Ralph Surette’s April 3rd column in the Chronicle Herald hopes to convince us (especially those of us who are over the hill?) that now that a revised MAID (Medical Assistance In Dying) law has passed, a large portion of our population, “the frail, the elderly, the poor and terminally ill” are on a slippery slope to early death whether we yearn for it or not.
The new MAID law, Bill C-7, which passed in March, amends the Criminal Code to:
a) repeal the provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for medical assistance in dying;
(b) specify that persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying;
(c) create two sets of safeguards that must be respected before medical assistance in dying may be provided to a person, the application of which depends on whether the person’s natural death is reasonably foreseeable;
(d) permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner; and
(e) permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.
Surette claims “economics” will cause the young and healthy to succumb to the temptation to stop funding healthcare for those older and sicker, a claim he buttresses by citing reports of American insurance companies refusing to fund expensive end-of-life treatments in favor of the “cheap medically assisted death option;” American polls that find the young and healthy support MAID more than do the “elderly, the poor and terminally ill;” a British study bemoaning the lack of a role for economists in the debate over euthanasia; and — finally, a Canadian reference — a 2017 CBC article with the headline “Medically assisted deaths could save millions in health care spending,” (based on research published by the Canadian Medical Association Journal).
I find it hard to picture his fears becoming reality, given the manner in which doctors and other healthcare workers have been working, often in unbearably difficult conditions, to save lives in this pandemic — including the lives of the frail, the elderly, the poor and those with underlying conditions. Not to mention the way the elderly have been prioritized for vaccines in this province and the poor treated no differently than anyone else in their particular age cohorts.
But to further question Surette’s scary outlook for what could transpire now that a new and improved MAID has been enacted into Canadian law, I would just quote from an Ontario study of those who have already been recipients of MAID which reveals that:
More are likely to be married, more are likely to be from a higher income group, are less likely to reside in an institution, less likely to be widowed, more likely to be women and more likely to have a cancer diagnosis.
A retired RN, Nesta Yeo, in a letter that appeared in the Herald on the same day as Surette’s column, stressed that:
[N]o one but you decides to have MAID. You are not forced to accept it, and do not be pressured by anyone to do so. But I believe that we should have the choice and the privilege of advanced consent when life, to us, becomes unbearable.”
I agree but wonder if I would have the courage to make the decision.
Surette (and good for him) has joined a Yarmouth group to visit “lonely and neglected” seniors, a group instituted in 2016, as MAID became law, by Sr. Nuala Kenny — a former NS deputy minister of health and well known “medical activist” who opposes MAID.
First, I would point out that such groups have been carrying out this charitable act for years. Here in Cape Breton, and no doubt in other parts of the province that boast Catholic Women’s League (CWL) Councils, visits to nursing homes to provide entertainment and refreshments to residents are common. Anyone who has sat with a palliative care patient knows the reality of those generous women and men, often members of a hospice group, who offer tea or juice to patients and visitors, as well as to those awaiting appointments in cancer-care facilities.
Photo of her medical aid in dying drugs posted by Ronni Bennett, a 64-year-old former New York television producer, who chronicled her own illness and decision to seek MAID on her Time Goes By blog)
But second, and on the subject of palliative care, I have to note that some of us find it difficult to understand the subtle difference between it and MAID, and why the Catholic Church considers MAID immoral but palliative care permissible.
The “ethical rationale” for palliative care is based on the Roman Catholic doctrine of “double effect,” which the Stanford School of Medicine defines as:
…a rule of conduct frequently used to determine when a person may lawfully and ethically perform an action from which two effects will follow, one bad, and the other good.
Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable. Palliative care is a special form of disinterested charity [?]. As such it should be encouraged.
My very first experience with a palliative care patient (this was pre-MAID) comes to mind. This woman, knowing her cancer was terminal, made the decision to accept “a cocktail of drugs” that would ease her way to a dignified and pain-free death. It impressed me as an act of tremendous courage.
Having visited six different palliative patients over the past few years, I feel the benefit to the patient’s family and friends is the opportunity to be present at the end, but MAID can offer an added benefit, in that the patient is usually aware and in control of what transpires, having spent time with those in attendance, perhaps sharing a meal and final goodbyes.
Some worry MAID will be chosen by people without access to palliative care. But the new Hospice being erected in Sydney will offer palliative care to patients who do not wish to die at home and will follow the steps already in practice in the hospital. Family will be able to stay with the patient and a bed for someone wishing to stay overnight will be available. Families who have experienced the care and concern from palliative care staff at the Cape Breton Regional Hospital have only praise for the manner in which they and their loved ones have been received and treated during what is a difficult experience for all concerned.
Activists in this country have been pushing for medical assistance in dying for decades. Dying With Dignity, according to its website, was founded in Canada in 1980 by Marilynne Seguin and a “handful of fellow pioneers.” Seguin, a registered nurse, having heard from “desperately suffering patients over the course of her career,” felt compelled to become involved, even to the point of writing a book, The Gentle Death, which shared “heartbreaking stories” and made a “forceful case for assisted dying.” Seguin’s book was published six months after Sue Rodriguez’s bid to have such a death was struck down by Canada’s Supreme Court in a 5-4 decision.
Since MAID was introduced in Canada in 2016, there have been 13,946 assisted deaths, 358 of them in Nova Scotia. In 2019, MAID accounted for 2% of deaths in Canada.
Back in January 2020, Ellen Riopelle interviewed Dr. Gord Gubitz, a member of the Nova Scotia Health Authority’s “MAID Team,” for The Signal.
Gubitz was discussing plans to provide more “support” for the doctors who volunteer for the program and who “tend to do these things on evenings and weekends,” making them vulnerable to burnout. At the time he spoke to Riopelle, the MAID team had grown from about six people initially to “more than 50” across the province.
Gubitz told Riopelle that while MAID can seem “horrible and daunting” to those who have never been involved, for him “it’s a rewarding experience.”
It’s a terribly, terribly sad time…but there’s a sense of happiness that the person is no longer suffering and they got what they wanted.
There’s almost a weight that comes off people’s shoulders when they see that finally this person is at rest, and they are not suffering any longer.
Dolores Campbell, a lifelong resident of Sydney, is a freelance writer whose work has appeared in The Cape Breton Highlander, the Nova Scotian, Cape Breton Magazine, Catholic New Times and The Cape Breton Post.
