Medical assistance in dying when natural death is not reasonably foreseeable, 2023, Wiebe and Kelly

Free fulltext:
https://www.cfp.ca/content/69/12/853

Medical assistance in dying when natural death is not reasonably foreseeable
Survey of providers’ experiences with patients making track 2 requests
Ellen Wiebe and Michaela Kelly
Canadian Family Physician December 2023, 69 (12) 853-858; DOI: https://doi.org/10.46747/cfp.6912853


Abstract
Objective To describe clinicians’ experiences with assessing patients making track 2 requests for medical assistance in dying (MAID) and providing MAID to such patients in the first 6 months after Canada amended relevant legislation in March 2021 to expand access to MAID.

Design Online survey with closed and open-ended questions about clinicians’ experiences with individual patients making track 2 MAID requests.

Setting Canada.

Participants Doctors and nurse practitioners who were members of the Canadian Association of MAID Assessors and Providers.

Main outcome measures The most common reasons patients gave for making track 2 MAID requests and the challenges providers identified in doing these assessments.

Results Twenty-three MAID providers submitted information about 54 patients who had made track 2 requests between March 17, 2021 and September 17, 2021. The most common diagnoses were chronic pain syndromes, affecting 28 patients (51.9%), and complex chronic conditions such as myalgic encephalomyelitis or chronic fatigue syndrome, affecting 8 patients (14.8%). The most common challenges providers reported were related to patients having concurrent mental illness, noted in 37 assessments (68.5%). In 8 cases (14.8%), providers faced challenges in finding experts to help with assessments. In 19 cases (35.2%), providers felt patients had not been offered all appropriate and available treatments, and in 9 cases (16.7%) providers encountered difficulties in finding such treatments for patients.

Conclusion Providers of MAID described many challenges in their experiences with patients making track 2 requests, including assessing individuals with concurrent mental illnesses, being uncertain that patients had been offered appropriate treatments prior to seeking MAID, and being unsure whether patients had seriously considered available treatments. Many providers experienced moral distress in attempting to balance patients’ rights with what might be in patients’ best interests. This is different from experiences providers have had with patients making track 1 requests, as most of these patients have end-stage malignancy or organ failure and seldom have unmet health care needs. This information could be used to enhance education and support for clinicians as they help patients with track 2 requests access their right to peaceful deaths.

 

I have read articles about 2 Canadian pwME who wanted to, or have applied to MAID partially because of poverty.

This, along with ME is a huge burden to carry. In addition to the stigma, neglect and other mistreatment levied on pwME this situation can be extremely difficult to cope with.

Provincial and territorial governments, along with the federal government should put some effort into providing more specialist care, and research dollars to find treatments for the ME community, rather than marking time with the abysmal situation we currently have.

 

On March 9, 2023, legislation to extend the temporary exclusion of eligibility for persons suffering soley from a mental illness received Royal Assent and immediately came into force. As a result, persons suffering solely from a mental illness and who meet all other eligibility criteria will now be eligible for MAID in Canada as of March 17, 2024.

https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html#e

 

This change to MAID, as noted by @Mij
in the above posting is concerning as regards pwME.

ME is not a mental illness, however medical personnel uneducated about ME may assume this biomedical illness is a mental illness.

This, in combination with the poor treatment many with ME receive from all sides, may help tip the balance in favour of choosing MAID.

Our governments should be attending to ME health issues by funding research for treatments, and providing medical education for physicians who in general, very clearly lack knowledge about ME. Just to name a couple of the aspects of this problem.

 

News out today

Who qualifies for MAID in Canada? Federal government considers pausing expansion.

It would be the second time the federal Liberals have hit pause on the plan. The first came in February, when the government decided to impose a one-year delay amid widespread public and political concern.

Supporters say expanding the regime provides choice for those who are suffering and have no other options; denying it violates their rights. Some disability advocates, however, say proper mental-health supports are a better option.

Other organizations, like the Centre for Addiction and Mental Health, note there is no clear medical consensus on what constitutes a “grievous and irremediable” mental illness, or on how to distinguish that from suicidality.

https://www.ctvnews.ca/health/who-q...ernment-considers-pausing-expansion-1.6688608

 

There was a programme last night on the same subject on BBC Radio 4:

https://www.bbc.co.uk/sounds/play/m001t9km

Euthanasia is illegal in the UK. All attempts to change the law have failed.

Other countries have legalised assisted dying and/or euthanasia. In this week’s Briefing Room with David Aaronovitch we find out what their experience has been and what, if anything, the UK could learn from that.

Joining David on the programme are:

- Imogen Goold, professor of medical law at University of Oxford
- Agnes van der Heide, Erasmus University Medical Center in Rotterdam
- Thaddeus Pope, Professor, Health Law Institute, Mitchell Hamline School of Law (Minnesota, USA)
- Richard Huxtable, professor of medical ethics and law at the University of Bristol

Production: Kirsteen Knight and Alex Lewis
Production co-ordinators: Jacqui Johnson and Gemma Ashman
Sound: James Beard
Editor: Richard Vadon

 

There is also the issue that persons with poor health may be pressured by those with vested interests to choose MAID.

 

For me a big concern with such as the Canadian system is that someone chronically ill who is experiencing suffering, not solely because of their condition but also because of the social and benefits culture they inhabit, is eligible for assisted dying. In this situation it is not clear that their wish to die would be there if their care and financial needs were met.

On the other had would it be fair to refuse such assistance if there is no reasonable prospect of the health provision and societal change necessary to improve their quality of life in the foreseeable future.

 

@Peter Trewhitt

They would choose to die with dignity rather than continue living without dignity. Some eat every other day because they can't afford healthy food, this makes their health issues worse, they are under constant stress that they might become homeless which increase their mental health issues.

 

Matthew Parris in the UK Times, Friday 29th March 2024


https://twitter.com/user/status/1773982823495409708




Tweet Text:
"Matthew Parris has predictably gone from “disabled people are all faking it for benefits to fleece the taxpayers” to “we should just kill them all, burdens on society anyway”.

Link for the article without paywall
https://archive.ph/2024.03.29-21083...nt-afford-a-taboo-on-assisted-dying-n6p8bfg9k





https://twitter.com/user/status/1773967442093486575



Thread/Tweet:
"Whatever your views on assisted dying, one thing I’d hoped we’d all agree on is that the topic is ethically fraught & complex. Not so Matthew Parris. For him, it’s simple. Old & frail people *should* be killed - to save society the cost of looking after them. 1/n"

 

My big concern is that we end up with the situation that now can happen in Canada where the failure to officially recognise a disabling medical condition (eg ME) results in lack of access to appropriate benefits which in turn is regarded as a valid reason for assisted dying, rather than addressing the the inequities of the benefit system.

 

This was in the news recently.

Calgary judge rules woman with autism can seek MAiD

Justice Colin Feasby said his decision will be stayed for 30 days so lawyers for the father of the woman can decide whether to file an appeal.

“This is a terrible choice that should not be forced on MV, as attempting to end her life without medical assistance would put her at increased risk of pain, suffering and lasting injury.”

But Feasby said he understood the desire of MV’s father, WV, and mother to try to keep their adult daughter alive.

The father was granted a temporary injunction the day before his daughter’s assisted suicide under MAID was to take place on Feb. 1.


https://calgaryherald.com/news/loca...ht MAID last,before the procedure is complete

 

I wrote my comment above before reading the article itself. In my experience Matthew Paris is a genuinely kind and caring person in his personal life, but my concern is that his argument will ultimately blur the line between voluntary assisted dying and forced euthanasia.

At least in the developed World we not yet at the point where economic or environmental collapse forces the issue.

[edited - to add final sentence]

 

Same with my Mother.

 

Matthew Parris may well be kind and caring in his own life but in the Times he is a whipper-up of resentment and hostility against sick/disabled people who are too sick/disabled to work and therefore have to claim benefits. The resentment and punitive judgements whipped up in the Comments to Matthew Parris's disability benefit related articles is frankly frightening.


And Matthew is NOT knowledgeable about the disability benefits application, assessment or tribunal processes - he just pretends he is. He portrays it as easy to apply for and get PIP for Mental Health conditions. When according to benefits advisors it is exceptionally difficult to access PIP (for anything, but especially mental health conditions. Matthew Parris says he doesn't believe in ADHD and thinks that it's the benefits system that 'stokes bad medical science'

And no, Matthew does not mean bad science such as PACE and the rest of the CBT/LP/Mindfulness etc research dross..




March 8th 2024.

'Our disability benefits system invites abuse'
Matthew Parris

https://www.thetimes.co.uk/article/our-disability-benefits-system-invites-abuse-rxgrhp73w

'More and more young people are making sickness-related benefit claims, ever more of which feature mental health issues.....

'Economically inactive young adults were 50 per cent more likely than older claimants to report a mental health problem.

So how do we account for this? An increasingly alienating and disorderly world may explain some of it; the recognition and labelling of mental difficulties which have always beset us will be part of it too. Perhaps in the past people just “soldiered on”. Perhaps many would be happier if they still did so, rather than isolating themselves from the world of work.

But more than all this, and simpler too, is an explanation from which both the Tories and Labour now seem to be shrinking. Follow the money. Someone on standard universal credit gets around £70 a week if under 25, and around £90 if over. Disability payments are in addition to this.

The system is hellishly complicated and I’ve no idea how claimants manage to understand it, but it seems that standard-rate PIP payments may almost double these figures, depending on the nature of the disabling condition and the various additional allowances to which a range of circumstances may entitle them. If one seeks the primary explanation for why PIPs are sought by those who believe they can make an acceptable claim, it’s hard to see why one need look further.'
The Times 8/3/2024

.

 

... T4 planners began in the autumn of 1939 to
distribute carefully formulated questionnaires to all
public health officials, public and private hospitals,
mental institutions, and nursing homes for the
chronically ill and aged. The limited space and wording
on the forms, as well as the instructions in the
accompanying cover letter, combined to convey the
impression that the survey was intended to gather
statistical data. ...

Secretly recruited "medical experts," physicians --
many of them of significant reputation -- worked in
teams of three to evaluate the forms. ...

-- [[http://www.ushmm.org/wlc/en/article.php?ModuleId=10005200][Holocaust Encyclopedia]]

===

as it is i do not find any means of sustainable survival or security for myself even without this type of thing.