The 2022 Elections and MAiD by Advance Medical Directives

The following is an open letter from the Physicians’ Alliance against Euthanasia, written by Alex King and Dr. Catherine Ferrier:

OPEN LETTER

The 2022 Elections and MAiD by Advance Medical Directives

The Bill that no party wants to talk about

September 21, 2022

It is difficult to predict the first course of action of the government that will be elected on October 3. However, we know that most parties have promised to reintroduce Bill 38 on medical aid in dying as soon as possible – a Bill that died on the Order Paper before the election was called.

Surprisingly, this Bill, that has a tremendous scope, is not part of the discussions of the current campaign. As if there were such a consensus on the Bill that there is no need to debate it. Really!

Yes, the key measure of the Bill, MAiD by advance directives for persons deemed incapable of decision-making, recommended by the Select Committee on the Evolution of the Act respecting end-of-life care, seems to be very popular with the people of Quebec.

Who does not fear the loss of autonomy associated with the advanced stages of neurodegenerative diseases such as Alzheimer’s?

This was evident during the debates among the members of the parliamentary commission studying the defunct Bill 38, but the application of such an idea raises a series of major ethical issues. Popular support would undoubtedly be undermined if these issues were clearly explained to the public.

For example, consider the challenge of administering death when a patient is showing symptoms of ‘happy dementia’. No matter what stage of illness they are in, if they resist or refuse, we would not proceed with MAiD. How many times will we try again? It remains to be discussed. It is very difficult to know what the incapable patient might refuse if the health care team does not tell him or her what they are going to do, especially if they use a sedative. As in the now infamous case in the Netherlands of the person with dementia who was euthanized against her will, there is a significant risk. Before the so-called ‘mercy killing’, one cannot imagine telling the incapable person that he or she is about to be injected with a lethal “medication”. Let us be fully cognizant of the impact on the health care teams who would administer MAiD under these circumstances. Advance medical directives should never legitimize such an action.

This is why international specialists such as Dr. Raphael Cohen-Almagor, who are usually in favour of medical aid in dying, draw a line that should not be crossed. A society like ours should never give death to incapable people, no matter what the circumstances.

On this International Alzheimer’s Day, one of the largest organizations studying the disease, Alzheimer’s Disease International, releases its 2022 Global Report. What does it say about euthanasia (the international term for MAiD) for people with dementia who are conscious but incapable of decision-making, and who have provided advanced consent? That the Dutch model (the Netherlands being the only country in the world to offer it) is not a preferred option. It should also be remembered that a significant proportion of the general population and caregivers in that country disagree with this practice.

In addition, the expert invited to write this chapter is a Quebec geriatrician, Dr. Félix Pageau (page 186 of the World Alzheimer Report 2022, published this morning).  

Given Dr. Pageau’s internationally recognized expertise, it is ironic that he was not invited to testify on the one day of hearings scheduled to hear expert reactions to Bill 38. In fact, no voices opposing MAiD by advance directives for incapable persons were heard in this review. We hope that this will not be the case in the future.

There are many outstanding questions that deserve the attention of the candidates

Should the adoption of a version similar to Bill 38 be considered as a foregone conclusion? It would be a clear democratic deficit to avoid the issues raised by this Bill and to adopt it quickly after the election.

We hear a lot in the current campaign about the importance of protecting vulnerable seniors from past abuse. However, we seem to have forgotten that MAiD in advanced dementia encourages many forms of discrimination.

We hope that the parties and their candidates will speak out before the end of the campaign, not only on the issues specific to MAiD by advance directives and its application, but also on other components of the Bill that have certainly not been publicly debated.

Two very concrete questions:

Do you really want to force palliative care homes to offer medical aid in dying? Whether one is for or against offering MAiD in these places (a majority of them now choose to offer it), it is always counterproductive to impose an act of such magnitude in palliative care homeswhose primary mission will always be palliative care until natural death.

Do you really want neuromotor disorders to be studied in the next Bill on MAiD? Disability as a criterion for access to medical aid in dying has never been the subject of parliamentary debate in Quebec. Despite the opposition of national disability rights associations (please click the following links for examples: Inclusion Canada and Disability without poverty), the federal Bill C-7 (March 2021) takes this criterion into account in certain circumstances, but it is not regulated in the Quebec legislation. A discriminatory view of the situation of disability underlies this vision. Disability alone would be sufficient to want to die. This is unacceptable in a liberal democracy that seeks to protect those who are most vulnerable to discrimination, such as those with dementia.

In closing, although the issue has not yet been addressed in Quebec, one would have to bury one’s head in the sand to ignore the national and international media coverage (including an Associated Press article entitled ‘Disturbing’: Experts troubled by Canada’s euthanasia laws) of several MAiD cases in the country, cases that call into question recent extension of access to MAiD. Before considering new extensions, let us have the courage and honesty to publicly debate those already made, before and after the October 3 election.

Mr. Alex King
President, Citizen Network Living with Dignity

Dr. Catherine Ferrier
President, Physicians’ Alliance against Euthanasia