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Alberta to ban doctors from bringing up MAID death options before their patients do
Alberta doctors will be explicitly banned from raising assisted death with a patient without the person first bringing it up, according to a new bill tabled in the province on Wednesday.
The goal is to ensure the potentially life-ending decisions are “initiated and driven” by people themselves.
Some critics argue that it’s “mind boggling” that, across Canada, medical assistance in dying (MAID) is being presented as a care option. The fear is that initiating a discussion about MAID risks unduly influencing someone to choose it, given doctor-patient power dynamics.
However, Canada’s MAID providers argue that doctors have a duty to disclose “all available treatment options,” including, when appropriate, MAID.
Among other changes, Alberta’s proposed Safeguards for Last Resort Termination of Life Act would, if passed, restrict all regulated health professionals, including doctors and nurse practitioners, from bringing up MAID unless the person raises it.
That fits with most jurisdictions in the world with legalized euthanasia: The suggestion must come from the person.
“We don’t want anyone to be counselled to end their life prematurely if they do not have a terminal illness,” Alberta Premier Danielle Smith said at a news conference Wednesday.
“If we have to make that clear in law, we’ll make it clear in law.”
A guidance document produced by the Canadian Association of MAID Assessors and Providers, updated this month, states that doctors may have a professional obligation to bring up “care options that may relieve suffering” for people with a grievous and irremediable illness, disease or disability, including MAID for people who are likely eligible.
While it’s a criminal offence to counsel a person to die by suicide, “to counsel,” within a doctor-patient relationship, “means to inform, explore and discuss — not to persuade,” the document reads.
Doctors “must not discuss MAID with the intention of inducing, persuading or convincing a patient to request it,” the authors wrote. “The aim is to inform, not to influence,” they said, adding that all options should be discussed to respect patient autonomy and meet informed consent standards.
No doctor should be prevented from discussing MAID when it is “legally permitted and professionally appropriate to do so,” according to the guidance document.
However, at Wednesday’s press briefing, Ontario family physician Dr. Ramona Coelho said she has witnessed patients being approved for MAID quickly, “without a deep dive of their suffering” or discussions around possible solutions to reduce the suffering.
MAID was inappropriately raised with Canadian military veterans by a Veterans Affairs Canada case worker.
Federal Conservative MP Garnett Genuis has a private member’s bill that would prohibit bureaucrats from proposing doctor-assisted death to a person who has not asked for information about it first.
Coelho, who cares for people with complex conditions such as disabilities, mental health issues and chronic pain, said patients have told her they’ve been offered MAID repeatedly, by different people, “and sometimes felt pressured to book MAID assessments.”
While it’s not the majority of doctors in MAID practice, it raises patient safety issues, she said.
“While these conversations are often framed as compassionate, we have to consider the risks, particularly the risk of discrimination,” Coelho later said in an email.
Doctors, like anyone else, can hold both conscious and unconscious biases, she added.
“This means certain groups — such as people with disabilities, older adults, racialized communities and women — may be more likely to have MAID raised to them based on assumptions about their quality of life, and discrimination,” Coelho said.
“The suggestion that MAID should be put on the table for anyone who might qualify runs counter to the core duty of physicians to respect the standard of care,” said Trudo Lemmens, a University of Toronto professor in health law and policy.
“In standard medical practice, physicians must not offer a therapy that comes with significant risks, if other less intrusive means to help the person are available,” he said.
“It’s mind boggling that MAID would have to be offered as some form of universal therapy for chronic illness,” Lemmens added.
“Imagine what that will mean if suffering from a mental illness is a basis for MAID.” Would a person who has had recurrent cycles of depression be offered MAID at some point, he asked.
“It’s perfectly reasonable and in line with suicide prevention if health-care providers are prohibited from bringing up MAID,” Lemmens said.
National Post
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