Paying Attention to Medical Assistance in Dying

The thief comes only to steal and kill and destroy. 

I came that they may have life, and have it abundantly.

                                             John 10:10

Yesterday the government of Canada introduced amendments to the legislation concerning Medical Assistance in Dying or MAID. These are the legal guidelines for those who want to end their lives for a number of reasons, but often related to ending pain and suffering without reasonable opportunity of recovery or living with dignity. 

I have been involved in several forums and discussions about Medical Assistance in Dying, both before the legislation was enacted back in June of 2015 and again in January of this year as possible changes to that legislation were being considered. 

An event at Bridge St. United with Member of Parliament Rob Oliphant in May, 2015 attracted more than 100 people from the community. Most were seniors and many felt that the legislation would be too restrictive, particularly regarding the "Catch-22" of dementia. Why couldn't they make the choice for MAID in advance of becoming mentally incompetent to do so? 

A group of us met at Trenton UC earlier this year to discuss the Federal Questionnaire on MAID to which all Canadians were invited to respond. We discussed the faith implications of assisted death and suicide as well as the content of the questionnaire. I was disappointed that the United Church of Canada wasn't proactive in addressing the changes to legislation although the church has since responded. 

I am cautiously supportive of MAID, although I feel that as a society we must do far better in providing palliative care which addresses the whole person. I do recognize that medical technology allows us to extend the lives of persons, but doesn't necessarily provide a commensurate quality of life. This is an ethical and spiritual issue, as well as medical. While some faith communities, including several Christian denominations, are categoricallyt opposed to MAID, I've come to the conclusion that there is "a time and a season for everything." Life is sometimes extended in ways that are inadvertently cruel. 

A CBC report on the amended legislation from yesterday suggests that these are the significant changes to the legislation: 

Patients Without Reasonably Forseeable Deaths 

The amended legislation requires that the person requesting medical assistance in dying is fully informed and has given "serious consideration to reasonable and available treatment options," a government statement said. 

The legislative changes also introduce a waiver of final consent that exempts a person receiving a medically assisted death from giving final consent prior to the procedure being administered.

That waiver will be available for people whose deaths are reasonably foreseeable, those who have been assessed and approved for a medically assisted death or those who are at risk of losing decision-making capacity before their chosen date to die.

The new safeguards designed to protect patients whose deaths are not reasonably foreseeable include a requirement that two independent doctors or nurse practitioners provide an assessment confirming the patient is eligible. One of those professionals must have expertise in the condition causing the patient's suffering.

The professionals are also required to discuss with the patient all available means to relieve their suffering and must confirm that the patient has seriously considered 

alternative treatments.These assessments must take a minimum of 90 days, unless a loss of mental capacity is fast approaching. The person must also be provided with information regarding treatment, mental health, disability support services and palliative care and be given the opportunity to withdraw their request. 

The new legislation also rules out access to a medically assisted death for people who are suffering solely from a mental illness. 

Here are the revisions to the United Church of Canada statement about MAID from earlier this year.

On May 25, 2020, the General Council Executive accepted recommendations to update the church’s statement on Medical Assistance in Dying (MAID) (see TICIF 02; statement begins on page 3).

Since the original 2017 statement was adopted, challenges to the legislation governing Medical Assistance in Dying have arisen. The revised statement offers guidance on these issues for people in the United Church engaged in discussion around end-of-life decisions.

The revised statement includes the following updates:

1. that the criterion of “foreseeable death” for access to Medical Assistance in Dying be maintained
2. that ending suffering due to mental illness not be a category for MAID, and that the church advocate for increased mental health resources
3. that advance directives in relation to MAID not be permitted
4. for mature minors, capacity to make a decision for MAID be judged on a case-by-case basis, by medical professionals in consultation with family and community

My concern is that all this will fly under the radar of awareness for most Canadians, including for those of us who want to be informed as Christians, because of our understandable preoccupation with the pandemic. And how do we engage in discussion or register our concerns and convictions when we aren't able to gather to enter into conversation? 

Is MAID the "thief in the night" or a recognition that the fullness of life is more than keeping someone alive at all costs? 

My encouragement is to pay attention and to prayerfully consider your own stance on this very important subject. We cherish life as Christians and we also believe that Christ is the source of abundant life.