Addressing Canada’s Bill C14:Medical Assistance in Dying (MAID) Patient Eligibility Criteria

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Canada is currently in the midst of a contentious debate regarding the validity and composition of a recently passed bill that permits suffering patients to consensually select a physician-mediated death. The bill, Bill C14: Medical Assistance in Dying (MAID), was passed during June 2016 by the Canadian Parliament and only applies to patients who suffer from a “grievous or irremediable condition” (Lancet). According to MAID, a patient must be at least 18 years old, have an incurable disease, be in an advanced state of irreversible decline and death must be reasonably foreseeable.

MAID was passed only after a narrowing of patient eligibility criteria deemed too expansive according to the Supreme Court of Canada, who stopped the original bill in 2015. It is our opinion that the current patient eligibility criteria, which does not include mature minors, patients with advanced mental disorders (ex. Dementia), or patients with advanced directives, should be expanded to include these vulnerable groups that are being unfairly excluded. We are on the side of a substantial stakeholder cohort that believes that an expanded patient eligibility criteria focusing on overall suffering and patient interpretation of their quality of life should be amended to Bill C14.

It is vital that leaders of patient advocacy groups, such as Dying with Dignity Canada, work with family members of individuals who could benefit from an expansion to raise public awareness and jointly formulate a strategy to engage influential peripheral stakeholders, such as the Canadian Medical Association (CMA). With regards to the CMA, clarification regarding patient eligibility and avenues by which physicians can refer patients, that they are uncomfortable in helping die, to another willing physician would help address barriers that the medical community have with respect to the implementation of a policy that they generally support on moral and ethical grounds (see figure 1)

strategic-session-on-endoflife-care-in-canada-dr-blackmer-14-638 (2).jpg

(Figure 1: Graph depicting survey responses of 595 Canadian Medical Association Members,Source:Dr. Blackmer, CMA)

Raising public awareness, combining patient advocacy into one voice, and addressing the logistical issues preventing a key stakeholder from supporting a cause that they morally support are just a few suggestions that may convince the Canadian Parliament to amend bill C14. Only an amendment would allow the MAID bill to achieve the spirit of justice and mercy that underlies its’ core goal.

 

Helpful links:

  1. Presentation regarding CMA physician regarding MAID:http://www.slideshare.net/CanadianMedicalAssociation/strategic-session-on-endoflife-care-in-canada-dr-blackmer/14
  2. Lancet article arguing for MAID criteria expansion:http://ac.els-cdn.com/S0140673616312557/1-s2.0-S0140673616312557-main.pdf?_tid=235f7cf2-6340-11e6-ae06-00000aab0f26&acdnat=1471303960_532d675e72c06b219a268e618df47f51
  3. Local stakeholders provide commentary on MAID to media: http://www.ctvnews.ca/health/key-stakeholders-react-to-assisted-dying-bill-1.2860104
  4. News release by Canadian Supreme Court articulating their rejection of original bill in 2015: http://news.gc.ca/web/article-en.do?nid=1085689&tp=1
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3 Responses to “Addressing Canada’s Bill C14:Medical Assistance in Dying (MAID) Patient Eligibility Criteria”

  1. mtait0508 Says:

    This is a very interesting topic and a thoughtful blog entry. In effort to raise public awareness, would it also be helpful to add to this entry or subsequent media what has been happening in the U.S.? I know the U.S. and Canada differ quite a bit on technical issues of health and health care, but it seems to me there may be something gleaned from sharing how physicians and advocacy groups in the U.S. (based on Canada’s experience) are approaching issues related to physician-assisted death.

    On a different note, do you think this issue requires a shift in medical training? Is there something to be done to prepare physicians in training about this issue?

  2. Malik Burnett, MD MBA Says:

    This is an excellent issue to explore and thanks for providing some insight into the Canadian experience. I agree that a greater level of coversation surrounding this topic would be very helpful to advancing the legisaltion. Perhaps an intial strategy could be built around increasing the general public’s understanding of advanced directives. This would allow people to become more comfortable with reality that everyone’s life eventually expires, and planning for this eventuality is a prudent strategy. Getting greater understanding of this reality will allow more people to relate to the experiences of those with terminal illness and grow support for the death with dignity legislation.

    In addtion, getting greater particiaption from the general public has the added benefit of having more people avoid expensive end of life care and improving their opportunity to have a good outcome at the end of life. Thanks again for sharing.

  3. eleanorfitall Says:

    Thank you for providing this blog post around a very difficult topic. I agree with you that there does need to be an expansion of criteria and agree with the points above, particularly with regards to the need to consider how this impacts medical training. One of the interesting issues of current U.S. healthcare delivery is the concept of patient shared-decision making and engaging the patient in their own care. I think that this is the perfect example of how far shared-decision making can go, to the absolute benefit of the patient.

    We are already seeing this type of policy be implemented in select states in the United States (Washington, California, Vermont, and Oregon). I think there is a lot that other state can learn from these successful examples. As you suggested in the Canadian example discussed here, the role of the patient advocacy group is critically important and demonstrates the power of the patient voice.

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