MPs debate 10-day ‘reflection’ period for medically assisted death
Conservatives want to amend Liberals’ proposed MAiD bill to include mandatory delay
Should a person who has an intolerable, terminal illness be required to wait 10 days between their request for a medically assisted death and the procedure?
It’s a question that was hotly debated last week at the House of Commons’ standing committee on justice and human rights, as the Conservatives tried to amend the federal government’s new bill on medical assistance in dying, or MAiD.
They tried to reinsert a 10-day reflection period — between the person’s request for MAiD and the procedure itself — that is mandated by the current MAiD law, but the Liberals have not included in the new proposed bill. The amendment failed, as did an attempt to add a seven-day reflection period.
Those opposed to the removal of the reflection period argue it’s crucial to keep so an individual knows they can change their mind and perhaps explore other options.
“I think it’s really a matter of common sense that someone should be able to have the time to reflect upon making a request that, if carried out, results in the termination of their life,” Conservative MP and justice committee member Michael Cooper told the Star.
Some physicians and disability advocates have been vocal in their demand that the 10-day period stay.
But proponents of removing the reflection period, including physicians who assess people for MAiD and provide it, say individuals with reasonably foreseeable deaths who are already suffering intolerably have typically long made up their minds to access a medically assisted death, and being told they still have to wait 10 days is cruel and unnecessary.
“This is not something that people come to quickly, this is not a decision they take lightly,” said Dr. Stefanie Green, a MAiD provider and president of the Canadian Association of MAiD Assessors and Providers.
Green said some patients will stop taking their pain medication for fear they will lose their capacity to go ahead with the procedure. “They’re terrified that they’re going to lose this option,” she said.
Among the medical groups opposing the removal of the 10-day period is the Canadian Society of Palliative Care Physicians. The society’s treasurer, Dr. Ebru Kaya, said without a waiting period, palliative care physicians may not have enough time to provide care, ranging from medication to manage symptoms to social and psychological supports.
“We really believe that we should be making careful efforts to ensure that we’re providing good care and that we’re not quickly facilitating death when people are distressed and at their lowest point, that we do everything we can to support that person so that they really, genuinely understand all their options,” she said.
(MAiD assessors and providers who spoke to the Star said they always review palliative care options with the patient.)
The federal government is racing toward a court-imposed deadline of Dec. 18 to pass Bill C-7, after part of the previous MAiD law was struck down last year by a Quebec court, which found the condition that a person’s natural death be “reasonably foreseeable” in order to access MAiD was unconstitutional.
The new bill includes two tracks for MAiD — one for deaths deemed reasonably foreseeable, for which the 10-day reflection period has been removed. A second track has been added for deaths deemed not reasonably foreseeable. In those cases, the new bill proposes that eligibility assessments must take a minimum of 90 days, though certain circumstances allow that period to be shortened.
David Taylor, a spokesperson for Justice Minister David Lametti, said a clear consensus from medical providers emerged during the government’s consultation process for Bill C-7 that the 10-day reflection period for individuals whose deaths were reasonably foreseeable “was not serving its intended function, but instead prolonging a patient’s suffering.”
Some physicians and other opponents of the change to the bill have described the removal of the10-day reflection period for reasonably foreseeable deaths as amounting to “same-day death.”
But Dr. Justine Dembo, a psychiatrist affiliated with the University of Toronto and a MAiD assessor, said there are already situations now where a person is assessed expeditiously following their request because there is an imminent risk of loss of capacity, or of death. The current MAiD law permits the 10-day window to be shortened in such situations.
“One would hope that the country could trust its practitioners to be ethical about how they handle those situations.”
DR. JUSTINE DEMBO
PSYCHIATRIST AFFILIATED WITH THE UNIVERSITY OF TORONTO
“One would hope that the country could trust its practitioners to be ethical about how they handle those situations,” she said. “I imagine there could be a concern that the request is an impulsive decision where someone hasn’t really thought about it, but the assessor would see that as not being an enduring request and therefore they wouldn’t be eligible. There needs to be some trust in practitioners around that.”
Green said she finds it “absurd” the way some physicians have characterized a MAiD regime without the 10-day reflection period.
“The idea that some of my peers in this country have repeatedly suggested, the idea that somebody can have a ski accident in the morning, get to hospital, be told they’re paralyzed, apply for MAiD and have MAiD by nightfall, is blatantly absurd and, I have to say, insulting to those of us who do this work,” she said.
“That cannot happen. It cannot happen now, it cannot happen if the 10-day reflection period is removed. Clinicians do this well, do it carefully, follow all the safeguards and eligibility criteria.
“Nobody I know would find that person eligible for MAiD.”
The impact on some patients who are told they have to wait 10 days after their request for MAiD is “horrible,” said Dr. Donna Stewart, a professor at the University of Toronto and physician at University Health Network where she conducts MAiD assessments.
“I think the reflection period was put in out of an abundance of caution at the very beginning because of all the opposition, but over the last four and a half years it’s been clear that it causes more problems than it solves, and so I’m glad that (Lametti) heard those problems and has made those changes,” she said.
Stewart said many patients are often reassured just knowing they qualify for MAiD, and decide to delay the procedure well beyond the reflection period, sometimes for months.