The federal government recently launched a “
national conversation” about allowing advance requests for medical assistance in dying (MAiD). The national conversation includes an
online questionnaire that is open to the public until February 14, 2025.
An advance request for MAiD would allow a person’s life to be ended when they are no longer able to consent. This is different and more specific than an advance directive on health care, in which a person indicates their priorities and wishes for their future care.
Some groups are pressuring the federal government to allow advance requests for MAiD. The province of
Quebec started allowing advance requests for MAiD on Oct. 30, even though it remains prohibited in the
Criminal Code.
The EFC has consistently expressed its opposition to allowing advance requests for MAiD and will continue to do so as part of this national conversation.
Why do we oppose advance requests?
- Requiring that a person be capable of consent at the time their life is ended by MAiD is a critical safeguard against abuse and involuntary euthanasia.
- Allowing advance requests would set a very troubling precedent of ending the life of a person who isn’t able to give their consent. The ability to consent is one of the protections that make children and infants ineligible for MAiD (along with the current age limit, which some have proposed removing) or adults with severe physical or intellectual disabilities who are unable to communicate consent.
- One of the central rationales for allowing MAiD has been that it is all about autonomy, allowing a person’s choice to end their life. And yet, with an advance request, it would no longer be the person who is choosing the time of their death. They would instead be held to a prior wish that they are no longer capable of confirming, with a doctor or nurse practitioner interpreting their wishes and choosing the time of death.
- People change their minds. In the early MAiD reports, when there was a reflection period of 10 days for those who were dying, people changed their minds. As one study noted, half of the terminally ill patients who had seriously considered euthanasia or assisted suicide for themselves changed their minds after a few months. Patients with depressive symptoms were more likely to change their minds about desiring euthanasia.
- A person may be content in their circumstances in ways they didn’t anticipate. They may experience a quality of life they did not predict. Their wishes and perspectives may change over time and with new circumstances. Predictions about future suffering are speculative. It is anticipated suffering. As a study on dementia and euthanasia noted: “Dementia affects each individual differently, in part due to the area and magnitude of the damage to the brain, but also because of the uniqueness of each individual. Some sufferers of dementia may retain their personality while others may experience dramatic personality changes; there is simply no way to know how the disease will affect a person or how the person will feel about their quality of life once the disease has set in.”
- We don’t know the future. There are often complications in the application of advance directives because of the difficulty of trying to fit previously expressed wishes with a reality that is more complicated or doesn't align with the anticipated progression. As Dr. Blackmer of the Canadian Medical Association stated to the Special Joint Committee on Physician-Assisted Dying in reference to advance directives: “What I can tell you is that in real-life practice, putting advance directives into action is incredibly complex and difficult, because it's very hard to capture all of the nuances and the specifics of a very complicated medical condition and intervention. Even in the best of situations, physicians have a lot of difficulty actualizing an advance directive.”
- A person may not remember their request or understand what’s happening to them. A study from the Netherlands notes that many Dutch elderly care physicians “state it is impossible to determine at what moment an advance euthanasia directive is to be carried out if the patient can no longer specify this. Also, it is probable that physicians cannot conceive of performing euthanasia in a patient with dementia who might not fully comprehend what is happening.” In such instances, decisions are not based on the individual’s autonomous decision in the moment, but on the determination of others.
- There may be the possibility of a conflict of interest for the decision-maker – the doctor or family member – such as pressure from administration to make beds available, considerations of the cost of care, family conflict, inheritance, etc.
- Determining when the preconditions for ending a person’s life have been met is a significant burden to bear. Advance requests put significant additional responsibility on the physician, who must decide at what point a patient’s life will end. Currently the doctor carries out the request of the patient. With advance directives, the doctor must identify the particular time at which the patient would want to die. It is an interpretive role but also a progression in role. The doctor goes beyond carrying out the patient’s request to having to interpret the request, possibly in the midst of unforeseen circumstances and complications, and decide on the timing.
- Discrimination against people with disabilities is implicit in advance requests for MAiD. Allowing a person to request their life be ended by MAiD if they lose certain abilities or require a particular level of care can legitimize the idea that the life of a person who is in those circumstances is not worth living.
Please join us in opposing this expansion to the euthanasia law. Your voice makes a difference. Call or write
your local MP to let them know you oppose advance requests for MAiD. MPs would need to pass any new expansion in law, and it’s not too early to let them know that you oppose it.
And please keep our country and its vulnerable citizens in prayer.