Opinion: Politics has no place in patients' end-of-life decisions

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The Alberta UCP has recently come out with a number of policy proposals they will consider at their AGM on Nov. 3 and 4. One of these proposals concerns Medical Assistance in Dying and, if passed, will have the effect of seriously hindering Albertans’ access to timely information about MAID, despite the fact it is a legal option for all residents who meet the eligibility criteria.

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The proposal recommends that health-care workers in any facility shall not be allowed to present or promote MAID to a patient as a care option. The procedure must be considered a tragic last resort and only be discussed with a patient of legal age upon request by the patient or their proxy.

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Fewer than two-thirds of Albertans know that MAID is legal. It is difficult to ask for information about an option if you don’t know that it exists. Prohibiting health-care workers from discussing MAID with their patients amounts to withholding information regarding one of their care options. Where will sick, tired and aging patients learn of their option to have help dying, if not from health-care workers?

There is a vast difference between encouraging a patient to end their life and making a patient aware of all of the care options that are available to them. Every patient has the right to refuse care, the right to a do-not-resuscitate order, and the right to die when they are ready to if they meet the MAID eligibility criteria; (one of which is having enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable). Goals-of-care conversations are standard practice in Alberta health-care facilities and offer a segue into discussion of MAID if it seems warranted. The Canadian Association of MAID Assessors and Providers’ new MAID curriculum covers situations and methods in which it is and is not appropriate to introduce MAID into such clinical conversations.

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Another UCP policy proposal suggests that individual health-care workers and private hospice facilities must have their rights to freedom of conscience honoured when deciding to participate in administering MAID.

Health-care workers in Alberta already have freedom of conscience in the matter of MAID. They are not required to participate but must provide an effective referral. It is not appropriate to grant “freedom of conscience” to publicly funded institutions, which in turn impose this “conscience” on employees, as is currently the case in Alberta.

Accessing MAID is a deeply personal decision made infinitely more challenging and frustrating by a health-care team that won’t, or can’t, talk to you about your options. In a patient-centred care model, decisions about personal directives, bodily autonomy and medically assisted death should first and foremost be about patient choice.

Support for the Carter vs. Canada decision, which legalized MAID, remains strong among Canadians at 84 per cent. Seventy-three per cent of people across Canada believe that publicly funded health-care facilities should be required to provide the full range of health-care services, including MAID. Interestingly, 73 per cent of Catholics and 63 per cent of Protestants also support this statement.

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The rationale for both parts of the UCP proposal No. 10 suggests that we should “put the focus back on life-affirming care and suicide prevention, and offer people hope and healing instead of a quick end.” Recent research shows that 70 to 80 per cent of Canadians choosing MAID have a terminal illness. Healing is not an option for these people and “hope” is a subjective concept.

It is not the government’s role to define what it means and it is unconstitutional to interfere with someone’s access to MAID.

The government’s job is to ensure that patients’ rights and choices are protected, respected and delivered in a compassionate and accessible manner, especially at the end of life.

Cynthia Clark is the co-author of The Many Faces of MAID. She supported her husband through his medically assisted death several years ago and now serves as a board member of MAID Family Support Society.

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