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A dangerous path: Why expanding access to medical assistance in dying keeps us up at night

Heidi L. Janz, University of Alberta and Leonie Herx, Queen’s University, Ontario

When a government starts making laws based on the premise that some lives are not worth living, it is setting out on an extremely dangerous path.

That is the path that Bill C-7, the proposed law to expand access to Medical Assistance in Dying (MAID) to people whose death is not imminent, sets Canada on.

This is what keeps us — two MDs and a PhD on wheels — up at night. We each have a different perspective on the dangers of expanding MAID eligibility to people who are not dying.

Bill C-7 was passed in the House of Commons in December, and is proceeding to the senate in February.

Health ethics: Careening down a slippery slope

Heidi Janz is an ethics professor at the University of Alberta, and chair of the Council of Canadians with Disabilities’ Ending-of-Life Ethics Committee

I describe myself as a long-hauler in the struggle against the legalization of assisted suicide and euthanasia for people with disabilities.

What first activated me was the unqualified media and public support that Robert Latimer received in 1993 when he was charged with killing his daughter, Tracy, who had cerebral palsy. I remember watching a news magazine show on the topic When is it right to kill someone with severe disabilities? and realizing that most Canadians would consider my life not worth living.

The Latimer case revealed the prevalence of ableism in Canada and marked the start of the slippery slope down which our country is careening.

As a professor of health ethics who has disabilities, I worry about the effect that the expansion of MAID under Bill C-7 will have on kids and youth with disabilities. I attended a school for kids with disabilities. Roughly half the students had muscular dystrophy, and a life expectancy of 14-18 years. Growing up, we all knew that some of us would live longer than others. But we also knew that all of us would live with the best quality of life possible, until we died.

Read more: Think disability is a tragedy? We pity you

What keeps me up at night is knowing that this is not the message the current generation of kids with disabilities is getting. Instead, they’re hearing about parents requesting MAID for their disabled kids.

I hope that Canadians with disabilities can find safe doctors who will fight for our lives, instead of encouraging us to end our lives.

Palliative care: Healing vs. hastening death

Leonie Herx is past president of the Canadian Society of Palliative Care Physicians and chair of the Division of Palliative Medicine at Queen’s University

As a palliative care physician, I was drawn into the “assisted dying” debate when the Supreme Court of Canada struck down the prohibition against assisted suicide in the 2015 Carter decision.

After the Carter ruling, there was a lot of erroneous talk about how palliative care already hastens death, and an expectation that palliative physicians would therefore take on this life-ending procedure as part of our practice. Our speciality has spent a lot of time helping people understand that hastening death or intentionally ending life violates the core principles and internationally recognized definition of palliative care.

Dr. Leonie Herx’s testimony before the House of Commons Justice Committee studying Bill C-7

One of my concerns is that physicians would be expected to raise MAID as if it were like any other medical option, when it is not. For a doctor to say, “Well, you could choose this drug, or these supports to help you, or you could choose death,” would be suggesting to someone that their life isn’t worth living.

As a physician, my job is to restore hope and promote healing. It’s not to suggest death as the answer to suffering and to facilitate ending someone’s life.

Bill C-7 is based on a very narrow view of autonomy and people who want to have control over their own death via an assisted suicide make up a very small percentage of the population, around two per cent. Legislative protections need to be put in place to prevent people from being pressured into MAID and doctors from being forced to facilitate it.

Family medicine: Support for the vulnerable

Ramona Coelho is a family physician in London, Ont.

As a family physician who cares for people with chronic illnesses and disabilities, I was drawn into the debate around assisted dying out of concern for my patients, who often suffer from poverty and inadequate resources. So they might feel pressured to choose death because of inadequate supports to live or because a doctor perceives that they might be better off dead. https://www.youtube.com/embed/UFdBFmgOn2Y?wmode=transparent&start=0 Dr. Ramona Coelho’s testimony before the Senate Committee Pre-Study on Bill C-7.

By expanding MAID, I believe we are ignoring the common good. We are wearing masks right now to protect our vulnerable due to COVID-19. But we must similarly consider how expanding MAID will affect vulnerable persons.

One of my patients told me she is planning to access MAID because she lives in poverty and isolation, and doesn’t have home care supports for her disability. Sadly, many other people with disabilities share her desperation.

No one belongs on the margins of society. I chose to practise medicine because built into this work is the opportunity to help and heal. What a privilege! If many of us can keep our focus on reducing social inequality, I can remain hopeful.

Losing sleep

We each have different reasons to lose sleep over Bill C-7 as it inches its way closer to becoming law. As the bill proceeds to the Senate, Canadians need to consider where this path leads, and understand how it will affect vulnerable people.

Rather than expanding access to MAID, the priority should be to ensure access to the care and supports necessary to live and, when the time comes, to have a peaceful natural death with high quality palliative care.

This article was also co-authored by Ramona Coelho, a family physician in London, Ont.

Heidi L. Janz, Adjunct Professor of Disability Ethics, John Dossetor Health Ethics Centre, University of Alberta and Leonie Herx, Division Chair & Associate Professor of Palliative Medicine, Queen’s University, Ontario

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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