Medical Aid in Dying; Advance Consent for Patients with Degenerative Disorders
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Medical Aid in Dying
Advance Consent for Patients With Degenerative Disorders
Since the legalization of Medical Aid in Dying (MAiD) bill in Canada, ther has been much debate regarding the bill’s implementation, which includes advanced consent for patients with degenerative diseases. Medical aid in dying is an assisted death provided to patients with terminal illnesses by a physician to relieve them from their pain and suffering endured from their illnesses. This essay upholds the federal law that denies advance consent provided by a patient with degenerative diseases.
Since 2016, MAiD was legalized in Canada under special instances.MAiD in Canada was allowed by the supreme court in February 2016, and the bill which provided the conditions under which medical assisted dying could be provided, Bill C-14, passed by the parliament in the same year (Canada, 2016; Malina et al., 2017). The passing of Bill C-14 came along with contentious debate in the country regarding the permissibility of medical aid in dying. It also left too much ambiguity regarding the implementation of medical assistance in dying. Medical aid in dying in Canada was allowed by the supreme court in February 2016, and the bill which provided the conditions under which medical assisted dying could be provided, Bill 14, passed by the parliament in the same year (Canada, 2016; Malina et al., 2017). The passing of Bill 14 came along with a contentious debate in the country regarding the permissibility of medical aid in dying and also left too much ambiguity regarding the implementation of medical assistance in dying.
The Canadian Medical Aid in Dying law allows assisted death for individuals who meet a specified requirement. According to Bill C-14, the criteria that must be met for consideration of a Medical Aid in Dying is that one must be having severe and incurable disease, illness or disability, be in a state where the decline in the health is irreversible, must be enduring physical or psychological suffering from the illness and the condition of their natural death is foreseeable (Canada, 2016). Furthermore, the person requesting the MAiD must be over 18 years of age and able to make their own healthcare decision, and the request for the medical aid in dying should be voluntary.
The Canadian Medical Aid in Dying law allows assisted death for individuals who meet a specified requirement. According to Bill C-14, the criteria that must be met for consideration of a Medical Aid in Dying include; having severe and incurable disease, illness or disability, be in a state where the decline in the health state cannot be reversed, enduring physical or psychological suffering from the illness and the patient be in a condition where their natural death is foreseeable (Canada, 2016). Furthermore, the person requesting the MAiD must also be over 18 years of age and able to make their own healthcare decision, and the request for the medical aid in dying should be voluntary.
In order to safeguard persons applying for MAiD, several rules formulated in Bill C-14 lead to the prevention of advance consent. Firstly, the person requesting for MAiD should request in writing. Secondly,the person should be informed that they may withdraw the request at any given point. Thirdly, there should be atleast ten days between the day of request and the date in which the aid in dying is provided, immediately before administering the aid the medical practitioner gives the person a chance to withdraw. At the time request, patients are required to have an understanding of their decision and be aided to communicate in the case of difficulty. These safeguards provided are the basis in which the patient’s advance consent for Medical Aid in Dying is formed.
From these safeguards provided, Bill C-14 requires a person to make consent before and when the assistance is conducted. In the instance, when the person loses decision-making capacity, the law does not allow the procedure to be carried out (Berlin & Zeeshan; Marwaha, 2019). People with degenerative diseases such as Alzheimer cannot be granted Medical aid in dying after they have lost their consciousness during their illness.
According to the report presented by Hon. Kelvin Kenneth Ogilvie and Robert Oliphant, advance consent for MAiD, should be allowed if the patient had requested with a competent mind (Hon. Kelvin Kenneth Ogilvie and Robert Oliphant, 2016), but under special advanced situations. These include a situation where a person had requested and was accepted for MAiD but lost the consciousness before MAiD took place, in a situation where a patient is diagnosed with the irremediable condition and is enduring intolerable suffering to diagnosis. This brought about a lot of debate from different stakeholders regarding the permission of MAiD.
There is a risk of abuse and error when administering advance consent with regard to MAiD. One of the concerns presented stakeholders in response to these concerns is the committee that advocates for advanced consent are the possibility of an increase in risk and abuse of MAiD if advance consent is allowed. In response to this, the committee amended that the authorization of advance consent in medical aid in dying may be permitted whenever after one is determined to have a condition that is sensibly liable to cause loss of capability or after a conclusion of an extreme or irremediable condition before the enduring gets grievous (Hon. Kelvin Kenneth Ogilvie and Robert Oliphant, 2016). Development consent may not be made, preceding being determined to have such a condition. The development demand is dependent upon indistinguishable procedural shields from those set up for contemporaneous solicitations.
The Alzheimer Society of Canada opposes advanced consent in MAiD because they believe that the future is unpredictable. In their concerns regarding Dementia, the Alzheimer Society of Canada stated that advanced consent should not be provided for people with dementia. After all, these people cannot make an informed decision and consent to end their life at the late stages of the disease (Alzheimer’s Association, 2019; Curley, 2017).
Dying with Dignity Canada (DWDC) advocates for advanced consent because the criteria outlined in Bill C-14 contain problematic safeguards to people who want to access MAiD. In their report, the DWDC argues that Bill C-14 discriminates against Canadians with terminal illnesses that make them lack mental capacity in the matter of the courses (Curley, 2017; Dying With Dignity Canada, 2013). They further state that the combined effects of the safeguard against advance requests and Bill C-14’s eligibility criteria mean that they will never qualify for MAiD (Dying With Dignity Canada, 2013).
From these different views of advanced consent, it is evident that the criteria for providing advanced consent should be provided in Bill C-14. For instance, countries that have allowed advanced requests such as Belgium, Colombia, Luxembourg, and the Netherlands have different strategies that are critical for allowing advanced consent and could be an eye-opener for Canada in the effort to implement advance dance consent for MAiD. For instance, in Colombia, advanced consent applies to patients whose death has been deemed imminent. Belgium and Luxembourg allow advance consent in a situation where the patient is irreversibly unconscious. If such amendments are provided in Bill C-14, there will be an assurance that safeguards patients dangers that are likely to be faced with advanced consent for providing MAiD. On the other hand, this will ensure that those with degenerative diseases uphold their values and beliefs, and mental incapacitation does not stop them from achieving them.
In conclusion, the debate that has been ongoing since the passing of Bill C-14 on medical aid in dying, a review to allow advance consent in particular instances, is inevitable. While the future is unpredictable concerning patients who have lost consciousness, advanced consent should be viewed from the intention of the person applying for MAiD. If they qualify when they have a mental capacity to make an independent decision, their mental capacity when the MAiD is administered should not be the stumbling block to dying them a dignified death.
References
Alzheimer’s Association. (2019). Alzheimer Society of Canada | HealthPartners. October. https://healthpartners.ca/alzheimer-society-canada
Berlin, N. A., & Zeeshan; Marwaha, S. (2019). Advance requests for MAID: What are the important questions and concerns? https://healthydebate.ca/2019/02/topic/advance-requests-for-maid Accessed: 25/05/2020
Canada. (2016). Government Bill (House of Commons) C-14 (42-1) – Royal Assent – An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) – Parliament of Canada. First Session, Forty-second Parliament. https://www.parl.ca/DocumentViewer/en/42-1/bill/C-14/royal-assent
Curley, A. (2017). Advance Consent and Medical Assistance in Dying (MAiD) | British Columbia Law Institute. https://www.bcli.org/advance-consent-and-medical-assistance-in-dying-maid: Accessed 25/05/2020
Dying With Dignity, Canada. (2013). Challenges to Choice: Bill C-14 One Year Later. In JLTA Journal (Vol. 16, Issue 0). https://doi.org/10.20622/jltajournal.16.0_toc1
Hon. Kelvin Kenneth Ogilvie and Robert Oliphant. (2016). MAiD A patient-centered Approach Govt of Canada Publication: Report of the Special Joint Committee on Physician-Assisted Dying. February 1–57.
Malina, D., Li, M., Watt, S., Escaf, M., Gardam, M., Heesters, A., O’leary, G., & Rodin, G. (2017). Medical Assistance in Dying-Implementing a Hospital-Based Program in Canada.