Expanding the rules for medical assistance in dying

Married with Children television character Peggy Bundy’s invitation to her husband Al: “I’m gonna take a shower. Do you care to join me?”. Al’s response: “Honey, there’s a gun in the footlocker in the garage. If I ever say no to that question, I want you to use it on me.”

Have you considered the criteria you would use for wanting your life to end? I suspect most of us will tolerate life just fine after a loss of libido. I also suspect most of us hope death takes us before we reach a stage of decline with terminal cancer where we’re suffering uncontrollable pain and loss of bodily functions and before the stage of a neurodegenerative disease where we are no longer able to breathe.

Some would accept that suffering believing it to be God’s will, a valid personal choice. My choice will be for medical assistance in dying (MAID) to avoid that suffering.

Until 2016, vulnerable folks facing those horrible realities did not have that choice. The only way they could end their suffering was to do it themselves. Left to a patient’s own devices, suicide can be horrific and inhumane for both the patient and their loved ones. Worse, it might have to be done prematurely, before they are ready to die, because waiting could leave them without the physical ability to follow through.

It took two hard fought legal battles to force the federal government to change the law to allow MAID. February 6 was the 10th anniversary of the unanimous decision of the panel of nine justices of our Supreme Court of Canada in the seminal case of Carter v. Canada (AG), 2015 SCC 5, striking down the Criminal Code provision that got in the way of MAID. Additional legal battles resulted in further improvements in our laws in 2021.

It is now the law in Canada that you can access a merciful and dignified end to your suffering.

There remains a hitch however. You must have the necessary cognitive capacity to access MAID.

Dementia is a feared degenerative condition of aging. I fear losing my cognitive abilities more than I fear physical decline. Dementia gradually erodes memory, personality, decision-making abilities as well as function.

At the time of initial diagnoses, I might be experiencing some frustration with subtle losses of mental capacity, but my quality of life will probably be excellent. I certainly wouldn’t be thinking about ending my life at that early point of my illness. But I emphatically wish to meet my life’s end before my condition advances to the point where I no longer recognize my loved ones and I’m spending my days virtually comatose.

In June, 2023, Quebec law changed allowing Quebecers to make an advance request for medical assistance in dying if they’ve been diagnosed with a serious and incurable illness that will lead to the lack of capacity to request MAID – an illness such as Alzheimer’s disease.

The request must include a list of objective and observable manifestations of the illness that the patient considers intolerable to the point of wanting a merciful death.

If it were me, I would include the following:

• Repeatedly failing to recognize close family members.

• Inability to communicate coherent thoughts or make simple decisions.

• Complete dependence on others for basic activities (eating, dressing, toileting, bathing).

Quebec has protocols in place to ensure a merciful death is provided only if:

• The patient is exhibiting the patient-chosen clinical manifestations of their illness

• They are in a medical state of advanced, irreversible decline in capability.

• The medical assessor believes the person is experiencing enduring and unbearable suffering that cannot be relieved under conditions considered tolerable.

Quebec’s laws are not applicable in British Columbia. Properly, MAID laws are federal because they pertain to the Criminal Code of Canada. The federal government would need to change the law to give these rights to all Canadians.

As a British Columbian, I need to wait until my dementia condition progressed to the point of being in an advanced state of irreversible decline before I qualify for MAID. By then, I may have already lost the required cognitive capacity and be completely deprived of a merciful end to my life.

I’m not alone in wanting those rights. According to a 2024 poll, 83% of Canadians support advance requests for MAID for a person diagnosed with a capacity-eroding grievous and irremediable medical condition who will eventually lose the ability to make decisions for themselves.

Not everyone wants to exercise these rights, so they wouldn’t be forced on anyone. It will always be up to the individual to make the choice.

Health Canada is currently conducting a survey on the subject. I hope the federal government will change the law giving all Canadians the same rights if those surveyed are overwhelmingly in favour of such a change.

The survey started on Dec. 12 and will close on Feb. 14. A link to the survey can be found here.

Please take the survey and spread the link to everyone in your sphere of influence encouraging them to do the same.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.