scholarly journals The Right to Die: Legalizing Medical Assistance in Dying in Canada

2017 ◽  
Vol 5 (3) ◽  
Author(s):  
Noushon Farmanara
Keyword(s):  
Right To Die ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
The Right

scholarly journals P.117 The opinion of Canadian spine surgeons on medical assistance in dying (MAID); a cross-sectional survey of Canadian spine society (CSS) members

2019 ◽  
Vol 46 (s1) ◽  
pp. S44
Author(s):  
E Leck ◽  
S Barry ◽  
S Christie
Keyword(s):  
Cervical Spinal Cord ◽  
Criminal Code ◽  
Supreme Court Of Canada ◽  
Medical Assistance ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical Assistance In Dying ◽  
Cord Injury ◽  
The Right ◽  
Spine Tumour

Background: On February 6, 2015, the Supreme Court of Canada struck down the Criminal Code absolute prohibition on assisted dying, and in June 2016 the new law, Bill C-14, came into effect allowing for medical assistance in dying. We sought to determine the attitudes and opinions of Canadian neurosurgeons and orthopedic spine surgeons regarding MAID. Methods: A cross-sectional survey was sent out to members of the Canadian Spine Society (CSS), which included 21 questions pertaining to opinions regarding MAID. Responses were collected between May-June 2016. Results: A total of 51 surgeons responded to the survey, comprised of a mix of spine surgeons from across the country. The majority of surgeons supported MAID (62.8%), and right of physicians to participate (82.4%). Most surgeons supported the right to conscientious objection (90.1%), but also mandatory duty to refer (49.0%). The conditions most frequently felt to be appropriate for MAID included metastatic spine tumour (76.5%), malignant intramedullary tumour (64.7%), primary malignant spine tumour (54.9%), cervical spinal cord injury with tetraplegia (49.0%) and multiple myeloma (33.3%). Conclusions: This study highlights the complex landscape that exists when discussing MAID, but also the overall support of physicians, and need for ongoing conversations, particularly with issues not addressed by the current legislation.

Canadian neurosurgeons’ views on medical assistance in dying (MAID): a cross-sectional survey of Canadian Neurosurgical Society (CNSS) members

2019 ◽  
Vol 45 (5) ◽  
pp. 309-313 ◽  
Author(s):  
Alwalaa Althagafi ◽  
Chris Ekong ◽  
Brian W Wheelock ◽  
Richard Moulton ◽  
Peter Gorman ◽  
...  
Keyword(s):  
Position Statement ◽  
Conscientious Objection ◽  
Supreme Court Of Canada ◽  
Medical Assistance ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical Assistance In Dying ◽  
Neurosurgical Society ◽  
Views And Perceptions ◽  
The Right

BackgroundThe Supreme Court of Canada removed the prohibition on physicians assisting in patients dying on 6 February 2015. Bill C-14, legalising medical assistance in dying (MAID) in Canada, was subsequently passed by the House of Commons and the Senate on 17 June 2016. As this remains a divisive issue for physicians, the Canadian Neurosurgical Society (CNSS) has recently published a position statement on MAID.MethodsWe conducted a cross-sectional survey to understand the views and perceptions among CNSS members regarding MAID to inform its position statement on the issue. Data was collected from May to June 2016.ResultsOf the 300 active membes of the CNSS who recevied the survey, 89 respondents completed the survey, 71% of whom were attending neurosurgeons and 29% were neurosurgery residents. Most respondents,74.2%, supported the right of physicians to participate in MAID with 7.8% opposing. 37% had current patients in their practice fitting the criteria for MAID. 23.6% had been asked by patients to assist with MAID, but only 11% would consider personally providing it. 84% of neurosurgeons surveyed supported the physicians’ right to conscientious objection to MAID while 21% thought attending surgeons should be removed from the inquiry and decision-making process. 43.8% agreed that the requirment to refer a patient to a MAID service should be mandatory. Glioblastoma multiforme (65%), quadriplegia/quadriparesis secondary to spinal tumour/trauma (54%) and Parkinson’s disease (24%) were the most common suggested potential indications for MAID among the neurosurgical population.ConclusionsOur results demonstrate that most neurosurgeons in Canada are generally supportive of MAID in select patients. However, they also strongly support the physicians’ right to conscientious objection.

scholarly journals Refusing care as a legal pathway to medical assistance in dying

2019 ◽  
Vol 2 (2) ◽  
pp. 73-82
Author(s):  
Jocelyn Downie ◽  
Matthew J Bowes
Keyword(s):  
Spinal Stenosis ◽  
Healthcare Providers ◽  
Natural Death ◽  
Medical Assistance ◽  
Competent Patient ◽  
Medical Assistance In Dying ◽  
Ethical Implications ◽  
Brain Stroke ◽  
The Right ◽  
Right To Refuse

Can a competent individual refuse care in order to make their natural death reasonably foreseeable in order to qualify for medical assistance in dying (MAiD)? Consider a competent patient with left-side paralysis following a right brain stroke who is not expected to die for many years; normally his cause of death would not be predictable. However, he refuses regular turning, so his physician can predict that pressure ulcers will develop, leading to infection for which he will refuse treatment and consequently die. Is he now eligible for MAiD? Consider a competent patient with spinal stenosis (a non-fatal condition) who refuses food (but not liquids in order not to lose capacity from dehydration). Consequently, her physician can predict death from starvation. Is she now eligible for MAiD? Answering these questions requires that we answer three sub-questions: 1) do competent patients have the right to refuse care?; 2) do healthcare providers have a duty to respect such refusals?; and 3) are deaths resulting from refusals of care natural for the purposes of determining whether a patient is eligible for MAiD? If a competent patient has the right to refuse some particular care, and healthcare providers have a duty to respect that refusal, and if the death that would result from the refusal of that care is natural, then that refusal of care is a legal pathway to MAiD. However, if the competent patient does not have the right to refuse some particular care, or if healthcare providers do not have a duty to respect that refusal, or if the death that would result from the refusal of that care is not natural, then that refusal of care is not a legal pathway to MAiD. In this paper, we explore this complex legal terrain with the most profound of ethical implications – access to MAiD.

scholarly journals Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

2018 ◽  
Vol 5 ◽  
Author(s):  
Timothy Christie ◽  
John Sloan ◽  
Dylan Dahlgren ◽  
Fred Koning
Keyword(s):  
Health Care Professionals ◽  
Criminal Code ◽  
Conscientious Objection ◽  
Supreme Court Of Canada ◽  
Conscientious Objector ◽  
Medical Assistance ◽  
Right To Life ◽  
Medical Assistance In Dying ◽  
Deontological Ethics ◽  
The Right

Background: The Supreme Court of Canada (SCC) has ruled that the federal government is required to remove the provisions of the Criminal Code of Canada that prohibit medical assistance in dying (MAID). The SCC has stipulated that individual physicians will not be required to provide MAID should they have a religious or conscientious objection. Therefore, the pending legislative response will have to balance the rights of the patients with the rights of physicians, other health care professionals, and objecting institutions. Objective: The objective of this paper is to critically assess, within the Canadian context, the moral probity of individual or institutional objections to MAID that are for either religious or conscientious reasons. Methods: Deontological ethics and the Doctrine of Double Effect. Results: The religious or conscientious objector has conflicting duties, i.e., a duty to respect the “right to life” (section 7 of the Charter) and a duty to respect the tenets of his or her religious or conscientious beliefs (protected by section 2 of the Charter). Conclusion: The discussion of religious or conscientious objections to MAID has not explicitly considered the competing duties of the conscientious objector. It has focussed on the fact that a conscientious objection exists and has ignored the normative question of whether the duty to respect one’s conscience or religion supersedes the duty to respect the patient’s right to life.

What Kind of a Right Is the ‘Right to Die’?

2009 ◽  
Vol 4 (2) ◽  
pp. 165-180
Author(s):  
Constance E. Putnam
Keyword(s):  
Right To Die ◽  
The Right

scholarly journals Association of socioeconomic status with medical assistance in dying: a case–control analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e043547
Author(s):  
Donald A Redelmeier ◽  
Kelvin Ng ◽  
Deva Thiruchelvam ◽  
Eldar Shafir
Keyword(s):  
Socioeconomic Status ◽  
Palliative Care ◽  
Low Socioeconomic Status ◽  
Case Control ◽  
Control Analysis ◽  
Medical Assistance ◽  
Low Socioeconomic ◽  
Medical Assistance In Dying ◽  
Income Status ◽  
Economic Constraints

ObjectivesEconomic constraints are a common explanation of why patients with low socioeconomic status tend to experience less access to medical care. We tested whether the decreased care extends to medical assistance in dying in a healthcare system with no direct economic constraints.DesignPopulation-based case–control study of adults who died.SettingOntario, Canada, between 1 June 2016 and 1 June 2019.PatientsPatients receiving palliative care under universal insurance with no user fees.ExposurePatient’s socioeconomic status identified using standardised quintiles.Main outcome measureWhether the patient received medical assistance in dying.ResultsA total of 50 096 palliative care patients died, of whom 920 received medical assistance in dying (cases) and 49 176 did not receive medical assistance in dying (controls). Medical assistance in dying was less frequent for patients with low socioeconomic status (166 of 11 008=1.5%) than for patients with high socioeconomic status (227 of 9277=2.4%). This equalled a 39% decreased odds of receiving medical assistance in dying associated with low socioeconomic status (OR=0.61, 95% CI 0.50 to 0.75, p<0.001). The relative decrease was evident across diverse patient groups and after adjusting for age, sex, home location, malignancy diagnosis, healthcare utilisation and overall frailty. The findings also replicated in a subgroup analysis that matched patients on responsible physician, a sensitivity analysis based on a different socioeconomic measure of low-income status and a confirmation study using a randomised survey design.ConclusionsPatients with low socioeconomic status are less likely to receive medical assistance in dying under universal health insurance. An awareness of this imbalance may help in understanding patient decisions in less extreme clinical settings.

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