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In June 2016, Canada and California both enacted legislation allowing medical assistance in dying . However, the annual reports reveal a significant contrast, with 486 deaths reported in California in 2021 compared to 10,064 in Canada under their respective laws. The essay explores factors influencing Canada’s rise in medically assisted deaths, contrasting it with California’s more conservative stance amid global pressures to liberalize access to such assistance.
In 1994, George Annas wrote a satirical letter in the Hastings Center Report, set in the year 2020, warning about a fictional plan by the National Health Board to close Kevorkoria, places where individuals could choose dignified end-of-life experiences. The letter raised concerns about the medicalization of suicide, undermining personal autonomy. While the U.S. did not follow this dystopian path, Canada passed legislation in 2016 allowing medical assistance in dying (MAiD), and subsequent amendments expanded eligibility, even including mental illness. Critics worry about Canada’s rapid liberalization of MAiD, contrasting it with the more cautious approach in various U.S. jurisdictions. The debate on assisted dying legislation continues on both sides of the border, with potential lessons to be learned.
ASSISTED DYING IN CANADA ANDCALIFORNIA: A DISTURBING COMPARISON
Medical assistance in dying (MAiD) was legalized in Canada in June 2016, coinciding with the enactment of the End of Life Option Act in California. While California’s legislation closely mirrors conservative approaches in the U.S., Canada looked to European examples like Belgium and the Netherlands for a more liberal approach. Annual reports from both Canada and California reveal stark differences in MAiD statistics. In 2020, Canada reported 7,595 MAiD cases (2.5% of all deaths), whereas California reported 435 cases (0.15% of all deaths). In 2021, Canada saw a 30% increase, reaching 3.3% of all deaths, while California’s percentage remained constant at 0.15%. From 2016 to 2021, 31,664 Canadians and 3,344 Californians died under MAiD. The reasons for the substantial difference in numbers are speculative, involving factors like restrictive access criteria, better end-of-life care, or quicker acceptance by Canadian healthcare providers. The criteria for accessing assisted death in both regions involve terminal conditions, with Canada’s “reasonably foreseeable natural death” criterion interpreted liberally. Quebec challenged this criterion in 2018, deeming it a violation of rights. Bill C-7, introduced in response, expanded eligibility beyond terminal illness. Concerns were raised about its impact on vulnerable populations and potential violation of disability rights. The difference in mode of death between the two regions is notable, with California allowing oral ingestion by patients, while Canada permits intravenous administration by healthcare professionals. The role of practitioners in actively administering lethal medication in Canada raises ethical concerns about patient autonomy and potential coercion. The expansion of eligibility criteria, particularly for mental illness, has stirred debate on safeguards and the medicalization of suicide. The impact of the revised legislation is evident in the increased number of MAiD cases in Canada, reflecting a more permissive interpretation of eligibility criteria. The contrast in numbers between Canada and California emphasizes the importance of scrutinizing the role of healthcare professionals in the MAiD process, raising questions about autonomy and the potential for undue influence.
SLOWING THE SLIDE: POTENTIAL LESSONS FORTHE ETHICAL ADMINISTRATION AND LEGALOVERSIGHT OF ASSISTED DYING
In 1994, George Annas and Grant Gillett presented contrasting perspectives on physician-assisted death in the United States. Gillett defended the idea that although killing a patient should remain illegal, there might be situations where it is the morally right action. Canadian scholars in 1994 supported the notion that certain acts hastening death could be ethically justifiable without changing laws to permit advance authorization for euthanasia.
Nearly three decades later, California has maintained legal restraint by restricting assisted dying to those near death, whereas Canada has moved towards legalizing physician-assisted death, relying on healthcare professionals’ moral intuitions. The comparison highlights the success of the cautious approach in the U.S., emphasizing stringent eligibility criteria. Canada is urged to reconsider its path, learning from California’s approach and limiting subjective interpretations of reasonably foreseeable natural death criteria.
The U.S. may also consider exceptional cases where patients, due to progressive illnesses, might need direct assistance in ending their lives. However, this should be approached cautiously with strict guidelines and ongoing oversight. The essay concludes by emphasizing the complexity of end-of-life decision-making, warning against hasty solutions, and stressing the need for moral judgment informed and constrained by the law. Canada is urged to learn from the U.S., while the U.S. should remain vigilant to avoid potential pitfalls in the evolving landscape of physician-assisted death.
Source:
Daryl Pullman (2023) Slowing the Slide Down the Slippery Slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US, The American Journal of Bioethics, 23:11, 64-72, DOI: 10.1080/15265161.2023.2201190