Does Allowing Track 2 MAiD Harm Disabled People?
DOI:
https://doi.org/10.7202/1124209arKeywords:
medical assistance in dying, discrimination, disability, Canada, autonomyLanguage(s):
EnglishAbstract
In 2021, in response to the Superior Court of Quebec’s decision in Truchon v. Canada, the Canadian Parliament amended the Criminal Code to allow Medical Assistance in Dying (MAiD) for some people who don’t have a “reasonably foreseeable natural death.” Debate rages over this amendment. In particular, some academics and activists argue that it should be repealed because it discriminates against disabled people. In 2024, these arguments appeared in a Canadian court proceeding; two disabled individuals and four disability rights organizations filed a lawsuit in the Ontario Superior Court of Justice, challenging the amendment. In this paper, I critically analyze the harm-centric arguments in the applicants’ notice of application (which crystallizes the broader opposition to the amendment). In doing so, I draw on analysis from both sides of the ethical debate over the amendment. Ultimately, I conclude that the applicants’ arguments — and those from other opponents of the amendment — don’t succeed. Some of my recurring objections include that the alleged harmful effects of the amendment are either 1) harmful only if the applicants’ dubious ethical assumptions are true, 2) not attributable to the amendment, or 3) nonexistent, negligible, or unlikely. In defence of the amendment, I discuss how it respects people’s autonomy and avoids instrumentalization.
References
1. Department of Justice. Legislative Background: Medical Assistance in Dying (Bill C-14, as Assented to on June 17, 2016). Government of Canada. 2 Feb 2023.
2. Department of Justice. Charter Statement: An Act to amend the Criminal Code (medical assistance in dying) (C-7). Government of Canada. 21 Oct 2020.
3. Grant I, Benedet J, Sheehy E, Frazee C. A conversation on feminism, ableism, and medical assistance in dying. Canadian Journal of Women and the Law. 2023;35(1):31-72.
4. K.C., Kathrin Mentler, Inclusion Canada, Indigenous Disability Canada / The British Columbia Aboriginal Network on Disability Society, Council of Canadians with Disabilities, and Disabled Women’s Network of Canada v. Canada (Attorney General). 2024 OSCJ CV-24-0072847-0000.
5. Canadian Association of MAiD Assessors and Providers. The Interpretation and Role of “Reasonably Foreseeable” in MAiD Practice. CAMAP. Feb 2022.
6. Health Canada. Fifth Annual Report on Medical Assistance in Dying in Canada 2023. Government of Canada. 11 Dec 2024.
7. Grant I. Legislated ableism: Bill C-7 and the rapid expansion of medical assistance in dying in Canada. McGill Journal of Law and Health. 2024;15(2):259-335.
8. Quinn G, Mahler C, De Schutter O. Mandates of the Special Rapporteur on the rights of persons with disabilities; the Independent Expert on the enjoyment of all human rights by older persons; and the Special Rapporteur on extreme poverty and human rights. Office of the United Nations High Commissioner for Human Rights. 3 Feb 2021.
9. Canadian Association of MAiD Assessors and Providers. Bringing up Medical Assistance in Dying (MAiD) as a clinical care option. CAMAP. Feb 2022.
10. Downar J, MacDonald S, Buchman S. Medical assistance in dying, palliative care, safety, and structural vulnerability. Journal of Palliative Medicine. 2023;26(9):1175-9.
11. Mathison E. Assisted dying and abortion are connected. Value Judgments. 1 Jun 2023.
12. Mathison E. Assisted dying in Canada is working great. Value Judgments. 16 Aug 2022.
13. Mathison E. Lack of housing is a housing issue. Value Judgments. 19 Oct 2022.
14. Sørheim P, Barra M, Norheim OF, Gamlund E, Solberg CT. Premature death as a normative concept. Health Care Analysis. 2024;32(2):88-105.
15. Luper S. Death. In: Zalta EN, Nodelman U, editors. The Stanford Encyclopedia of Philosophy. Winter 2024 Edition. 25 Aug 2021.
16. Schuklenk U. Argumenta ad passiones: Canada debates access thresholds to MAiD. Bioethics. 2022;36(6):611-2.
17. Genuis QIT. Hopeless hope, autonomy, and anthropology: a response to Wiebe and Mullin. Journal of Medical Ethics. 22 May 2024.
18. Coelho R, Maher J, Gaind KS, Lemmens T. The realities of medical assistance in dying in Canada. Palliative and Supportive Care. 2023;21(5):871-8.
19. Coelho R, Gaind KS, Lemmens T, Maher J. Normalizing death as “treatment” in Canada: Whose suicides do we prevent, and whose do we abet? World Medical Journal. 2022;70(3):27-35.
20. Raikin A. No other options. The New Atlantis. 16 Dec 2022.
21. Lemmens T, Shariff MJ, Herx L. How Bill C-7 will sacrifice the medical profession’s Standard of Care. Policy Options. 11 Feb 2021.
22. Gunderson M, Mayo DJ. Restricting physician-assisted death to the terminally ill. Hastings Center Report. 2000;30(6):17-23.
23. Fichten L. As Canada delays medically assisted dying in mental illness cases, some find relief, others fear consequences. CBS News. 19 Nov 2024.
24. Moawad H. The effects of self-inflicted neck trauma. Verywell Health. 29 May 2022.
25. Downie J. An alternative to medical assistance in dying? The legal status of voluntary stopping eating and drinking (VSED). Canadian Journal of Bioethics / Revue Canadienne de Bioéthique. 2018;1(2):48-58.
26. Truchon v. Canada (Attorney General). 2019 QCCS 3792.
27. Downie J. A watershed month for medical assistance in dying. Policy Options. 20 Sep 2019.
28. Downie J, Schuklenk U. Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada. Journal of Medical Ethics. 2021;47(10):662-9.
29. Carter v. Canada (Attorney General). 2015 SCC 5, 1 SCR 331.
30. Nelson LJ. Respect for the developmentally disabled and forgoing life-sustaining treatment. Mental Retardation and Developmental Disabilities Research Reviews. 2003;9(1):3-9.
31. Lemmens T. How Canada’s medical assistance in dying law turned euthanasia and assisted suicide into a quasi-universal therapy for suffering. Journal de Droit de la Santé et de l’Assurance Maladie. 2024;39:110-22.
32. Chisholm C. Saying goodbye to April. CBC News. 17 Nov 2024.
33. Janz H. Plagued to death by ableism: what the COVID-19 pandemic and the expansion of eligibility for MAID reveal about the lethal dangers of medical and systemic ableism in Canada. Canadian Journal of Bioethics / Revue Canadienne de Bioéthique. 2023;6(3-4):137-41.
34. Wiebe K, Mullin A. Choosing death in unjust conditions: hope, autonomy and harm reduction. Journal of Medical Ethics. 2024;50(6):407-12.
35. Scoccia D. Physician-assisted suicide, disability, and paternalism. Social Theory and Practice. 2010;36(3):479-98.
36. Khader SJ. Adaptive preferences and procedural autonomy. Journal of Human Development and Capabilities. 2009;10(2):169-87.
37. Downar J, MacDonald S, Buchman S. Medical assistance in dying and palliative care: shared trajectories. Journal of Palliative Medicine. 2023;26(7):896-9.
38. Khader SJ. Must theorising about adaptive preferences deny women’s Agency? Journal of Applied Philosophy. 2012;29(4):302-17.
39. Janz H. MAID to die by medical and systemic ableism. In: Kotalik J, Shannon DW, editors. Medical Assistance in Dying (MAID) in Canada: Key Multidisciplinary Perspectives. Cham, Switzerland: Springer; 2023. p. 299-308.
40. Coelho R. Medical assistance in dying overused in Canada even before expansion. The London Free Press. 9 Jul 2022.
41. Mathison E. MAID and marginalization. Value Judgments. 28 Oct 2024.
42. Kious BM. Hard choices: how does injustice affect the ethics of medical aid in dying? Cambridge Quarterly of Healthcare Ethics. 2024;33(3):413-24.
43. Pullman D. Moral and intellectual gymnastics in defense of Canada’s out-of-control MAiD regime. Impact Ethics. 19 May 2023.
44. Ipsos. Support for Medically-Assisted Dying in Canada. Dying With Dignity Canada. 9 May 2022.
45. Ipsos. Support for Medically-Assisted Dying in Canada. Dying With Dignity Canada. 30 Jun 2023.
46. Banerjee S. Quebec coroner says Jehovah’s Witnesses had right to refuse blood transfusions. Toronto Star. 14 Nov 2017.
47. Kittay EF. When caring is just and justice is caring: justice and mental retardation. Public Culture. 2001;13(3):557-79.
48. Gill MB. When is self-perceived burden an acceptable reason to hasten death? In: Cholbi M, Varelius J, editors. New Directions in the Ethics of Assisted Suicide and Euthanasia. 2nd ed. Cham, Switzerland: Springer; 2023. p. 315-36.
49. Kious B. Burdening others. Hastings Center Report. 2022;52(5):15-23.
50. Stoll J, Ryan CJ, Trachsel M. Perceived burdensomeness and the wish for hastened death in persons with severe and persistent mental illness. Frontiers in Psychiatry. 2021;11:532817.
51. Box G, Chambaere K. Views of disability rights organisations on assisted dying legislation in England, Wales and Scotland: an analysis of position statements. Journal of Medical Ethics. 2021;47(12):e64.
52. Mathison E. A look at the recent Charter challenge to track two MAID. Value Judgments. 3 Oct 2024.
53. Davis J, Mathison E. The case for an autonomy-centred view of physician-assisted death. Journal of Bioethical Inquiry. 2020;17(3):345-56.
54. Ball IM, Anderson S. Availability of medical assistance in dying can be therapeutic. CMAJ. 2017;189(9):e372.
55. Thienpont L, Verhofstadt M, Van Loon T, Distelmans W, Audenaert K, De Deyn PP. Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study. BMJ Open. 2015;5(7):e007454.
56. Hellman D. When Is Discrimination Wrong? Cambridge, Massachusetts: Harvard University Press; 2008.
57. Casey R. Disability and unmet health care needs in Canada: a longitudinal analysis. Disability and Health Journal. 2015;8(2):173-81.
58. Hopper T. The time when Canada’s elite wanted to sterilize “insane” and disabled people. National Post. 16 Aug 2023.
59. Brown I, Radford JP. The growth and decline of institutions for people with developmental disabilities in Ontario: 1876-2009. Journal on Developmental Disabilities. 2015;21(2):7-27.
60. Colburn B. Disability-based arguments against assisted dying laws. Bioethics. 2022;36(6):680-6.
61. Riddle CA. Assisted dying & disability. Bioethics. 2017;31(6):484-9.
62. Burnett M. A history of abortion in Canada: The quest for women’s reproductive rights. Journal of Obstetrics and Gynaecology Canada. 2019;41(supp. 2):S293-5.
63. James-Abra E. The road to inclusion: transgender health care in Canada. The Canadian Encyclopedia. 29 Jul 2014.
64. MacDonald NE, Stanwick R, Lynk A. Canada’s shameful history of nutrition research on residential school children: The need for strong medical ethics in Aboriginal health research. Paediatrics & Child Health. 2014;19(2):64.
65. Gibson E, Downie J. Consent requirements for pelvic examinations performed for training purposes. CMAJ. 2012;184(10):1159-61.
66. Kilbride MK, Joffe S. The new age of patient autonomy. JAMA. 2018;320(19):1973-4.
67. The Canadian Press. MAID litigant says disability doesn’t make her vulnerable to pressure to end her life. CTV News. 16 Dec 2020.
68. Sastre-Buades A, Alacreu-Crespo A, Courtet P, Baca-Garcia E, Barrigon ML. Decision-making in suicidal behavior: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews. 2021;131:642-62.
69. Beaudry J-S. Bill C-7, assisted dying and “lives not worth living.” Policy Options. 14 Dec 2020.
70. Schuklenk U. Time to rethink assisted dying? Bioethics. 2024;38(4):273-4.
71. Kious BM. Disability, offense, and the expressivist objection to medical aid in dying. Journal of Medicine and Philosophy. 2024;49(6):532-46.
72. Health Canada. Model Practice Standard for Medical Assistance in Dying (MAID). Government of Canada. Mar 2023.
73. Canadian Institute for Health Information. Access to Palliative Care in Canada, 2023. CIHI. 2023.
74. Mathison E. The better world argument. Value Judgments. 17 Nov 2022.
75. Carter v. Canada (Attorney General). 2012 BCSC 886.
76. British Columbia College of Nurses & Midwives. FAQs. BCCNM.
77. Downie J, Chandler J. Interpreting Canada’s Medical Assistance in Dying Legislation. Institute for Research on Public Policy. Mar 2018.
78. Stainton T. Disability, vulnerability and assisted death: commentary on Tuffrey-Wijne, Curfs, Finlay and Hollins. BMC Medical Ethics. 2019;20:89.
79. Riddle CA. Medical aid in dying: the case of disability. In: Cholbi M, Varelius J, editors. New Directions in the Ethics of Assisted Suicide and Euthanasia. 2nd ed. Cham, Switzerland: Springer; 2023. p. 225-41.
80. Roley G. CBC headline on assisted suicide expansion is fake. AFP. 31 Jul 2024.
81. Goldin M. Canada isn’t pushing minors to end their lives. Current euthanasia laws don’t apply to them anyway. AP Fact Check. 24 Jul 2023.
82. Gamage M. She sought help in crisis and was suggested MAID instead. The Tyee. 9 Aug 2023.
83. Lazin SJ, Chandler JA. Two views of vulnerability in the evolution of Canada’s medical assistance in dying law. Cambridge Quarterly of Healthcare Ethics. 2023;32(1):105-17.
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