Dy­ing with dig­nity and as pain­lessly as pos­si­ble

How will we pro­tect the vul­ner­a­ble while al­low­ing these peo­ple con­sti­tu­tional rights

The Hamilton Spectator - - COMMENT - JOHN WIL­SON John Wil­son, P.Eng. (ret), MPhil., for­mer Hy­dro One Board Mem­ber

Cur­rently in Canada we al­low ma­ture mi­nors, peo­ple us­ing ad­vance med­i­cal di­rec­tives who can’t oth­er­wise com­mu­ni­cate and those suf­fer­ing solely from men­tal ill­ness to make de­ci­sions that will end their lives. Across the coun­try the courts, ca­pac­ity and as­sess­ment boards, ethi­cists and med­i­cal per­son­nel al­low these peo­ple to refuse or stop med­i­cal treat­ment and there­fore die.

We are now faced with the ques­tion, if these peo­ple choose death should they be al­lowed to die with dig­nity and as pain­lessly as pos­si­ble? How will we pro­tect the vul­ner­a­ble while al­low­ing these peo­ple the same con­sti­tu­tional rights as other Cana­di­ans in choos­ing med­i­cal aid in dy­ing (MAID)?

In 2016 when the Par­lia­ment passed leg­is­la­tion to le­gal­ize MAID, the gov­ern­ment com­mit­ted to un­der­take stud­ies to ex­am­ine these three sit­u­a­tions. The Coun­cil of Cana­dian Acad­e­mies (CCA) was cho­sen to con­duct the stud­ies.

The CCA is an in­de­pen­dent, not-for-profit or­ga­ni­za­tion that con­ducts ev­i­dence­based as­sess­ments to in­form pub­lic pol­icy is­sues, such as cli­mate change and medicines for chil­dren.

The stud­ies were ini­ti­ated in De­cem­ber 2016 and are sched­uled to be fin­ished and re­leased in 2018. They will be sum­maries of the in­for­ma­tion gath­ered with­out rec­om­men­da­tions. It will be — as it was with as­sisted death — up to Par­lia­ment to act.

Across the coun­try con­fer­ences, sym­po­siums, in­sti­tu­tions and pan­els are now ex­plor­ing the is­sues in­volved in the three stud­ies.

Que­bec has a sep­a­rate MAID law that was in place prior to the fed­eral law. The Que­bec gov­ern­ment re­cently de­cided to ex­am­ine whether or not to let peo­ple use ad­vance med­i­cal di­rec­tives to re­quest as­sisted death. This would give peo­ple with de­men­tia ac­cess to MAID. The Que­bec Health Min­is­ter has stated that he wants an ex­pert group to ex­am­ine the is­sue and that the con­sul­ta­tion process will take at least a year. A Fe­bru­ary 2016 Ip­sos-Reid poll in­di­cates that 8 out of 10 peo­ple sup­port MAID for those with de­men­tia.

MAID for men­tal ill­ness is a dif­fi­cult topic as polls in­di­cate that the ma­jor­ity of Cana­di­ans do not un­der­stand that some psy­cho­log­i­cal pain can be un­bear­able and in­cur­able. How­ever, con­sti­tu­tional rights are not sub­ject to the will of the ma­jor­ity. Cur­rent law al­lows com­pe­tent peo­ple with men­tal ill­ness to make life-end­ing de­ci­sions. MAID and men­tal ill­ness events are now un­der­way to ex­plore how and in what cir­cum­stances peo­ple with men­tal ill­ness might ac­cess an as­sisted death.

Cana­dian courts have ruled that ma­ture mi­nors may refuse or stop med­i­cal treat­ment if they have the in­tel­li­gence and ca­pac­ity to un­der­stand the pur­pose of a pro­posed treat­ment and the abil­ity to ap­pre­ci­ate the rea­son­able fore­see­able con­se­quences of the de­ci­sion. This means they can un­der ex­ist­ing law make de­ci­sions that would cause their death. In what cir­cum­stances should ma­ture mi­nors have ac­cess to MAID?

Next year when the CCA re­leases its MAID stud­ies, the Par­lia­ment will have an op­por­tu­nity to act in the in­ter­ests of peo­ple suf­fer­ing with un­bear­able and in­cur­able pain and their loved ones. You should let your MP know your opinion and that you ex­pect timely ac­tion rather than wait­ing for many years as these is­sues are lit­i­gated in the courts.

I, like many Cana­di­ans, have watched loved ones die with need­less suf­fer­ing. Decades ago the late Pa­trick Now­ell-Smith, one of my grad­u­ate phi­los­o­phy pro­fes­sors, brought the so­lu­tion to this prob­lem — as­sisted death — to my at­ten­tion. He went on to co-found Dy­ing with Dig­nity and then to serve as the pres­i­dent of the World Fed­er­a­tion of Right to Die So­ci­eties. It’s time for us to con­tinue Now­ell-Smith’s work by pro­vid­ing pru­dent in­creased ac­cess to death with dig­nity.

TORSTAR FILE PHOTO

It’s time for us to con­tinue the im­por­tant work of pro­vid­ing pru­dent in­creased ac­cess to death with dig­nity, writes John Wil­son.

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