Medical Assistance in Dying (MAID) Quiz

MAID - Eligibility Issues

• The law no longer requires a person's natural death to be reasonably foreseeable for eligibility for MAID.
• As of March 17, 2021, individuals seeking MAID must meet certain criteria, including:
  • Being 18 years of age or older and having decision-making capacity.
  • Eligibility for publicly funded health care services.
  • Making a voluntary request free from external pressure.
  • Giving informed consent after receiving all relevant information.
  • Having a serious and incurable illness, disease, or disability (excluding mental illness until March 17, 2024).
  • Experiencing enduring and intolerable physical or psychological suffering not alleviated by acceptable methods.

Review - Passive vs. Active Euthanasia

• Passive euthanasia: Withholding or withdrawing life support (e.g., pulling the plug).
• Active euthanasia: Physician-assisted suicide (PAS), self-administered MAID, or voluntary active euthanasia (VAE), clinician-administered MAID.

Review - Common Arguments for and Against MAID

• In Favour:
  • Respecting autonomy of competent patients who request MAID.
  • Relieving extreme suffering (utilitarian argument).
• Against:
  • MAID is a form of killing (deontological argument).
  • MAID could potentially coerce vulnerable groups (like minorities and the poor; utilitarian argument).

Are Active and Passive Euthanasia Morally Distinct?

• The central intention behind both passive and active euthanasia is to relieve suffering.
• If both have the same central intention and result in death, they are equally permissible.

Responses from the Discussion Boards

• Premise 2 of the argument (passive and active euthanasia differ only by their primary intentions) is rejected.
• Active differs from passive euthanasia because of its deliberate intention to end a life, as opposed to relieving suffering through passive means.

Non-Voluntary Active Euthanasia

• Legalized MAID comes in the forms of passive euthanasia, PAS, and VAE.
• Non-voluntary active euthanasia is ending someone's life without their consent.
• The question raised is: if intention to relieve suffering justifies MAID in cases of voluntary consent, is it also justifiable in non-voluntary cases?

Case Study - Tracy Latimer

• In 1993, Robert Latimer was convicted of murdering his daughter, Tracy, who had severe disabilities and nearly constant pain.
• Robert killed Tracy by using carbon monoxide poisoning and the case led to a discussion around non-voluntary active euthanasia.
• Tracy was incapable of giving consent.

Class Poll

• Questions raised about the case include: was Robert's action morally permissible? Was his intention to relieve Tracy's suffering sufficient to justify his actions, and if the action was considered impermissible, was it due to the lack of consent?

Argument - Robert Did Something Impermissible

• Taking a life without consent (regardless of the intention) is impermissible.
• Robert took Tracy's life without her consent, therefore his action was impermissible.

Objection to the Argument from Intention

• The argument claims that intention to end suffering is what makes active and passive euthanasia morally equal.
• This argument ignores the fact that active euthanasia directly ends a life, while passive might allow a death to occur without direct intent.
• Using Robert Latimer's case as an example, intention to relieve suffering does not justify involuntary euthanasia.

Hypothetical Consent & the Latimer Case

• Hypothetical consent asks: what would a person do if they had the capacity, and if Tracy would have consented to her death.
• The issue is whether the hypothetical consent of Tracy would have justified Robert's actions

Hypothetical Consent – Argument

• If Robert had good reasons to believe Tracy would consent to her death given an opportunity, then Robert's action is permissible.

MAID in Canada - Eligibility

• MAID eligibility criteria (include age, consent, and diagnosis).
• The criteria now does not require a reasonably foreseeable death.

Age Restrictions - Another Slippery Slope?

• The age of 18 might be arbitrary for MAID eligibility, challenging the rationale for the restriction
• The debate questioned whether a competent 16, 15 or younger year old could and should be allowed to receive MAID

Two Interpretations of the Slippery Slope

• Anti-MAID interpretation: An age limit is needed to prevent the euthanasia of children.
• Pro-MAID interpretation: Competency should be the determinant, not age.

Let's Hear Your Arguments!

• Questions about the need to adjust age restrictions on MAID eligibility.

MAID and Poverty - Some Ethical Challenges

• Discusses the ethical challenges of MAID eligibility when a person cannot afford the medical care or living expenses after applying for MAID.
• This raises the discussion around coercion related to MAID and the necessity for reinstatement or justification of the original criteria of 'reasonably foreseeable death'.

MAID and Poverty - Ethical Challenges

• Raises questions about the potential for coercion in MAID applications due to poverty.
• Whether poverty is a form of coercion relevant to MAID eligibility.
• Questions about whether a system that allows for MAID eligibility to occur in situations of poverty is inherently coercive.

A brief video to watch on your own time – MAID and Poverty

• A video about the challenges of MAID eligibility when financial hardship is a factor in the decision.

Advance Directives – Current Legislation

• An advance directive in MAID is a request made before you lose capacity. • Advance directives are not currently permitted. • Parliament’s committee has pushed for advance directives, but more study is needed.

Advance Directives - Argument in Favour

• Canadian physicians are already required to respect advance directives (such as in Jehovah's Witness blood transfusions).
• A case of blood transfusion refusal can be used as a justification for MAID advance directives.
• Advance requests should also be allowed given the similarities between the finality of MAID and blood transfusions.

Advance Directives for MAID - Argument Against

• Advance requests for MAID might be made under duress from pressure from external parties (family, medical professionals etc.) • This raises a possibility that the expressed wishes can change later when the patient is able to understand the implications. • Advance requests should thus be prohibited.

MAID and Mental Illness - Should We Expand Eligibility?

• People with mental illness cannot access MAID currently, leading to a debate.
• Supporters argue that mental suffering is as serious as physical suffering and that exclusion is discriminatory.
• Opponents argue that mental illness's ability for consent may be affected until thorough study is completed.

MAID and Mental Illness - Thoughts from the Discussion Boards

• Discussing if people with mental illness should be allowed to access MAID and considering the challenges involved.
• A possible consideration, the debate involves whether or not a mental illness should be excluded as a factor for access or eligibility.