evidence so far, that even if 99% of MAID applicants were receiving the very best palliative care most MAID requests wouldn't be rescinded. Why? Because pain isn't one of the top reasons why people request assisted-dying in the jurisdictions that have legalized it. Loss of autonomy, loss of dignity, and inability to engage in the activities they find to be enjoyable are by far and large the most common reasons. Palliative care is primarily about symptom management, which doesn't target this.
https://jamanetwork.com/journals/INTEMED/articlepdf/414824/ioi80188_489_492.pdf
Thank you for this piece. The offer of MAiD by your oncologist reminded me of what appeared to be an approval based on a very limited and in some significant ways, completely wrong, knowledge of my father. I wrote the experience here. https://christopherlyon.substack.com/p/dying-indignity
I'm also concerned about who is attracted to providing MAiD. It's one thing to feel that ending the life of someone in extremis is perhaps a benefit to them, but quite another to want to involve themselves in ending the lives of people who are not dying and/or children, and who express personal gratification as a result. If we propose screening patients of suicidality and mental illness, we should do likewise for clinicians wishing to involve themselves in MAiD.
Thank you for this helpful article on MAID including comments from your personal and medical experience. I was horrified that your surgeon suggested assisted-suicide based on his calculation of your life span (which was off by more than a few years!). Medical ethics need to be discussed and laws/ policies constantly reviewed, especially when they have life-changing consequences.
I came to your substack after reading "Eucharist ,Cancer, Love", your beautiful, poignant and insightful article in Comment Magazine, Winter 2023. May the Lord bless you for teaching us how to use each precious day of life well, in the centre of God's love.
Excellent post, Bill. And 10,000+ instances per year seems to me to be quite persuasive evidence that this option is being overused.
Great article. In addition to personal awful circumstances (homelessness, poverty) I think I would add sense of being burden to family would prompt suicide. Offering by physicians legitimizes the choice when people are very vulnerable.
Insightful reflections. It rejoins a piece we wrote when Bill C7 was being debated. Canada's MAID system is unique in that respect. No other regulatory regime treats MAID as first line therapy available to be put on the table for any seriously ill or disabled person (i.e. everyone with serious illness, disease, or disability and has irreversible decline of capability (quite an ableist/ageist concept, in fact: who doesn't have that?) and who may be suffering intolerably. It's CAMAP's recommendation to explicitly introduce it to everyone who 'might qualify;, and the law doesn't prevent that and also doesn't require that all other options be made available and attempted first. In B & Nl, until recently the most liberal regimes, doctors have to agree that no other reasonable options other than euthanasia are available. In practice, this may sometimes come to the same, when you combine that with the right to refuse treatment, but as you discuss and know as a physician, an expert opinion about 'reasonable options' has an impact on what patients see as reasonable choices...
https://policyoptions.irpp.org/magazines/february-2021/how-bill-c7-will-sacrifice-the-medical-professions-standard-of-care/