MAID remains a controversial subject for many, and after welcoming everyone to the session, van der Meer acknowledged that those attending probably had different views and perspectives. “We are not here to persuade you in any direction,” he assured them. “We are here to respect where each other is coming from and to give enough information, so you have some insight about Medical Assistance in Dying,” and to provide a setting where people felt comfortable asking questions.

He introduced the two guest speakers:

• Dr. Justine Amaro, an emergency medicine and MAID physician at the Ottawa Hospital, and assistant professor in the Faculty of Medicine at the University of Ottawa
• Dr. James Downar is the head and professor of the Division of Palliative Care in the Department of Medicine at the University of Ottawa; Clinical Research Chair in Palliative and End of Life Care for the Faculty of Medicine at the University of Ottawa; staff physician, department of Critical Care at the Ottawa Hospital, and investigator for the Bruyere Research Institute.

The discussion provided an overview of MAID, including some of its history and its path to being legalized, who is using it, ethical concerns or legal constraints, as well as practical details about what happens with a MAID procedure, who qualifies and how MAID is accessed.

Downar began the discussion with a brief history of MAID including landmark legal cases such as Sue Rodgriuez’s, when her fight to have a physician help end her life as her condition of ALS advanced lost in a Supreme Court of Canada decision by one vote in 1993. Many cases followed, but none succeeded until a case brought forward by two women — one with ALS, the other with spinal stenosis—won their case in BC Supreme Court, BC Court of Appeal, and ultimately the Supreme Court of Canada in the early 2015. This ruling struck down the law that made medical assistance in dying illegal for people with “a grievous and irremediable medical condition, ..[defined] as serious and incurable, advanced state of irreversible decline in capability, and somebody who’s experiencing intolerable suffering or suffering that was intolerable to them,” he explained.

When the federal government passed Bill C-14, they added the criteria that a natural death must be reasonably foreseeable, but that was soon challenged in court by two people with disabilities but not terminal conditions. Downar explained that the governments of Quebec and Canada amended the law, so there are now two tracks, one if there is a reasonably foreseeable death, and another if the person does not have a terminal condition but they find their suffering intolerable.

He noted that Quebec has gone one step further, passing a bill allowing advanced requests for people who have a condition where they know they will lose their ability to make decisions in the future.

So far, that is not allowed in the rest of the country, and it touches on one of the difficult complications of MAID that Dr. Amaro discussed. A safeguard in the process is that the person who has applied for MAID must be capable of understanding what is happening and giving their consent on the chosen day. “If on the day of the procedure, I arrive and say, ‘Would you still like to go ahead today?’ and the patient is unexpectedly confused, delirious, they don’t know why I’m there, they don’t understand what’s happening, we can’t go ahead,” she explained.

That concern causes some people to ask for MAID sooner than they might otherwise. Although Amaro says that an amendment to the law has been made that allows for a waiver of final consent, a signed agreement with the doctor specifying conditions in which the person wants the procedure to go ahead if they have lost capacity. Nevertheless, Amaro explained that any sign of refusal on the designated day still ends the process entirely. “We can’t ask later. We’re finished,” she said. “Whereas if you have capacity, you always have the right to change your mind…. “If you say, ‘Dr. Amaro, I’m actually feeling pretty good today. I don’t think I do want MAID yet. Can we put this off?’ 100%. No problem. No one’s going to be upset with you. We can put it off till any future date if capacity is maintained.”

Amaro’s description of how patients are assessed highlighted some of the other safeguards in place. As opposed to the time pressures in much of health care these days, Amaro says assessing physicians visit people who have applied for MAID in their homes, which she says gives her the opportunity to listen to people and understand their situations. “Some patients … want to just get the questions answered and go through it in 20, 25 minutes and we’re done. And sometimes I have the pleasure of sitting over a cup of tea for an hour or two.” A second physician does a follow-up visit, going over all of the same questions again.

She added that part of the assessment process is ensuring that patients know that MAID is not their only option. “There’s almost always a long discussion about the fact that palliative care is a spectrum. And it is an expertise in medicine where you can be provided with care to help … optimize and improve your quality of life throughout the trajectory of your disease…. It’s a wide scope, but part of MAID eligibility is you must be made aware that palliative care exists, and you have to demonstrate that you understand that and you can weigh it out.”

Downar also provided some numbers on who is applying for MAID. The majority of people applying for MAID are people who have a terminal condition, mostly cancer or ALS, as well as some heart and lung diseases. People in the second track whose death is not reasonably foreseeable make up about four percent of MAID in Canada, and most commonly they are suffering with neurological conditions such as Parkinson’s.

Some of the questions asked by those who attended related to clergy and the church. One person said a Roman Catholic friend was wondering if she could be buried in a consecrated cemetery if she chose MAID.

Canon van der Meer, who is the diocesan interfaith officer, said: “I can’t speak for all churches, but we have a friendship among our neighbourhood churches: Baptist, Presbyterian, Roman Catholic and Anglican churches. We had a conversation about this leading up to this event. The Catholic Church does have an official teaching about the sanctity of life, which they interpret to mean that MAID is not possible. However, the Catholic priest has said he would not hesitate to pray with people for any reason. He would do a funeral in the church and a person could be buried in the way anyone else would be.”

As an Anglican priest, he added, “Our church also holds to the sanctity of life, but it does not have an official teaching on MAID…. There is a range of comfort level among my clergy colleagues. Clergy are encouraged to bring their conscience into pastoral matters; they may choose to be pastorally available or if they’re not comfortable, they would invite another clergy person to provide pastoral care. I (and most clergy that I know) would all say that ‘I respect the medical profession, and I will accompany any person pastorally.’ …My intention as a pastor is to be supportive and to trust that the person has made a considered and mature decision and offer whatever spiritual support is needed.”

A full transcript of this very informative discussion was posted in a link in one of St. John’s weekly newsletters: https://files.constantcontact.com/3730ca79501/e5ef67a0-6716-41bd-99b1-402f751a334d.pdf

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