Doctors and experts write public dissent of MAID report

07 March 2023

If you read anything on medical assistance in dying, read this letter.

This is a powerful critique by doctors and experts who testified before the special joint parliamentary committee on MAID. They go through the recommendations in the committee’s report, identify flaws and explain their dissent. They identify the underlying bias and ideological commitment in favour of MAID expansion in the committee’s report. They describe what should be studied or recommended based on the evidence. 

This letter is incisive, cutting to the heart of the issues.

It goes through the five topics dealt with by the committee: the state of palliative care in Canada, protections for Canadians with disabilities, MAID for mental disorders as the sole underlying medical condition, MAID for mature minors and advance requests for MAID.

Following are some excerpts from the letter. See the letter itself for the list of doctors, psychiatrists, ethicists, disability experts and others who signed it and for more complete text.

On palliative care

The committee also ignored the reality of the power imbalance between healthcare professionals and patients, and how a healthcare professional raising the option of MAiD unsolicited may coerce those who lack support and feel a burden into considering they are better off dead.

Choosing to die from MAiD in the face of lack of timely, quality palliative care and supportive services is NOT a choice. For those with a terminal illness, provision of early, quality palliative care should be a prerequisite for MAiD if it is to be an effective safeguard (contrary to the committee’s Recommendation 7). Failure to provide palliative care early should be considered a medical error.

Canadians should know that the Joint Parliamentary Committee has failed to consider compelling testimony by palliative experts, as well as polls from Canadians wanting access to timely and quality palliative care. The lack of significant action on access to quality palliative care across Canada will have a significant impact on Canadians with serious illness for years to come.

On protection for Canadians with disabilities

The Report on MAiD by the Special Joint Committee ignored, diminished and misrepresented the statements of disabled witnesses who were allotted 5 minutes to contextualize and explain MAID’s place in Canada’s history of eugenics and oppression of disabled people.

Understanding the body of knowledge and critical analysis of disabled scholars, academics, professionals, activists and community members should have been the Committee’s focus. The importance of this cannot be overstated.

Disabled people are the only people eligible for MAiD. Disability is a large umbrella term that includes people with chronic and mental illness of varying degrees as well as a range of impairments. All the language used in MAID legislation is a synonym for disability. To say that someone has a serious illness or disease is to say that person is disabled. …The fact MAiD is only available to disabled people is not reflected within the process and report.

On MAID for mental disorders

The Committee’s recommendations place Canadians who would recover from mental illness at risk of avoidable premature death, and if enacted will be responsible for facilitating state provided deaths to marginalized and suicidal Canadians who would have recovered.

… presupposing that MAID [for mental illness alone] should be implemented, rather than pausing expansion pending proper review of evidence, reveals the Committee’s ideological bias. This ignores unresolved concerns of evidence showing that: (1) mental illnesses cannot be predicted to be irremediable in any individual, yet assessing irremediability is the fundamental underpinning of MAID; (2) suicidality cannot be distinguished from requests for MAID …, and; (3) marginalized individuals, including women by a 2:1 margin, are particularly at risk of seeking premature death by MAID MD-SUMC for social suffering.

In ignoring known evidence-based risks of providing avoidable death to marginalized and potentially suicidal individuals suffering from social distress who could recover, while favouring MAID expansion to increase autonomy of the more privileged, the Committee is condoning a form of eugenics through expanding MAID in Canada.

On MAID for mature minors

The committee's recommendations undermine the ability of those individuals most responsible for protecting the child, the child's parents, or caregivers. By making no provision for parental consent to treatment, the fundamental safeguard in a minor’s life is effectively nullified.

The committee failed to act as mature adults who recognize that minors are a group with unique disadvantages arising inherent within human development, and thereby are dependent upon adult legislators to create laws that effectively protect minors from systemic abuses.

On advance requests for MAID

To permit MAID for persons unable to consent would require solid evidence that prior consent remains valid. The Special Joint Committee on MAiD report fails to provide it. 

Advance consent cannot be informed in the way that contemporaneous consent can be—and even that form of consent faces challenges. It is self- evident that it cannot be withdrawn once the person is incapable. Most would conclude therefore that it is not true consent. Witnesses pointed out that it therefore runs counter to the emphasis on ‘clear consent’ in the Supreme Court’s Carter decision. The parliamentary report glosses over it.