Vulnerable falling through MAiD cracks

As the outcry from those who say the life of a loved one was wrongfully extinguished due to blind spots in Medical Assistance in Dying (MAiD) legislation has grown louder, many are worried that their concerns are falling on deaf ears.

Families working to hold the federal government accountable for their loved ones falling through the cracks say no one in government is listening to their pleas for more safeguards to prevent unnecessary deaths.

“It is imperative that these safeguards ensure vulnerable people are provided care as the first option, not death,” said Alicia Duncan.

Duncan’s mother’s life came to an end, to Alicia’s shock, Oct. 29 at age 61. After experiencing a decline in health after a car accident in March 2020, Donna Duncan, her daughter found out, had applied for and been approved to end her life through MAiD. She was scheduled to die in less than 48 hours.

The Duncan family believes their mother had not followed through with any prescribed treatment. Since her death the family has been able to review her records and discovered that the diagnosis for which she received MAiD had never been confirmed by a specialist, a safeguard legislated in Bill C-7. The family is supporting a police investigation into Donna Duncan’s death, the first such investigation into a MAiD killing.

“We cannot understand how activist doctors can justify access to specialists taking months or years yet access to dying can take just days,” said Duncan. “This is a direct indication of a broken health-care system and killing patients who have the possibility of recovery is not the answer.”

Donna Duncan’s story was one of many related at a May 10 news conference in Ottawa intended to sound the alarm to the apparent negligence in ignoring these voices. Arguments were made for greater safeguards to protect the vulnerable and marginalized persons who could find medically-assisted death easier to access than social services, medical specialists or treatments that could help ease suffering.

Gabrielle Peters, co-organizer of the Disability Filibuster, a grassroots group of Canadian disability and equality right activists, has heard the stories of many in their community who say MAiD legislation is adversely impacting their lives. One person disclosed that the expansion of MAiD has triggered suicidal ideation, which combined with their unsupported chronic condition and poverty is making it a sometimes hourly struggle to go on. The lack of adequate support throughout the pandemic for those with disabilities, Peters says, makes the ease of accessibility to MAiD an even greater injustice.

“The pandemic response and failure to include us and to actually create policy that ignores or conflicts with our needs, while crafting a specifically tailored just for us red carpet to lethal injection, can’t help be interpreted as a value statement on our lives if not outright coercion,” said Peters in a statement. 

Sr. Nuala Kenny, professor emeritus of paediatrics and bioethics and Dalhousie University, has been a long-time advocate for the protection of the vulnerable and says these situations were predictable from 2015 when the Supreme Court decriminalized medically assisted death. Based on the Charter of Rights and Freedoms, the court recognized the protection of the vulnerable and the protection of conscience in that no physician would be forced to perform the procedure. But “everything that’s happened since has been the exact opposite,” said Kenny.

The basis of the 2015 decision was that everyone should have the freedom of choice on whether to live or die. Under medical ethics, part of the requirements for a free and informed choice is freedom from undue influence or coercion. In the case of people who are seriously ill or suffering from intractable pain or mental anguish, freedom is compromised, Kenny explains.

“You’re not free if you don’t have any options,” said Kenny. “The poorer you are and the more the circumstances of your situation are failing and you’re on the margins, it’s the more likely you are to have no options. How can you be free if you don’t have any options?”

Trudo Lemmens, professor in health law and policy at the University of Toronto, says particularly in areas where people are dealing with the intersectionality of factors such as poverty, health conditions, mental illness and disability, they are not getting the support needed for a dignified life. With long wait times for specialists, rising food and housing prices and the opioid crisis, he believes the cases of wrongful death coming to the surface due to MAiD are the “tip of a volcano about to erupt.”

A big part of the danger in Canada, Lemmens says, is that physicians are not obligated to ensure patients interested in MAiD explore all other reasonable options to relieve suffering before being granted their approval for euthanasia.

“Canadian law doesn’t give us a lot of tools to prevent this.”

Still, the federal government is forging ahead with plans to further expand legislation which now permits individuals to pursue MAiD whether or not natural death is reasonably foreseeable.

A special joint committee of Parliament and the Senate is reviewing the current legislation and considering the expansion to those with mental illness, as well as the possibility that those with conditions such as dementia could pre-apply for MAiD while they still have the mental capacity to do so. MAiD had initially required that a patient be physically suffering and have a terminal diagnosis, which a majority of Canadians supported, according to opinion polls.