Dementia and MAID

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Originally posted @allaboutestates.ca

Medically assistance in dying (MAID= Bill C14) for eligible Canadians was passed by federal legislation in June 2016.  To recap, eligibility includes:

  • Being 18 years and older and mentally competent
  • Having a grievous and irremediable medical condition
  • Making a voluntary request for MAID that is not the result of outside pressure or influence
  • Providing informed consent.

Grievous and irremediable has been defined as:

  • Having a serious illness, disease or disability
  • Being in an advanced state of decline that cannot be reversed
  • Experiencing unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable
  • Being at a point where your natural death has become reasonably foreseeable which takes into account all of your medical circumstances and does not require a specific prognosis as to how long you have left to live

One does not have to a fatal or terminal condition to be eligible for medical assistance in dying.

Informed consent means receiving all of the information required to make a decision at the time of your request AND immediately before medical assistance in dying is provided.[1]

Given the above criteria, for those individuals who have been diagnosed with a dementia and have indicated that when in the future, they have declined to a point when they no longer (recognize family/ communicate/ feed themselves/ respond  to those around them/able to get out of bed/breath on their own) have not been eligible to request MAID.

This past August 2019, a Victoria man became one of the first Canadians with a dementia diagnosis to have received MAID.  Dr. Stefanie Green is the physician who provided the medical assistance.  In a recent interview she shared:  “His care ‘seemed very much on the edge….The risk of not meeting the eligibility criteria, or not being found to have done so properly, is a criminal offence, which leaves me liable to go to jail for up to 14 year.’”[2]

Dr. Green expressed: “This is not an expansion of our law….This is a maturing of the understanding of what we’re doing.”

This is a difficult and very important topic.  A team of Canadian experts recently authored a paper to provide guidance to clinicians who assess and provide MAID in Canada.  Their report is linked here  https://camapcanada.ca/wp-content/uploads/2019/05/CPG-dementia.pdf.

I found the examples in the Appendix reflected the medical status of many clients with whom I have worked over the years and I wonder how many wanted a different ending.

 

 

 

 

[1] https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html

[2] https://www.cbc.ca/radio/thesundayedition/the-sunday-edition-for-october-27-2019-1.5335017/b-c-man-is-one-of-the-first-canadians-with-dementia-to-die-with-medical-assistance-1.5335025

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