White Coat, Black Art

Do changes to assisted dying in Canada help the most vulnerable or endanger them? Advocates are divided

Disability advocate Jeff Preston is raising concerns that new changes to Canada’s medical assistance in dying laws might end up hurting some of the people they ostensibly seek to help.

Bill C-7 expands medical assistance in dying to some people whose deaths are not ‘reasonably foreseeable'

Jeff Preston, as assistant professor of disability studies at Western University’s King’s College in London, Ont., has a rare form of muscular dystrophy and uses an electric wheelchair to get around. (Submitted by Jeff Preston)

Disability advocate Jeff Preston is raising concerns that new changes to Canada's medical assistance in dying laws might end up hurting some of the people they are intended to help.

"I think myself and many others are deeply concerned at the ways in which Bill C-7 devalues [the] lives of disabled people, see disability as inherently suffering, as being intolerable in nature," said Preston, an assistant professor of disability studies at King's University College at Western University in London, Ont.

Preston lives with a severe form of muscular dystrophy and uses an electric wheelchair to get around.

He and other advocates argue that widening the eligibility guidelines for medical assistance in dying (MAID) without also bolstering other kinds of health-care support will see MAID as a first choice rather than a last resort.

Preston says there needs to be 'a more nuanced and more complex conversation' about medical assistance in dying than the discussions held for Bill C-7 afforded. (Kate Dubinski/CBC News)

"I think even more concerning is the ways in which the federal government has moved much quicker to provide access to death for people with disabilities than it has to actually providing the means to live good, functional, safe and happy lives," he told White Coat, Black Art host Dr. Brian Goldman.

On Wednesday, the Senate passed Bill C-7 by a vote of 60-25, with five abstentions. The bill made the first major changes to medical assistance in dying since MAID became legal with Bill C-14 in 2016.

In the new law, Canadians with chronic illnesses and disabilities whose deaths are not reasonably foreseeable will be allowed to seek MAID, in compliance with a 2019 Quebec Superior Court ruling.

People suffering solely from grievous and irremediable mental illnesses will have to wait two years to gain the same right.

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The Senate has passed Bill C-7, which expands access to medical assistance in dying, including, eventually, to people suffering solely from mental illnesses.

In a statement to White Coat, Black Art, Justice Minister David Lametti told White Coat, Black Art that more than 300,000 Canadians were consulted on Bill C-7, including members of disabilities communities.

The result, he said, is that "the framework in Bill C-7 will help honour the difficult and personal decisions of some Canadians to end their suffering on their own terms, while enshrining important safeguards to protect the vulnerable."

Autonomy and 'peace of mind'

Andrew Adams, a volunteer for Dying with Dignity based in Fraser Valley, B.C., thinks that Bill C-7 is "bringing people into the modern age," and acknowledges the autonomy of people with debilitating conditions, "allowing us to decidewhat to do with our own bodies."

He lives with abdominal migraine, a chronic condition "kind of like having a very bad case of food poisoning combined with a migraine," he said. Its symptoms could last for months on end.

Adams has applied for access to MAID in the past, but failed to qualify. He described feeling "euphoric" at one point in the process when he thought he did qualify — but not because he planned to use it any time soon.

"It was actually because I thought that my life could be extended and prolonged in that I would not have to worry about having to end my own life in an unpredictable or violent way," he said.

Now that C-7 has widened some of the qualifications for MAID, Adams is considering applying again in the near future.

"I will look to see if I will be approved, and if I do, I will find great peace of mind."

The hands of an adult hold the hand of an older person, who is hooked up to intravenous and lying in a bed.
Bill C-7 has raised concerns among human rights experts about the rights of persons with disabilities. (Shutterstock)

Preston expressed sympathy for Adams's situation. Still, he cautioned wider access to MAID could result in people accessing it who "I don't think a lot of people would be particularly supportive of."

He acknowledged his own privilege, however, describing himself as "a white man from a middle-class family growing up in Ontario" who has enjoyed better access to aid and health care that may not be afforded to BIPOC (Black, Indigenous and other people of colour) and other marginalized communities.

Questions for health-care providers, too

As a physician who has provided MAID for patients, Dr. Sandy Buchman said he is "struggling" with how best to approach Bill C-7's changes.

The palliative care specialist at Toronto's North York General Hospital and past president of the Canadian Medical Association said that for now, he is comfortable with administering MAID as outlined under Bill C-14, but not in cases where death is not reasonably foreseeable, as outlined under C-7.

Dr. Sandy Buchman holds the Freeman Family Chair in palliative care at North York General Hospital in Toronto and is past president of the Canadian Medical Association. (Canadian Medical Association)

In his statement, Lametti noted that anyone who applies for MAID "must undergo thorough assessments by two independent medical assessors, who must agree that the individual has met all requirements and is making their decision in a free and informed manner."

That assessment period lasts 90 days. Buchman expressed concern that it may not be long enough in every case for health-care providers to determine whether other supports may alleviate a patient's suffering in lieu of MAID, or whether that same period ends up raising barriers "for people … who are really suffering and want access to it," he said.

"In a perfect system, maybe we could. But in our less-than-perfect system, where we have so many struggles with adequate resources … the reality is that people, I think, may opt for MAID because their suffering isn't addressed."

He hopes the discussions coming out of C-7's passing will help spur further conversations about other "shortfalls" in Canada's health-care system so that anyone considering a medically assisted death isn't doing so because other options are out of reach.

Preston agrees that the conversation isn't over.

"This needs to be part of a growing and continuing conversation to ensure that we're trying to balance out the needs for access for those who really do need it, while also safeguarding and protecting those from [choosing MAID] because of the lack of social supports, the lack of systemic change and the insidious nature of ableism right now in our culture."

Written by Jonathan Ore with files from The Canadian Press. Produced by Jeff Goodes and Sujata Berry.