Assisted Death Is Not a Choice of Last Resort in Canada
New York Times · LC · trust 46/100
Credit... Dagou Listen · 9:07 min Share full article By Gary Rodin and Madeline Li
Drs. Li and Rodin are professors of psychiatry at the University of Toronto.
We know that medical assistance in dying can be dignified and profoundly meaningful for everyone involved. We remember a man in his 30s in our palliative care unit who, thanks to the procedure, was able to choose to die before he became even sicker and potentially lost the ability to communicate. He said a final goodbye to everyone he loved, including his 5-year-old son, and died with his wife beside him and a music therapist singing Leonard Cohen’s “Hallelujah.”
But Canada’s system for assisted death is no longer an option of last resort. Too many people are receiving the procedure without the opportunity for careful reflection about it with a health provider. In some cases, patients are being approved who should not be. Reports have emerged of people seeking assisted death in the context of poverty or loneliness, raising concerns that they may feel they have no other options. In other cases, including for many of our cancer patients, medical assistance in dying may be the right choice eventually, but there’s a risk of rushing into it and shortening what can be a meaningful period in patients’ lives.
Canada’s medical assistance in dying program started in 2016 as an option only for patients with a “reasonably foreseeable” natural death. In 2021, Parliament removed the foreseeable death requirement. Today, Canada’s system is one of the most permissive in the world, allowing assisted dying for almost any form of subjectively intolerable suffering that has a medical basis, or even for medically unexplained physical symptoms. This latitude may contribute to Canada having the fastest growth rate of assisted dying in the world, increasing 16-fold in the eight years since legalization. The procedure now accounts for over 5 percent of all deaths in the country.
How did we get here? Within the Canadian system, medical assistance in dying is the result of a decades-long campaign aimed at enshrining it as a human right — often in the face of strong pressure from groups who opposed the procedure on religious or other grounds. Activists who support the procedure are still understandably wary of anything that could make it harder to get, often warning of unnecessary “gatekeeping” that might interfere with a patient’s autonomy. These activists helped shape the laws that govern the procedure and were instrumental in supporting the first medical networks that emerged to administer it.
Perhaps as a result of this influence, many doctors have come to see their primary role to be making sure their patients meet the legal eligibility requirements to qualify for assisted dying. They must, for instance, be experiencing intolerable suffering and have the mental capacity for informed consent. The problem is that there has become far more focus on whether patients can get an assisted death and not enough on whether they should.
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