Medical assistance in dying: The Canadian experience

2017 ◽  
Vol 41 (S1) ◽  
pp. S336-S337
Author(s):  
K. Gaind
Keyword(s):  
Task Force ◽  
Assisted Dying ◽  
Medical Assistance ◽  
Assisted Death ◽  
Medical Assistance In Dying ◽  
Canadian Experience ◽  
Association Task ◽  
Competing Interest ◽  
Physician Assisted Dying ◽  
Medical Concepts

Canada is in the midst of implementing new and rapidly evolving policies on medical assistance in dying (MAID). Following the landmark Canadian Supreme Court Carter v. Canada ruling in February 2015, the former prohibition against physician-assisted death was deemed to violate the Canadian Charter of Rights and Freedoms. The Court provided until 2016 for development of national legislation and policies that allowed for physician-assisted dying in cases of “grievous and irremediable” illness and “intolerable suffering”. This session will review shifting public, societal and medical concepts regarding assisted dying and the Canadian experience to date, including evolving local and national policies that have been developed to allow medical assistance in dying in certain circumstances. We will also review work of the Canadian psychiatric association task force on medical assistance in dying (presented by the Task Force Chair), with a focus on challenges and issues relevant to mental health and mental illness.Disclosure of interestThe author has not supplied his declaration of competing interest.

19. Medical Assistance in Dying

2019 ◽  
pp. 615-665
Author(s):  
G. T. Laurie ◽  
S. H. E. Harmon ◽  
E. S. Dove
Keyword(s):  
Medical Treatment ◽  
Assisted Suicide ◽  
Double Effect ◽  
Legal Aspects ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
Philosophical Concept ◽  
Medical Assistance In Dying ◽  
The Relationship

This chapter discusses ethical and legal aspects of euthanasia and assisted dying. It first examines the non-voluntary termination of life, covering the relationship between medical treatment and assistance in dying as a matter of failure to treat, and the philosophical concept of ‘double effect’. The chapter then discusses activity and passivity in assisted dying; dying as an expression of patient autonomy; suicide and assisted suicide; physician-assisted suicide; and assisted dying in practice.

Physician-Assisted Suicide: Where to Draw the Line?

2000 ◽  
Vol 9 (3) ◽  
pp. 407-410 ◽  
Author(s):  
ERNLÉ W.D. YOUNG
Keyword(s):  
Public Policy ◽  
Assisted Suicide ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
Assisted Death ◽  
Policy Issues ◽  
Moral Distinction ◽  
Physician Assisted Dying ◽  
Hippocratic Tradition

In brief compass, I will touch on three of the central ethical and public policy issues that divide those who are opposed to physician-assisted dying from those who are supportive of this practice. These are: (1) the moral distinction (if any) between actively hastening death and passively allowing to die; (2) how to interpret the Hippocratic tradition in medicine with respect to physician-assisted death; and (3) whether physician-assisted suicide can be effectively regulated. I shall summarize the arguments pro and con with respect to each issue, and also indicate my own position.

scholarly journals How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers

2021 ◽  
Vol 15 ◽  
pp. 263235242110459
Author(s):  
Anita Ho ◽  
Joshua S. Norman ◽  
Soodabeh Joolaee ◽  
Kristie Serota ◽  
Louise Twells ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Assisted Dying ◽  
Life Care ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Qualitative Thematic Analysis

Background: More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying. Understanding how end-of-life care discussions between patients and specialist palliative care providers may be affected by such legislation can inform end-of-life care delivery in the evolving socio-cultural and legal environment. Aim: To explore how the Canadian Medical Assistance in Dying legislation affects end-of-life care discussions between patients and multidisciplinary specialist palliative care providers. Design: Qualitative thematic analysis of semi-structured interviews. Participants: Forty-eight specialist palliative care providers from Vancouver (n = 26) and Toronto ( n = 22) were interviewed in person or by phone. Participants included physicians ( n = 22), nurses ( n = 15), social workers ( n = 7), and allied health professionals ( n = 4). Results: Qualitative thematic analysis identified five notable considerations associated with Medical Assistance in Dying affecting end-of-life care discussions: (1) concerns over having proactive conversations about the desire to hasten death, (2) uncertainties regarding wish-to-die statements, (3) conversation complexities around procedural matters, (4) shifting discussions about suffering and quality of life, and (5) the need and challenges of promoting open-ended discussions. Conclusion: Medical Assistance in Dying challenges end-of-life care discussions and requires education and support for all concerned to enable compassionate health professional communication. It remains essential to address psychosocial and existential suffering in medicine, but also to provide timely palliative care to ensure suffering is addressed before it is deemed irremediable. Hence, clarification is required regarding assisted dying as an intervention of last resort. Furthermore, professional and institutional guidance needs to better support palliative care providers in maintaining their holistic standard of care.

scholarly journals Author(iz)ing Death: Medical Aid-in-Dying and the Morality of Suicide

2019 ◽  
Vol 34 (1) ◽  
pp. 53-77 ◽  
Author(s):  
Anita Hannig
Keyword(s):  
Public Discourse ◽  
Medical Assistance ◽  
Death With Dignity ◽  
Assisted Death ◽  
Medical Aid ◽  
Medical Assistance In Dying ◽  
Aid In Dying ◽  
Death With Dignity Act ◽  
Twentieth Anniversary ◽  
Dignity Act

In 2017, Oregon marked the twentieth anniversary of enacting the Death with Dignity Act, allowing terminally ill, mentally competent adult patients to end their life by ingesting a lethal medication prescribed by their physician. In U.S. public discourse, medical aid-in-dying is frequently equated with the terminology and morality of suicide, much to the frustration of those who use and administer the law. This article reflects on the stakes of maintaining a distinction between a medically assisted death and the most common cultural category for self-inflicted death—suicide. It uncovers the complicated dialectic between authorship and authorization that characterizes medical assistance in dying and attendant moralities of purposive death, speaking to broader disciplinary concerns in the cultural study of death and medicine. By stressing the primacy of debilitating, life-limiting illness in an aided death and by submitting such a death to the rationale and management of institutionalized medicine, advocates carve out a form of intentional death that occupies a category of its own. The diffusion of agency onto a patient’s fatal illness, medicine, and the state—both discursively and in practice—enhances the moral and social acceptability of an assisted death, which becomes an authorized form of dying that looks very different from the socially deviant act of suicide.

scholarly journals Assisted dying for prison populations: Lessons from and for abroad

2019 ◽  
Vol 19 (2-3) ◽  
pp. 207-225
Author(s):  
Jocelyn Downie ◽  
Adelina Iftene ◽  
Megan Steeves
Keyword(s):  
Legal Status ◽  
Federal Legislation ◽  
Assisted Dying ◽  
Medical Assistance ◽  
Policy And Practice ◽  
Conditional Release ◽  
Medical Assistance In Dying ◽  
The World ◽  
Federal Prisoners ◽  
Prison Populations

Canadian federal legislation setting out the framework for medical assistance in dying (MAiD) in Canada came into effect in June 2016. Because of section 86(1) of the Corrections and Conditional Release Act, as soon as MAiD became available in the community, it also needed to be made available to federal prisoners. There are some good reasons to be concerned about MAiD in the Canadian corrections system based on logistical, legal, and moral considerations. Fortunately, Canada is not the first country to decriminalize assisted dying and so Canadian policies and practices can be compared to others and take some lessons from their experiences. Thus, by reviewing the legal status of assisted dying in prisons internationally, the regulation of assisted dying, demand for assisted dying from prisoners, and the process for prisoners accessing assisted dying, this article offers a comparative overview of assisted dying for prisoners around the world in an effort to inform Canadian and other jurisdictions’ law, policy, and practice.

You shall bury him: burial, suicide and the development of Catholic law and theology

2019 ◽  
Vol 46 (3) ◽  
pp. 299-310 ◽  
Author(s):  
Ranana Leigh Dine
Keyword(s):  
Canon Law ◽  
Current Debate ◽  
Assisted Dying ◽  
Religious Groups ◽  
Late 20Th Century ◽  
Assisted Death ◽  
Religious Perspectives ◽  
History Of ◽  
Physician Assisted Dying ◽  
The Church

Whether physician-assisted dying should be legalised is a major debate in medical ethics and much has been written on it from both secular and religious perspectives. Less, however, has been written on one of the potential consequences of legalised physician-assisted death: whether those who undergo this procedure will be given funerals by religious groups who oppose the practice. This article investigates the Catholic Church’s attitude to the burial of suicides, and how Catholic canon law has approached the question of ecclesiastic funerals for suicides throughout its history. From the sixth through the late 20th century, the Church technically did not bury anyone who willfully committed suicide. Broad shifts in the cultural attitude towards suicide, due in large part to new understandings of mental illness as disease, had a powerful effect on Catholic thought and practice in modernity, and the Church eventually dropped the ban on funerals for suicides from its law code altogether in the 1980s. The legalisation of physician-assisted death, however, raises again the possibility of a prohibition on funerals. The Church was able to drop its restrictions on funerals since suicide was seen as an act beyond the control of the deceased and thus worthy of mercy and compassion. In cases of physician-assisted dying, the patient must have consciously and willingly agreed to the procedure, undermining this understanding of suicide. The history of canon law on suicide funerals reveals the complexity of the Catholic attitude towards suicide and provides an important context to the current debate around physician-assisted death, and conflicts between medicine and religion more broadly.

Medically Assisted Dying in Canada: “Beautiful Death” Is Transforming Nurses’ Experiences of Suffering

2019 ◽  
pp. 084456211985623 ◽  
Author(s):  
Anne Bruce ◽  
Rosanne Beuthin
Keyword(s):  
End Of Life ◽  
Secondary Analysis ◽  
Emotional Impact ◽  
Assisted Dying ◽  
Medical Assistance ◽  
Narrative Study ◽  
Medical Assistance In Dying ◽  
Qualitative Secondary Analysis ◽  
The Impact

BackgroundNurses witness pain and distress up close and consequently experience their own suffering. A narrative study of Canadian nurses’ participating in medical assistance in dying found nurses’ previous witnessing of unresolved end-of-life suffering has shaped their acceptance of medical assistance in dying. Little is known about the impact of participating in medically assisted dying on nurses’ suffering.PurposeTo explore how nurses’ overall experience of suffering is shaped by participating in medical assistance in dying.MethodsQualitative secondary analysis using narrative inquiry and thematic analysis.ResultsNurses’ narratives are chronologically organized addressing experiences of suffering before medical assistance in dying was a legal option and after its implementation. An overarching narrative before the availability of medical assistance in dying is (1) a culture of nurses’ taken-for-granted suffering: feeling terrible. After medical assistance in dying, two key narratives describe (2) transformational feelings of a beautiful death and (3) residual discomfort. Nurses found their suffering transformed when participating in medical assistance in dying; end-of-life care was satisfying and gratifying. And yet, unanswered questions due to worries of becoming desensitized and ongoing deeper questioning remain.ConclusionsParticipating in medical assistance in dying has positively impacted nurses and starkly contrasts their previous experiences caring for those with unbearable suffering. Further research is needed to explore becoming desensitized and long-term emotional impact for nurses.

Perceptions and Experiences of Medical Assistance in Dying Among Illicit Substance Users and People Living in Poverty

2019 ◽  
pp. 003022281988982
Author(s):  
Jessica Shaw ◽  
Laura Harper ◽  
Emma Preston ◽  
Alysia Wright ◽  
Michaela Kelly ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Best Practice ◽  
Life Care ◽  
Medical Assistance ◽  
Substance Users ◽  
Assisted Death ◽  
Illicit Substance ◽  
Medical Assistance In Dying ◽  
The Difference

Since medical assistance in dying (MAiD) became legal in Canada in 2016, there have been concerns about vulnerable people feeling pressured to end their lives. It is important to understand what people in marginalized communities know and feel about MAiD in order to help prevent any pressure to hasten death and to prevent any barriers to accessing assisted death. This qualitative study explored the perceptions and experiences of MAiD and other end-of-life care options with 46 people who were illicit substance users, living in poverty, or who worked with marginalized people in these communities. Six broad themes were identified: the importance of family, friends, and community; the effects of the opioid crisis; barriers to accessing end-of-life care services; support for MAiD; the difference between suicide and MAiD; and what constitutes a good death. Findings from this research may be used to help inform future legislation, professional guidelines, and standards of best practice.

scholarly journals The provision of medical assistance in dying: protocol for a scoping review

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017888 ◽  
Author(s):  
Simon J W Oczkowski ◽  
Ian Ball ◽  
Carol Saleh ◽  
Gaelen Kalles ◽  
Anatoli Chkaroubo ◽  
...  
Keyword(s):  
Capital Punishment ◽  
Scoping Review ◽  
Assisted Suicide ◽  
Future Research ◽  
Medical Assistance ◽  
Knowledge Gaps ◽  
Eligibility Criteria ◽  
Assisted Death ◽  
Medical Assistance In Dying ◽  
Clinical Trial Registries

IntroductionMedical assistance in dying (MAID), a term encompassing both euthanasia and assisted suicide, was decriminalised in Canada in 2015. Although Bill C-14 legislated eligibility criteria under which patients could receive MAID, it did not provide guidance regarding the technical aspects of providing an assisted death. Therefore, we propose a scoping review to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of MAID, in order to identify knowledge gaps and areas for future research.Methods and analysisWe will search electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO), clinical trial registries, conference abstracts, and professional guidelines and recommendations from jurisdictions where MAID is legal, up to June 2017. Eligible report types will include technical summaries, institutional policies, practice surveys, practice guidelines and clinical studies. We will include all descriptions of MAID provision (either euthanasia or assisted suicide) in adults who have provided informed consent for MAID, for any reason, including reports where patients have provided consent to MAID in advance of the development of incapacity (eg, dementia). We will exclude reports in which patients receive involuntary euthanasia (eg, capital punishment). Two independent investigators will screen and select retrieved reports using pilot-tested screening and eligibility forms, and collect data using standardised data collection forms. We will summarise extracted data in tabular format with accompanying descriptive statistics and use narrative format to describe their clinical relevance, identify knowledge gaps and suggest topics for future research.Ethics and disseminationThis scoping review will map the range and scope of the existing literature on the provision of MAID in jurisdictions where the practice has been decriminalised. The review will be disseminated through conference presentations and publication in a peer-reviewed journal. These results will be useful to clinicians, policy makers and researchers involved with MAID.

scholarly journals An Ethical-Legal Analysis of Medical Assistance in Dying for Those with Mental Illness

2018 ◽  
pp. 149 ◽  
Author(s):  
Ryan Tanner
Keyword(s):  
Mental Illness ◽  
Assisted Dying ◽  
Legal Analysis ◽  
Medical Assistance ◽  
The Public ◽  
University Of Toronto ◽  
Medical Assistance In Dying ◽  
Physical Suffering ◽  
Canadian Culture ◽  
The University

This article considers sources of opposition to allowing access to medical assistance in dying for individuals with mental illness. It originated with an observation by members of the University of Toronto Joint Centre for Bioethics that in mainstream Canadian culture — as well as in political, academic, and professional circles — such opposition remains widespread (and often reflexive). This opposition exists even in light of broad support for access to assisted dying for individuals with illness manifesting in physical suffering. Most Canadians treat the prospect of assisted dying for those with mental illness with suspicion, and it is worth exploring why this opposition persists, what arguments can be leveled to support it, and whether those arguments can be sustained. To that end, I identify five objections to assisted dying for the mentally ill that seem to characterize the public debate, and argue that none are sustainable. They either rely on false premises or otherwise fail to secure the conclusion that assisted dying should be off limits to people suffering from mental illness, even when such mental illness is their sole underlying condition.

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