MAiD: When is the Patient Capable of Consenting?

Audrey Parker, a long-time advocate for medically assisted death, passed away peacefully, on November 1, 2018, surrounded by friends and family, but not before she pleaded with Canadians to seek changes to the two-year-old MAiD (medical assistance in dying) law.

The Canadian senate passed a law to allow for medical assistance in dying in 2016. The criteria to qualify includes being mentally competent and being at a state of physical health where death is foreseeable in the near future. In Parker’s case, because of the mental competency concerns, she was forced to move her date to November 1, 2019.

Dr. Beverly Smith stated that, “Right now, because of the competency issue those who are mentally ill cannot end their lives”. This also includes those who might become cognitively impaired as their planned MAiD date approaches. The patient must not only be of sound mind when applying for MAiD, but also at the time it is being administered. For Parker, because of the possibility that the painkillers she was taking for cancer could have left her unconscious or mentally incompetent before this crucial moment, the procedure would not have taken place, forcing her to reconsider the date.

There were 3978 suicides reported in Canada, in 2016, according to Stats Canada, compared to the 1961 medically assisted deaths which occurred in 2017. Smith attributes the difference in statistics to suicide being more prevalent in those who are mentally ill. “That’s the group where medically assisted dying would currently be precluded”.

Smith also noted that, “there’s some pressure on people who are in the legal area to open this up to those who may be cognitively impaired later on, so they can make the decision in advance before they lose their ability to make decisions”.

Jennifer Chalklin, RPN, also feels that this area of the law should be expanded. “Many live miserable lives with mental health issues that no amount of medication, treatments and therapy can cure” says Chalkin. “If all options have been exhausted why shouldn’t they [the mentally ill] have a peaceful death at a time that is pre-arranged?”

Smith, however, is concerned that by adjusting this criterion of the law, it “would lower the value of human life”. Chalklin believes that “life is forced on people”, and that allowing those with cognitive issues or mental issues should not be excluded from the law. “It would be far less traumatic for families and friends left behind,” says Chalklin.

Although it is too late for Audrey Parker, her plea to Canadians to push for change to current MAiD criteria continues.