Medical assistance in dying: Do doctors need to know more about Canada’s new law?

Click to play video: 'Medical assistance in dying: why some say they are being unfairly denied, despite new law' Medical assistance in dying: why some say they are being unfairly denied, despite new law
Health Matters May 6: A new law in Canada opens access to more people for medical assistance in dying. But some say, without increased awareness, people will still be unfairly denied. Su-Ling Goh has one Edmonton woman’s heartbreaking story. – May 6, 2021

Canada’s new law for medical assistance in dying (MAID) opens access to more Canadians, but some say awareness among physicians needs to increase because patients are still being unfairly denied.

When Bill C-7 received royal assent on March 17, the new legislation immediately came into force. It removes the requirement for a person’s natural death to be reasonably foreseeable.

READ MORE: Canadian Senate passes Bill C-7, expanding assisted dying to include mental illness 

“The person could have an underlying condition or could be early in a diagnosis of something that isn’t necessarily going to be fatal, but is causing them enduring suffering,” Dr. Chantal Perrot, an advisor for Dying with Dignity Canada, told Global News.

That’s why one Edmonton woman doesn’t understand why she was turned down for MAID. Shondra (who does not want to be identified because of fears her estranged family would try to interfere with her decision) had the required assessments by two doctors in April, after the new law came into effect.

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READ MORE: Alberta patients facing challenges accessing medical assistance in dying 

The first doctor approved her for MAID, but the second told her she was not sick enough to qualify.

“I (told the second doctor) I’m riddled with pain day after day… my breathing gets terrible and I (told him) I just can’t live like this anymore,” Shondra told Global News.

“You want me to live, but you want me to suffer in the meantime. It’s not fair.”

The 67-year-old has advanced chronic obstructive pulmonary disease and depends on an oxygen tank around the clock. She also has fibromyalgia, a thyroid condition and arthritis in her spine, which she describes as feeling like “bee stings” all over her body.

“(The pain) starts in my back and it goes down my arms and my legs. It’s just excruciating,” said Shondra.

Perrot has not met Shondra, but the family physician and psychotherapist has assessed more than 100 patients in Ontario for MAID eligibility.

READ MORE: Collaboration between House of Commons, Senate on assisted dying bill praised by senator 

She feels not enough physicians know about, and understand, the new law. And there have always been misconceptions about assisted dying legislation in Canada.

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“You never really had to be close to death. Your death had to be what is called ‘reasonably foreseeable’ or ‘reasonably predictable,'” explained Perrot.

“I think a lot of people, including some MAID assessors and providers, mistakenly interpreted ‘reasonably foreseeable’ as you had to be terminal, within weeks or months of a natural death, and that’s not the case.”

The new law introduces a two-track approach — relaxing some rules for people whose death is relatively predictable, and adding safeguards for those whose death is not.

For the latter group, that includes a minimum 90-day period between the person’s first assessment and when they receive the MAID procedure.

Perrot says MAID teams are required to educate patients about all treatment and support options to help them relieve their pain and suffering, and to ensure they are making an informed decision.

Still, in her five years of assessing for and providing MAID, few have changed their mind.

“Most of the patients that I have assessed have been very clear in their conviction: ‘I want MAID and I want it right now and it’s my right,'” said Perrot.

“I have had a couple of patients change their minds, because they didn’t think their families were supportive and they didn’t want to hurt or upset their families.”

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Since 2016, when MAID first became legal in Canada, more than 13,000 people have received the procedure. At least 571 who applied were declined.

According to a 2019 Health Canada report, the most common reasons for ineligibility were applicants’ lack of capacity to make health-care decisions (32.2 per cent), their natural death was not reasonably foreseeable (27.8 per cent) and they were not in an advanced state of irreversible decline in capability (23.5 per cent).

Shondra has requested a third assessment.

“I can’t go out. I’ve been secluded because of COVID(-19) for a year and a half, and it’s terrible when you’ve got to depend on strangers,” said Shondra.

The only people she sees are her home-care staff and grocery delivery people. She says she hasn’t left her apartment in over a year because she can’t get down the stairs with her walker.

The senior has considered jumping off her balcony, but would prefer to die peacefully.

“I want to get this pain over with. I want to rest in peace.”

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