RE: A Unique Milestone - Romantic and Inaccurate
References
Gerald Patrick Ashe. A unique milestone. CMAJ 2021;193:E345-E346.
Evenblij, K., Pasman, H.R.W., van Delden, J.J.M. et al. Physicians’ experiences with euthanasia: a cross-sectional survey amongst a random sample of Dutch physicians to explore their concerns, feelings and pressure. BMC Fam Pract 20, 177 (2019). https://d
Sinyor M, Williams M, Zaheer R, et al. The Relationship Between Suicide-Related Twitter Events and Suicides in Ontario From 2015 to 2016 Crisis 2021 42:1, 40-47
First Annual Report on Medical Assistance in Dying in Canada, 2019 Accessed at: https://www.canada.ca/content/dam/hc-sc/documents/services/medical-assistance-dying-annual-report-2019/maid-annual-report-eng.pdf
Downar J, Fowler RA, Halko R, et al. Early experience with medical assistance in dying in Ontario, Canada: a cohort study. CMAJ February 24, 2020 192 (8) E173-E181; DOI: https://doi.org/10.1503/cmaj.200016
We are responding to Dr. Ashe’s portrayal of his 100th case of medical assistance in dying (1).
MAiD should not be portrayed as something that people should seek instead of natural death for two reasons. A recent randomized survey of Netherland’s physicians (2) reported that ambiguity about being involved in requests for and performing euthanasia has increased over the past 20 years and that physicians are feeling increasingly pressured to perform this service by patients and family members who now see it as normal practice and their right. The second concern is that in seeing this service in a romanticized way it could induce contagion akin to suicide contagion that is known to occur depending on the portrayal by media (3).
Dr. Ashe says that MAiD will only be 1-2% of all who die in Canada. According to Health Canada in MAiD in Canada in 2019 (4) it already accounted for 2% of deaths and this is prior to opening the criteria to those whose deaths are not reasonably foreseeable and to mental illness.
Data from Ontario shows that MAiD is primarily sought by wealthy and educated Canadians (5). Now that MAiD has been expanded, the applicant demographic will likely begin shifting to include those from disadvantaged backgrounds with limited access to quality palliative care, disability support and/or mental health services. We are concerned that privileged Canadians’ enhanced freedom to choose MAiD will come at the expense of their vulnerable and disadvantaged compatriots, having been granted the “take it or leave it” choice of MAiD versus suffering within a health system that has failed to adequately serve them.
Our opinion is that equitable access to quality palliative care, disability support and mental health care would better reflect the mercy and respect that all Canadians truly deserve.