medically assisted deaths are 'lovely'

canada is a progressive country when it comes to dying. in 2016, the canadian government bill c-14, which formally legalized medical assistance in dying (maid). but in the meantime, there have been proposed changes to the legislation introduced that have been delayed due to the pandemic. and right-to-die activists are concerned these delays are leading to a lot of suffering.the amendments stem from a ruling in september 2019, the truchon decision, when the superior court of québec decided that two criteria in the legislation were unconstitutional: the “reasonable foreseeability of natural death” eligibility guideline in the criminal code, and the “end-of-life” criterion from quebec’s act respecting end-of-life care, according to the ministry of justice. on february 24, 2020, the minister of justice and attorney general of canada introduced bill c-7, which proposes changes to the criminal code’s provisions on maid. these changes are around who can qualify for a medically-assisted death as well as giving consent when loss of decision-making capacity is an issue.“it was decided that the current legislation violates individual rights,” says helen long, the ceo of dying with dignity canada.shortly after that announcement, covid-19 hit canada, pushing back the review of the legislation. an extension has been granted until dec. 18, 2020. but long is concerned the new amendment may be derailed by a prorogued parliament — and a possible fall snap election. she fears for the thousands of canadians who fall between the cracks of the original legislation.“we are talking about people who are suffering immeasurably,” she says.

where do things stand now?

consenting adult canadians with incurable, intolerable suffering are now legally able to end their lives, along with the assistance of a doctor or nurse practitioner.the current eligibility criteria for maid, according to the canadian government require that a person be 18 years of age or older, be eligible for federally-funded health services, are able to make health care decisions for themselves, can voluntarily request maid that is not the result of external pressure, and can give informed consent after they have received all of the information they need to make their decision.the person must also have a “grievous and irremediable medical condition,” meaning they have a serious and incurable illness, disease or disability; are in an advanced state of decline in capabilities that cannot be reversed; experiences unbearable physical or physiological suffering from an illness, disease, disability or state of decline that cannot be relieved under conditions that the person considers acceptable; are at a point where their natural death has become reasonably foreseeable, taking into account all medical circumstances, and not requiring a specific prognosis as to how long they have left to live.

who can assist?

those who can provide medical assistance in dying are doctors and nurse practitioners (in provinces where this is allowed). those who can help provide medical assistance in dying include pharmacists, family members or other people that the person has asked to help and health care providers who help physicians or nurse practitioners.

how does assisted death happen?

there are two routes canadians can take with assisted deaths. first, they must provide informed consent and have explored all other medical and palliative options related to their medical condition. this consent is given at the beginning and just before the assisted death and it can be withdrawn at any time.an assisted death includes a physician or nurse practitioner who directly administers a substance that causes death, such as an injection of a drug or provides or prescribes a drug that the eligible person takes themselves in order to die.in canada, the first line medication is propofol, which is injected, following an injection of rocurconium, which is a type of anesthetic. other options include phenobarbitol and morphine sulfate. anti-nausea medications and sedatives are also added to this infusion to keep the person comfortable as they fall into a coma. secobarbital, an oral medication, is also available in canada.in an interview with the atlantic, dr. lonny shavelson, a california-based physician who specializes in “aid-in-dying,” describes death by maid as “lovely,” calling the atmosphere “lighter than you think.” before he mixes the drug cocktail the patient will take, he asks if they are ready and the patient drinks it. he says they usually go silent, sitting quietly with their eyes open for a few minutes before their eyelids slowly close. shavelson repeatedly asks if they are still there. at first they answer or shake their head, but after five or ten minutes, they stop responding. he says he gently touches their eyelids, looking for the twitching response typical of someone who is not deeply conscious. once the twitching stops, usually within 10 or 15 minutes, the patient enters a deep coma, their pulse slows and oxygen levels drop.

how will bill c-7 change maid?

bill c-7 would keep all of these existing eligibility criteria, but would remove the requirement for “reasonable foreseeability of natural death.” what that means, says long, is that people who have an illness or disease that is causing them immense suffering can opt to end their lives even if their death is not imminent.another change that bill c-7 would introduce is around consent. under the current legislation, people must consent twice to a medically-assisted death within the 90-day process — and many with rapidly progressing neurological impairments fear that they will be unable to make that second consent. as a result, bill c-7 allows for a waiver of final consent for people whose natural death is reasonably foreseeable, who have been assessed and approved to receive maid and who have arranged with their practitioner for a waiver of final consent because they were at risk losing decision-making capacity before their chosen date to receive maid.

more work to be done

though the current assisted dying legislation is “a strong framework with good checks and balances,” long feels there are more changes needed. to begin with, bill c-7 would still exclude persons suffering solely from mental illness. long says that it a clause that also needs to be altered as she has heard from many canadians who feel that their suffering, though not physical, warrants an assisted death.“their suffering is no less real,” she says.long also believes consent should be allowed to be given well in advance of death, particularly in cases where canadians have dementia and cannot consent later.and she wants to see the right to a medically-assisted death granted to mature minors, rather than restricting it to those over 18. she says many medical decisions have recently been given to this group — and the right to die on their terms, albeit with many safeguards, should also be granted. “we don’t think this group should be excluded,” she says.“there are many individuals suffering from an intolerable condition.”