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Thursday, February 27, 2020

Proposed changes to Medical Assistance in Dying (MAID)

There are changes being proposed for Canada's law regarding medical assistance in dying (MAID). This is the legislation that allows a person to choose to end his or her life because of suffering caused by disease, injury, or other causes. Many clients of mine have questions and comments about how the existing law works and it appears that the proposed changes will be welcome. If accepted and put into place, the changes will increase availability of MAID to Canadians.

The proposed changes are being made to Canada's Criminal Code, the document that describes which actions and behaviours are illegal in our country. This means that any changes that are accepted and passed by the government will be applicable in all provinces and territories. Here are some of the changes being suggested by the amendment to the law:

1. It's suggested that the requirement that death by natural causes must be "reasonably foreseeable" should be removed from the law. Right now, in order for an action under MAID to be legal, it can only be done where the person choosing to die can reasonably foresee his or her death due to natural causes. The current law obviously means to allow MAID only for those who are soon going to die due to disease or dysfunction soon anyway.

2. When a person wants MAID and their death is reasonably foreseeable, the new law wants to dispense with their final consent (on the day of the procedure) where mental incapacity is or might be an issue. This is, in my view, a very important revision and I hope this change is endorsed by the government. It would go a long way to prevent individuals from ending their lives too soon because they may not have capacity to consent to MAID if they wait too long. It would probably also work well with Advance Healthcare Directives, which I will explore further if these amendments become law.

3. When a person wants MAID but their death is not reasonably foreseeable, there will be a requirement that the person be examined by two healthcare providers. One of the healthcare providers must have expertise in the condition that is causing the person's suffering. The assessment period should be at least 90 days, but that time limit can be shortened if the person doesn't have capacity and all the assessments have been done.

4.  It's proposed that a person whose only medical condition is mental illness should be disqualified from accessing MAID.

5. It's proposed that the mandatory ten-day reflection period be removed.

6. When a person signs to accept MAID, there must be two independent witnesses to verify the person's identity. The proposed change is to provide for only one witness.

7. Also built into the new proposal is a requirement that a person requesting MAID must be advised of options such as palliative care and supports.

Note that at present, these are only proposed changes to the law, but they will be dealt with by the government one way or the other in the near future. The changes are intended to improve access to MAID by those who need and want it. The proposal also asks for more reporting of information so that we can get a better picture of who is using MAID, and how they are using it.

As with any new law, or the first laws touching on certain subject matter, we had to start somewhere. We started with a limited law (that is, a law that allows MAID but perhaps was not extensive enough). After using the law for a while, we become aware of what could be improved. It will evolve over time as we gain some experience with it.

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