Ask the Canadian Council of Academies to expand access to MAiD

The Council of Canadian Academies (CCA) is consulting Canadians on whether access to medical assistance in dying (MAiD) should be expanded.

Specifically, the CCA is looking at the current restrictions to mature minors, advance requests and people whose sole underlying condition is a mental illness.

As Humanists, we support access to MAiD for all who freely choose it.

Our response says:

  • There is no moral argument to restrict mature minors from accessing MAiD
  • Without a provision for people to make an advance request for MAiD
  • It's discriminatory to exclude people with mental illnesses from accessing MAiD
  • There are additional barriers, including institutional conscientious objections, that prevent many Canadians from accessing MAiD.

If you support our position, add your name.

The CCA is accepting submissions until October 6 (deadline extended), at which point we will submit our response, including the number of supporters who back our position.

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Expand access to MAiD

We believe the current restrictions on mature minors, advance requests and people with mental illness are discriminatory and unjustly infringe on the dignity of Canadians.

Humanism is a worldview based on the recognition and advancement of human dignity. To this end we have called for the government to give all Canadians the right to freely choose a medically-assisted death. We have argued that there is no strong moral case for limiting access to just those who have “a grievous and irremediable medical condition that causes enduring suffering that is intolerable in the circumstances of his or her condition,” as set out in the Supreme Court of Canada Carter v Canada ruling. The ruling is “a floor and not a ceiling.”

Anyone mature enough, regardless of age, to give an informed and voluntary consent should be free to choose a physician-assisted death. It is the right of a competent individual to determine whether they are ready to end their life.

We commended much of the government’s approach to regulating MAiD. Specifically, they sought to ensure that patients would have access through whatever means were appropriate to them. This gives Canadians the flexibility to choose the time, place and manner to end their life. However, the restrictions on mature minors, advance requests and individuals with mental illnesses have closed the door for countless individuals to access their rights.

On the question of whether to allow mature minors the right, we argue that there is no moral difference between a person on the days before and after their 18th birthday. As healthcare professionals are already tasked under the law to determine whether a patient is capable of making decisions about their own health, the age-based restriction is extraneous and serves only to deny the rights of mature minors. Our healthcare system already recognizes the rights of mature minors to make life and death medical decisions, so this restriction ought to be removed. Competency, not age, should be the test for whether a decision is free and voluntary.

Similarly, we support broadening the law to explicitly allow individuals to specify in advance the circumstances under which they would want MAiD. Prohibiting against advance requests discriminates against individuals whose diagnosis results in their loss of competency but continue to suffer. For many people, their sense of dignity is closely tied to their mental capacity. To slowly lose that is to lose their sense of identity and is a worse fate than suffering or death. Without the ability to specify in an advance request that they would prefer an assisted death, individuals facing a diagnosis of a degenerative disease are denied their dignity.

The restrictions that a person’s “natural death” be “reasonably foreseeable” have been described by countless medical and legal experts as dangerously vague. This vagueness has led to a growing chill among healthcare professionals who are increasingly wary of providing MAiD. It has therefore both left countless Canadians, particularly those whose primary medical condition is mental illness, without access to MAiD and has also reduced access to those who might otherwise choose it as they may be unable to find medical practitioners willing to support their choice. This restriction further contributes to stigma against people with mental illness as it presumes that such an illness necessarily means they are perpetually unable to make competent decisions, a fact that is refuted by the lived experience of countless people with a mental illness.

Finally, while not directly in the scope of the CCA’s consultation, we also wish to reiterate our concern with another barrier to accessing MAiD. That is the numerous institutions and individuals that claim so-called “conscientious objections” to the practice and thereby restrict access in many communities. In particular, healthcare institutions that receive public funds should be required to allow MAiD within the institution. Institutions that refuse should see their funding withdrawn. We’ve already seen in both Quebec and across the country, hospices and hospitals refuse to provide MAiD. This has led to individuals being forced to endure grueling transfers to see their rights fulfilled. Similarly, individual conscientious objections and refusals to even provide effective referrals by some religious medical associations denies patients’ autonomy and dignity. Coupled together, these attempted opt-outs create systemic barriers to patients in remote areas and those with limited means to navigate an already bureaucratic healthcare system.

It’s time for Canada to take a leadership role on the right to die with dignity. The current restrictions on mature minors, advance requests and on people with mental illness are discriminatory and unjust. These create barriers and a chill on healthcare professionals who might otherwise consider providing Canadians with the option for a compassionate end. Coupled with other barriers, the rights of individuals are continuing to be infringed and people are being forced to suffer needlessly.

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