Medically assistance in dying (MAID= Bill C14) for eligible Canadians was passed by federal legislation in June 2016. To recap, eligibility includes:
- Being 18 years and older and mentally competent
- Having a grievous and irremediable medical condition
- Making a voluntary request for MAID that is not the result of outside pressure or influence
- Providing informed consent.
Grievous and irremediable has been defined as:
- Having a serious illness, disease or disability
- Being in an advanced state of decline that cannot be reversed
- Experiencing unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable
- Being at a point where your natural death has become reasonably foreseeable which takes into account all of your medical circumstances and does not require a specific prognosis as to how long you have left to live
One does not have to a fatal or terminal condition to be eligible for medical assistance in dying.
Informed consent means receiving all of the information required to make a decision at the time of your request AND immediately before medical assistance in dying is provided.
Given the above criteria, for those individuals who have been diagnosed with a dementia and have indicated that when in the future, they have declined to a point when they no longer (recognize family/ communicate/ feed themselves/ respond to those around them/able to get out of bed/breath on their own) have not been eligible to request MAID.
This past August 2019, a Victoria man became one of the first Canadians with a dementia diagnosis to have received MAID. Dr. Stefanie Green is the physician who provided the medical assistance. In a recent interview she shared: “His care ‘seemed very much on the edge….The risk of not meeting the eligibility criteria, or not being found to have done so properly, is a criminal offence, which leaves me liable to go to jail for up to 14 year.’”
Dr. Green expressed: “This is not an expansion of our law….This is a maturing of the understanding of what we’re doing.”
This is a difficult and very important topic. A team of Canadian experts recently authored a paper to provide guidance to clinicians who assess and provide MAID in Canada. Their report is linked here https://camapcanada.ca/wp-content/uploads/2019/05/CPG-dementia.pdf.
I found the examples in the Appendix reflected the medical status of many clients with whom I have worked over the years and I wonder how many wanted a different ending.