What Is Medical Assistance In Dying? 15 Things To Know

It is said that people come and go, be it expected or unexpected. When they come, we refer to it as birth and when they go, we refer to it as death. Death in health is referred to as the cessation of heart-lung function or whole brain function.

It can be natural, accidental, suicidal, a homicide, undetermined or pending. These deaths stated may be due to different reasons. However, death may also be caused medically by a licensed health practitioner.

1. What Is Medical Assistance In Dying? All You Need To Know

Medical assistance or aid in dying is a process whereby a licensed health practitioner assists an individual or a patient suffering from a terminal illness to intentionally end his or her life. This physician-assisted dying is done by administering the patient with drugs either intravenously or orally; in other words, aids in dying medications.

1.1. Other Terms for Medical Assistance in Dying (MAID)

• Physician-assisted suicide or assisted suicide.
• Dying medical aid.
• Medically assisted suicide.
• Assisted death.
• Voluntary euthanasia.

Medical assistance in dying and Euthanasia are two different things.

Euthanasia often referred to as mercy killing, is the act of painlessly ending one’s life, ending a patient’s suffering and misery from a disability or a disease that has no remedy. Euthanasia can be known as a suicide when the patient does it himself but it becomes murder if legalizing euthanasia is done by another individual.

While medically assisted suicide and Euthanasia may look similar or have the same goal to give to end one’s life peacefully, these two are different in certain ways. In MAID, a healthcare professional is involved, and the patient is mentally capable of deciding. It can be said that his lifespan is less than six months.

The patient decides on his fate himself and takes the medicine himself. In euthanasia, on the other hand, the patient’s death is caused by another person; that is, this person (who can be a relative, spouse, or parent) gives the order to end the patient’s treatment if they were on one.

2. Medical Assistance In Dying In Canada

It was and still is normal for people in critical health conditions to be in serious pain as it is a stage each one of us will have to go through. Medical assistance in dying as it is was prohibited in Canada as people who felt the pain would just think of ending their lives.

An individual with an amputated leg wakes up suddenly demanding medical assistance in dying. This alone was enough for the government to prohibit this action in the country.

On March 2017, 2021, the Canadian federal government changed this assisted suicide. With legislation made in June 2016, these changes were also enforced to the Criminal law for persons who meet the criteria of whether or not their death is justified.

This new law was put in place to reduce people’s suffering, increase their autonomy and give them freedom of choice; to provide protective measures for individuals who may be vulnerable.

3. Why Choose Physician-Assisted Suicide?

Individuals tend to live their lives to the fullest irrespective of what or who opposes their choice of lifestyle. Hence, when an accident or a particular circumstance meets them, they begin to get negative thoughts and resort to physician-assisted suicide.

However, this is wrong. It is in such situations that they think ending their lives is proper. While there are several reasons for choosing medical assistance in dying, the few below can be said to be common worldwide:

• People feel as if they are a burden to their families.
• No money to continue treatment.
• People have fulfilled their life’s purpose.
• They are being punished by law; here usually, the individuals are given choices to choose from as criminal penalties.

4. Who Can Provide MAID?

• Health physicians.
• Nurse practitioners.
• Pharmacists, technicians, and assistants.
• Family members who can be of help.

Healthcare providers attend to physicians and assist the nurse practitioners with the process.

These health professionals can only carry out assisted suicide if they follow the Criminal code of the country and if the process is applicable in the areas where they find themselves.

5. Death With Dignity

Death with dignity is an option allowed to eligible patients who are suffering from a terminal illness to take help from physicians to put their lives to an end in peace and dignity through a legal process.

5.1. Benefits of Death with Dignity

Death with dignity legislation may have direct and indirect benefits:

1. Patients with terminal illnesses have the autonomy to decide where and when their death should occur.
2. Most people wish to die comfortably in their homes which is allowed to them by law.
3. It assures relatives of those about to die that their loved ones will not die miserably.

5.2. Criteria for Eligibility to Receive MAID

Earlier, in Canada, the law demanded that a person’s death should be natural and predictable. As of March 2017, however, the law changed stating that eligible patients who wished to receive MAID must meet the following eligibility criteria:

1. Persons must be 18 years of age and above with the capacity to think for themselves.
2. The person must make this request voluntarily without being influenced by anything or anybody.
3. Documentation is always important for all processes. The individuals must present informed consent, showing that they have been informed of what they are about to do and that they agree with the process.
4. A patient with the flu cannot be admitted to a hospital unless it is a serious condition upon examination; that is, the individual must have a serious or critical condition.
5. The individual’s condition should be in an irreversible state, that is; there is a decline in a person’s abilities and the condition is fatal.
6. The individual’s psychological state should be intolerable and cannot be relieved under acceptable conditions to them.
7. The individual should be eligible for health care services that are funded publicly, be it by the federal government, or a province or territory.

5.3. Informed Consent

Informed consent is very important for medical assistance in dying to be carried out. Informed consent refers to the patient or individual giving their permission for the process to be carried out. For a patient to give their consent for the method, they should have received all information about the process.

One should have understood every detail about the process and the options one has, to be able to make a decision. Also, the following is included for informed consent to be granted:

• Medical diagnosis
• Alternative forms of treatment
• Alternative options to relieve suffering include palliative care.

It can be withdrawn at any time and in any manner. Informed consent should be obtained:

• At the time of the request
• Immediately before medical assistance in dying is provided in exceptional cases.

5.4. Available Options for MAID

In Canada, assisted suicide can be done through either of the following:

1. With a drug that causes instant death, which is administered and is known as clinician-administered MAID or;
2. Through prescribing a drug the person will take themselves to cause death, known as self-administered MAID.

   

6. Obtaining Medical Assistance in Dying

6.1. Where and How are Services Provided?

In Canada, as long as one is a resident of the country, one can request medical assistance in dying.

For persons experiencing lots of pain and suffering due to their conditions, they can talk to a healthcare provider about their condition and their interest in MAID in case they develop it. For a person receiving medical assistance in dying, it will be determined by the:

• Provinces and territories.
• The organizations regulating health professionals.
• Medical institutions.

Although death comes unexpectedly and may occur anywhere, patients receiving medical assistance in dying may wish to die in some particular places. Most people may choose to take the medications at home, and those who reside in assisted living or nursing home facilities tend to take them there.

Some however may decide to take it in a public place which is not advisable. The law has placed consequences for taking the medication in a public place. Aside from law enforcement on this issue, funeral homes will also find it difficult to remove the remains from a public place.

Taking a lethal dose prescribed under a death with dignity law outside the state where the individual obtained it, may cause them to lose the legal protections offered by the law in question. For example, their death may be seen as suicide under another state’s law.

7. Pro Arguments

7.1. Respect for Patient Autonomy

It has never been heard of a man being told to choose whether to live or die because of a certain situation. Everybody has the right to decide on their end-of-life options themselves; be it a patient or a healthy individual. This is referred to as autonomy.

Autonomy describes a person’s ability to decide his own healthcare decisions for himself without the influence of another party. Medical assistance in dying has never been an option for patients who are critically ill as it is their right to live. It only comes in when a patient is still in their senses and can take an informed decision.

8. Arguments Against MAID

8.1. Protection of Life is Paramount

A person with mental illness will die by suicide is a fact that all health practitioners are aware of. They may have respect for the person’s wish to suicide but do not participate in or facilitate it.

Mental illness may be difficult to treat in some cases, but many physicians must relieve suffering as they have little ability to predict who suffers constantly and who recovers fully or partially. In cases where there is no treatment, care can only be given to relieve the suffering of the individual.

The doctor’s opinion regarding the patient making this decision may lead to errors, not based on scientific evidence, but based on the values and morals of the doctor.

8.2. The Slippery Slope

Doctors must protect the weak or compromised people in society as there is a risk that some practices are prone to abuse, and there is a “slippery slope” of practices that may fail to always protect patients or those in need of protection.

Patients have confidence in medicine, so a conflict might occur due to the doctor’s involvement in certain practices that do not work in line with their duty to treat illness and promote health.

9. Final Consent

Just as informed consent is important for the procedure to be granted, final consent is equally needed to give the ‘go-ahead’ sign to the doctor. This consent is needed to give the person receiving medical assistance in dying to confirm if they to go on with the process or want to withdraw from it. An exception can be made in cases where the person’s death is already predictable.

9.1. Waiver of Final Consent

In Canada, the law concerning medical assistance in dying allows for final consent just before the process if and only if;

• The natural death of the person is foreseeable and,
• The person has a decision-making capacity
• The person is assessed and approved to receive MAID
• One’s practitioner advises that they are at risk of losing their capacity to provide a final consent

A written arrangement is made by the person and his practitioner in which they consent before receiving MAID on a chosen date if they can no longer consent on that date.

Arrangements for the waiver of final consent are considered invalid if, at the time that medical assistance in dying is to be provided, the individual no longer has the capacity and shows signs of refusal or resistance to the administration of MAID by words, sounds, or by actions.

Reflexes, on the other hand, and other involuntary movements like a response to touch or needle insertion, would not account for refusal or resistance.

10. Medical Aid by Self-Administration

Eligible persons can choose to self-administer prescribed medications for medical assistance in dying, and arrangements can be made in writing with your practitioner for a physician’s aid so that they can administer MAID in a specific situation.

This type of arrangement allows for physician aid in dying when complications arise with self-administration so that even if it causes a loss of capacity to make decisions, it does not become the cause of one’s death. This is to say that the health practitioner must be present at the time the person does self-administration.

11. Procedural Safeguards for Terminal Illness

• When death is not foreseeable

Doctors or physicians assess patients on a case-by-case basis. One’s MAID request along with the consulting physician determines if the patient is eligible to receive medical assistance in dying or not. Here are some of the factors considered and steps followed for the determination process:

1. Two medical practitioners must be involved in this process. One of them should be able to properly diagnose the reason for the patient’s suffering and the other should be aware of the appropriate means to alleviate pain, counsel the patient to improve mental health, and provide palliative care.
2. The patient should discuss with his doctor the reasons and the means available to alleviate pain so that they both reach a common point after considering and weighing the consequences.
3. The doctor in charge of the procedure should give the patient an opportunity to withdraw their decision, in case they change their mind before the procedure starts.

• Where death is foreseeable

The death rates of people differ at every stage for each individual, no matter the condition; the reason why natural death is not defined by the type of illness. When a patient’s life is assessed for a foreseeable natural death, certain factors are considered, which are:

1. The uniqueness of the patient’s medical condition.
2. A daily check-up of the person seeking physician-assisted death.

   

12. Implementing The Framework – For Healthcare Providers

Implementing clinical guidelines to help in physician-assisted dying will help physicians know what to do when they encounter this situation.

There are medical ethics all healthcare professionals are supposed to follow. The principle of confidentiality and fidelity is very crucial when a patient suffering from a serious illness, hands over a written request for MAID.

13. Roles of the Provinces and Territories

The federal legislation on medical assistance in dying is part of the Criminal Code. It states that one is not guilty of a criminal offense if they provide or assist in providing physician-assisted death according to the conditions and safeguards in the law.

All healthcare providers must follow criminal law.

Provinces and territories are prohibited from performing actions that are not allowed under the Criminal Code. If the rules they create are within provincial power, they may address health and other aspects of end-of-life care by:

• Using specific forms to be filled out
• Medical training, which serves as physician aids.
• Collection of information and data on the service.

14. Monitoring and Reporting on Medical Assistance In Dying

It is mandatory to always document or report in the death certificate after monitoring the dying medical aid procedure.

Accountability is not just a term but a very important feature every healthcare facility should have as all procedures are to be carried out flawlessly.

Monitoring the patient is a very critical point as it helps analyze physician aid throughout the end of one’s life.

According to Canadian laws, the Minister of Health must:

• Publish guidelines about what information is to be included on the death certificates of those dying through medical aid.
• Make regulations to collect information about race, full background checks, Indigenous identity, and disability.
• Report publicly on medical assistance in dying in Canada, including forms of inequality and disadvantage that may be present.
• When necessary, consult with the minister responsible for the status of persons with disabilities to amend the regulations.

These public reports give a clear picture of how the legislation works and the impact it has.

15. Is it a Safe Practice?

The main aim of dying medical aid is to give an individual who is terminally ill, a peaceful death. Usually, some may have been given palliative care but suddenly feel it is a waste of time for their life.

Medical assistance in dying is a relatively safe medical practice as the persons involved make their own healthcare decisions. The attending physician’s involvement in this situation only comes when the patient’s mind is set.

It is a suitable practice for persons with mental disorders who are terminally ill with no alternative to choose from when medical treatment has stopped working.

Because an individual can self-administer the drug, there is no fear of someone changing his medication.

With advantages come disadvantages. More than half of patients suffering from cancer show symptoms of depression. The elderly especially also suffer from high rates of depression and suicide could be a result. Because clinicians usually miss depression, if not screened, other conditions could follow as depression occurs somatically.

In Oregon for example, more than 70% of patients who elect assisted aid in dying are elderly and have cancer, but lesser than 5% are referred to a psychiatrist or psychologist to rule out clinical depression.

16. Conclusion

Medical assistance in dying has been on the rise and is a very crucial topic in the care of patients, be it palliative care or the mental health of patients. Although it is a peaceful death for patients, not all physicians are comfortable with the practice.

So, the American Medical Association’s House of Delegates voted in June 2019 to maintain the organization’s long-held opposition to physician-assisted suicide and Euthanasia.

Several strong arguments favor and oppose the practice, and physicians have an ethical responsibility to remain informed on this timely issue.