Safe places for patients in an era of MAiD

11 September 2023

A Vancouver woman went to the hospital this spring looking for psychiatric help. Kathrin Mentler was worried about her suicidal thoughts and feelings of hopelessness.

Her conversation with a clinician at the hospital was disturbing. A Globe & Mail article this summer shared her account:

She was like, “I can call the on-call psychiatrist, but there are no beds; there’s no availability,” Ms. Mentler said. She said to me: “The system is broken.” But it was the clinician’s next comments Ms. Mentler found particularly distressing. She said, “Have you ever considered MAID?”

MAiD, the acronym for medical assistance in dying, is Canada’s term for voluntary euthanasia.

Kathrin Mentler told The Tyee she was “shocked” and “sickened” because she’d gone to the Access and Assessment Centre for help, “not for recommendations on how to kill myself.”

The hospital says the questions were part of an assessment of the woman’s risk of suicide.

This conversation shows one of the very real risks of Canada’s euthanasia regime. In a strained healthcare system, is euthanasia more available than medical treatment?

It’s also an example of the distress that can be caused by having a medical professional raise euthanasia with a patient who hasn’t requested it.

Recently, Health Canada published guidelines suggesting provinces require doctors to inform patients of “the full range of treatment options to relieve suffering,” which may include bringing up MAiD to patients who haven’t requested it. If the doctor has reasonable grounds to believe a patient is eligible and it seems to be consistent with their values, the doctor is to “advise the person of the potential for MAID.” 

There are many, many problems with and concerns about doctors raising MAiD with their patients. One concern is the power imbalance of the doctor-patient relationship and the weight patients tend to give to treatments suggested by their doctor. As well, many people who request MAiD do so because they feel like they’re a burden. A doctor suggesting MAID to patients who feel that way may seem like confirmation that they are a burden. It’s also very problematic to bring up MAiD to patients when there is a lack of timely and accessible healthcare and supports.

Dr. Sonu Gaind, chief of psychiatry at Sunnybrook Hospital, explained in a recent iPolitics interview that he is deeply troubled about this proposed policy because Canada’s laws are so broad that a large number of patients could be considered eligible for MAiD. He raised the concern that if a doctor initiates a discussion about MAiD, it could be considered medical advice or suggest that a patient is a burden on the system.

“The reality is that there’s somebody in front of you that is suffering and coming to the medical professional for help, so they’re in a vulnerable state…and they’re seeking help from someone that they perceive as having expertise to help them,” he said. “When that person then says, ‘Oh, have you thought about’ MAID, it’s impossible to pretend that doesn’t also risk coming across as a suggestion.”

The EFC has consistently argued that requests for MAiD must be patient-directed. As the EFC said in a submission to the CPSO on MAiD last November, “Raising MAiD as an option suggests to a patient that the clinician sees their life as not worth living.” The EFC went on to point out that for patients, “Seeking treatment and healing – but instead being offered death by the one designated to provide care – can cause feelings of betrayal and great distress.”

As Brian Bird points out in a recent National Post column, “There is profound value in preserving sanctuaries from euthanasia in our healthcare system.”

These sanctuaries are needed to protect patients. It assures patients that they will receive the treatment they seek, treatment that is intended to preserve and protect their lives. These sanctuaries will also allow a place for doctors and healthcare staff who object to participating in ending the lives of patients via MAiD on the basis of conscience.

As Brian Bird states,

Healthcare communities that conscientiously refuse to provide euthanasia are not simply protecting their moral and ethical integrity and the persons who work within. They are protecting patients who do not want to be treated in facilities where euthanasia will be proposed.

Disability rights organizations recently posted on social media that they would not suggest or refer anyone for MAiD as an alternative to obtaining necessary supports and services. “You are safe here” was their message.

It is a tragedy that this is a message that needs to be conveyed in Canada.

In an era of MAiD, it is essential that there be safe places for Canadians to receive healthcare that values and supports their lives.

The EFC offers a free action kit on MAiD expansion.
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