An Advance Request: The Accessibility of Medical Assistance in Dying (MAID) for Patients Who Loose Decision-Making Capacity

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Natasha Harris
Keyword(s):  
Decision Making ◽  
Assisted Suicide ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
Waiting Period ◽  
Medical Assistance In Dying ◽  
Decision Making Capacity

Since the legalization of Medical Assistance in Dying (MAID) in Canada in 2016, there have been discussions regarding the extension of this service to patients who lose decision-making capacity but have made a prior advance request for physician-assisted suicide. Both caregivers and physicians have shown some support for allowing patients to make advance requests for MAID. The proposed changes to the legislation would remove the mandatory 10 day waiting period and include a waiver of final consent for those who loose decision-making capacity following their MAID request.

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.

To die, to sleep, perchance to dream? A response to DeMichelis, Shaul and Rapoport

2019 ◽  
Vol 45 (12) ◽  
pp. 832-834 ◽  
Author(s):  
Joel L Gamble ◽  
Nathan K Gamble ◽  
Michal Pruski
Keyword(s):  
Palliative Care ◽  
Medical Ethics ◽  
End Of Life ◽  
Assisted Suicide ◽  
Palliative Sedation ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
End Of Life Decisions ◽  
Medical Assistance In Dying ◽  
Life Decisions

In developing their policy on paediatric medical assistance in dying (MAID), DeMichelis, Shaul and Rapoport decide to treat euthanasia and physician-assisted suicide as ethically and practically equivalent to other end-of-life interventions, particularly palliative sedation and withdrawal of care (WOC). We highlight several flaws in the authors’ reasoning. Their argument depends on too cursory a dismissal of intention, which remains fundamental to medical ethics and law. Furthermore, they have not fairly presented the ethical analyses justifying other end-of-life decisions, analyses and decisions that were generally accepted long before MAID was legal or considered ethical. Forgetting or misunderstanding the analyses would naturally lead one to think MAID and other end-of-life decisions are morally equivalent. Yet as we recall these well-developed analyses, it becomes clear that approving of some forms of sedation and WOC does not commit one to MAID. Paediatric patients and their families can rationally and coherently reject MAID while choosing palliative care and WOC. Finally, the authors do not substantiate their claim that MAID is like palliative care in that it alleviates suffering. It is thus unreasonable to use this supposition as a warrant for their proposed policy.

Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory?

2019 ◽  
Vol 45 (12) ◽  
pp. 817-820 ◽  
Author(s):  
Joshua James Hatherley
Keyword(s):  
Decision Making ◽  
Assisted Suicide ◽  
Psychiatric Patients ◽  
Mental Illnesses ◽  
Psychiatric Condition ◽  
Physician Assisted Suicide ◽  
Psychiatric Illnesses ◽  
Decision Making Capacity ◽  
Psychiatric Conditions

Advocates of physician-assisted suicide (PAS) often argue that, although the provision of PAS is morally permissible for persons with terminal, somatic illnesses, it is impermissible for patients suffering from psychiatric conditions. This claim is justified on the basis that psychiatric illnesses have certain morally relevant characteristics and/or implications that distinguish them from their somatic counterparts. In this paper, I address three arguments of this sort. First, that psychiatric conditions compromise a person’s decision-making capacity. Second, that we cannot have sufficient certainty that a person’s psychiatric condition is untreatable. Third, that the institutionalisation of PAS for mental illnesses presents morally unacceptable risks. I argue that, if we accept that PAS is permissible for patients with somatic conditions, then none of these three arguments are strong enough to demonstrate that the exclusion of psychiatric patients from access to PAS is justifiable.

Requests for euthanasia and physician-assisted suicide and the availability and application of palliative options

2006 ◽  
Vol 4 (4) ◽  
pp. 399-406 ◽  
Author(s):  
MARIJKE C. JANSEN-VAN DER WEIDE, ◽  
BREGJE D. ONWUTEAKA-PHILIPSEN ◽  
GERRIT VAN DER WAL
Keyword(s):  
Decision Making ◽  
Observational Study ◽  
General Practitioners ◽  
Assisted Suicide ◽  
Medical Futility ◽  
Physician Assisted Suicide

Objective: This study investigated the palliative options available when a patient requested euthanasia or physician-assisted suicide (EAS), the extent to which the options were applied, and changes in the patient's wishes.Methods: In an observational study, 3614 general practitioners (GPs) filled in a questionnaire and described their most recent request for EAS (if any) (n = 1,681).Results: Palliative options were still available in 25% of cases. In these cases options were applied in 63%; in 46% of these cases patients withdrew their request. Medication other than antibiotics, which was most frequently mentioned as a palliative option (67%), and applied most frequently (79%), together with radiotherapy, most frequently resulted in patients withdrawing their request.Significance of results: GPs include the availability of palliative options in their decision making when considering EAS. The fact that not all options are applied or, if applied, the patient persists in the request is related to autonomy of the patient, the burden on the patient, and medical futility of the option.

scholarly journals P.137 A qualitative study of families’ experiences with medical assistance in dying (MAiD) in Nova Scotia

2021 ◽  
Vol 48 (s3) ◽  
pp. S59-S59
Author(s):  
E Leck ◽  
C Jackson-Tarlton ◽  
E Crumley ◽  
G Gubitz
Keyword(s):  
Decision Making ◽  
Nova Scotia ◽  
Family Members ◽  
Sense Of Control ◽  
Medical Assistance ◽  
Structured Interviews ◽  
Eligibility Criteria ◽  
Medical Assistance In Dying ◽  
Life Journey ◽  
Iterative Coding

Background: MAiD became legal in Canada in 2015, with Bill C-14 delineating eligibility criteria and access. Previous research found families are intimately involved with decision-making, with conflicting perspectives on how they cope. Our study sought to learn about the experiences of family members, and determine what supports might be beneficial to improve MAiD delivery and aftercare. Methods: We conducted hour-long semi-structured interviews with 20 family members of individuals who had MAiD. Interviews took place by telephone or virtually via MS Teams, and transcripts were analyzed using an iterative coding process and thematic analysis. Results: Prominent themes emphasized the importance of respecting autonomy, decision-making, and allowing people to regain a sense of control, particularly with so much taken away. The death itself was described as peaceful. Interviewees were overwhelmingly filled with relief and gratitude for being able to respect the individual’s wishes. Interviewees spoke of importance of support for themselves, and the desire to build a network of individuals with similar experiences; to share their stories, grieve together, and support the next generation. Conclusions: These results will help improve MAiD delivery and aftercare in Nova Scotia, by informing, developing and enabling access to resources for individuals who accompany a family member on their end-of-life journey.

Factors that Influence End-Of-Life Decision Making Amongst Attending Physicians

2021 ◽  
pp. 104990912110638
Author(s):  
Suraj Pai ◽  
Tracy Andrews ◽  
Amber Turner ◽  
Aziz Merchant ◽  
Michael Shapiro
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Work Experience ◽  
Assisted Suicide ◽  
Online Survey ◽  
Care Physician ◽  
University Hospital ◽  
Physician Assisted Suicide ◽  
Eol Care ◽  
Attending Physicians

Background: Medical advances prolong life and treat illness but many patients have chronically debilitating conditions that prevent them from making end-of-life (EOL) decisions for themselves. These situations are difficult to navigate for both patient and physician. This study investigates physicians’ feelings and approach toward EOL care, physician-assisted suicide (PAS), and euthanasia. Methods: An anonymous, self-administered online survey was distributed through the New Jersey Medical School servers and American College of Surgeons forums. The survey presented clinical EOL vignettes and subjective questions regarding PAS and euthanasia. Results: We obtained 142 responses from attending physicians. Respondents were typically male (61%), married (85%), identified as Christian (54%), had more than 20 years of experience (55%), and worked at a university hospital (57%). Religious beliefs and years of work experience seemed to be significant contributors in EOL decision making, whereas gender and medical specialty were not significantly influential. Conclusion: Factors such as years of work experience and religious belief may influence medical professionals’ opinions about PAS and euthanasia and their subsequent actions regarding EOL care. In many cases, the boundaries are blurred and require further study before concrete conclusions can be made.

The Somatechnologies of Canada's Medical Assistance in Dying Law: LGBTQ Discourses on Suicide and the Injunction to Live

Somatechnics ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 201-217 ◽  
Author(s):  
Alexandre Baril
Keyword(s):  
End Of Life ◽  
Assisted Suicide ◽  
Mental Disability ◽  
Medical Assistance ◽  
Disabled People ◽  
Canadian Government ◽  
Physically Disabled ◽  
Medical Assistance In Dying ◽  
Oppressed Group ◽  
Physically Disabled People

In June 2016, the Canadian government passed Bill C-14 on medical assistance in dying, allowing for medically assisted suicide when ‘death has become reasonably foreseeable.’ While available for ill or physically disabled people at the end-of-life, medically assisted suicide is denied in cases where people are perceived to have a mental disability and whose suffering is strictly emotional/psychological, such as suicidal people. I argue that this distinction results in constructing two classes of suicidal subjects by considering physically disabled or ill people as legitimate subjects who should receive assistance in dying and suicidal people as illegitimate subjects who must be kept alive through what I call the ‘injunction to live’ and ‘somatechnologies of life’. Analysing discourses on suicide targeting lesbian, gay, bisexual, trans* and queer (LGBTQ) people in LGBTQ scholarship, I argue that, based on the silencing of suicidal subjects through the injunction to live, suicidal people constitute an oppressed group whose claims remain unintelligible within society, law, medical/psychiatric systems and LGBTQ scholarship. This article calls for listening to suicidal people's voices and developing an accountable response to their suffering and claims.

Ethical and Legal Issues in Intensive Care

1997 ◽  
Vol 12 (6) ◽  
pp. 298-309 ◽  
Author(s):  
John J. Paris ◽  
J. Cameron Muir ◽  
Frank E. Reardon
Keyword(s):  
Decision Making ◽  
Managed Care ◽  
Assisted Suicide ◽  
Ethical Issues ◽  
Care Delivery ◽  
Physician Behavior ◽  
Physician Assisted Suicide ◽  
Emerging Issues ◽  
Ethical And Legal Issues ◽  
Seriously Ill Patients

The findings of the SUPPORT study, the largest, most comprehensive and costly study ever undertaken on decision making for critically ill patients, revealed a wide ranging gap between patient preferences and physician behavior with regard to treatment decisions for seriously ill patients. The ethical issues raised by that disparity are intensified as we enter into a market-driven managed care delivery system. This essay explores recent ethical and legal developments on several emerging issues: the decision making process; DNR orders; brain death; withdrawal of treatment; physician assisted suicide; and the constraints of managed care.

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