The relevant question arises as to why a member of the public thinks it ethical to write an article about the ‘ethics’ of MAiD using private medical records “stolen” from a regulating authority. Who is going to investigate the leak? Why isn’t the author prosecuted? Why wasn’t analysis instead conducted by scholars with specific ethics approval from their institution and access authorised by the regulating authority?
Maria Cheng and her ilk need to, as Tim Walz might say, "mind your own business". A relative of mine chose MAID and left this world on his own terms. His mobility rapidly declined over a period of 6 months and he despaired of losing his autonomy, of not being able to walk through his woods, enjoying nature, doing everything he loved. Before his diagnosis, he attempted suicide. That accelerated the hospital testing which a month later showed that he had ALS. But, had his condition been a chronic one that left him unable to walk or lift his arms, he would have still chosen MAID. He was a wealthy man and could have arranged for round the clock care by an army of health care providers, but that would not have prevented his own personal agony of losing autonomy. But, the Maria Cheng's of this world would like to see him continue in that agony.
I have to politely disagree with you Eric. Do you really think you can confidently say "maid is working great" ... for everyone? I respect you enough to hope you will be able to see that are a great number of people for whom our maid system is not working great for. Your title could use some revision; I can propose some suggestions if you're open to hearing them from me.
Also, I’m not so much concerned with the question of “should euthanasia be legal in Canada?” But the question “what should doctors be doing ?” I came into medical because I personally want to:
1. Promote health
2. Protect life
3. Palliative suffering
I do not want to kill someone (even if they ask me). Based on where I personally come from, giving a lethal injection to a patient will not be within my role. (I'm only a 2year medical student with a lot to learn - I'm open to changing my mind about many things, but I cannot see myself changing my mind on this one). I see my role being to cherish their life until it comes to a natural close, be present in walking with them in their pain and suffering, and doing everything I can to work towards the health of all.
I care about spending my time working towards making the lives of persons with disabilities worth living, instead of ending them. I care about working towards palliating their suffering, working for structural change, and giving their lives meaning instead of throwing in the towel and giving up. I see my role as a doctor as being one of 'holding out hope for my patient's lives' when they are unable to hold out hope for themselves. Guess what? Hope changes things. The research in counselling is clear about that. Hope is a co-created process, but so is despair, which is so often like to call "autonomy."
I care about reminding each person that they are a person of intrinsic worth no matter what society says about them. I care about considering every human being like a person, because I think that are a person. I care not about asking someone if they want to die, but asking someone how I can help them live, and do so well. I care about how people with disabilities live in such a way where they feel like gifts to world, and not just things to be gotten rid of. I care about working towards the fulfillment of their basic needs, like rent and food and meaningful things to do - and also to help them live in such a way where they get to give and receive.
I care about working for what is beautiful, true and good, and in my personal opinion: this is not it. Maid is not working great for every person in Canada, it is actually doing just the opposite for some cases. I will not hold back anything I can reasonably give my future patients that promotes their health, life and wellbeing, but I will never give them a lethal injection, no matter what.
Please reach out to me if you would like to chat. Please ask how you can support me become a family doctor in rural community. I’m currently a 2nd medical school in Canada who sees it as such a privilege and honour to serve patients, I hope I will be seen as a worthy physician in their eyes.
Thanks for sharing. Regarding hope, the evidence is clear that physicians pressure or force patients to accept treatment they don't want and likely won't benefit from. I think it's fine to have hope, but hope at all costs has significant downsides many areas of medicine aren't adequately addressing. Here's a post on this: https://valuejudgments.substack.com/p/psychiatry-has-a-futility-problem
Interesting, I look forward to reading. I wonder if physician lack of hope though has caused patients to receive a lethal injection they otherwise would not have chosen had their physician had more hope. Hope is actually a pre-requisite for working to change things - it opens up more possibilities and ways of thinking. Please let me know if you would benefit from learning from my expertise in hope-counselling.
In fact, there was a direct quote from an article trying to distinguish how maid is different from suicide that says the difference is that “maid is when someone agrees with you.” I will never agree with my patients if they tell me they do not have intrinsic worth and the reason they want to kill themselves is because they think they are worthless, because I think that is untrue.
Ellen Weibe says she's given MAID to people while disagreeing with their choice, so it isn't always true that getting MAID means agreeing with the patient. I've met a few people who would have qualified for MAID but decided to end their lives themselves. In those cases, I agreed with their suicides in that the decisions made sense. I don't think being a good healthcare provider requires agreeing with a patient's decision.
Interesting, so in your world would a good health care provider willingly remove someone’s healthy limb because the patient says they would prefer you do so?
In my view, it's an unethical form of paternalism for a physician to say "I'm not going to do this for you because, in my view, you should stay keep trying". Using 'tosses in the towel' implies that the physician is giving up on the patient, but that isn't what's happening.
Is it paternalistic then when I doctor says “I think we should ‘continue trying’ to see if this cold will leave before prescribing you antibiotics? Because it’s likely a virus in which case antibiotics would be of no benefit to your life and health. Is it paternalistic then when a doctor says “I will not remove your healthy limb because there is no medical benefit for it” even though you ask me to? If it is not paternalistic then on the grounds that they do not serve a patients life or health, how is it then also paternalistic to decline a maid request on the grounds that they do not promote a patient’s life or health?
I also would like to ask: would you rather have a physician like me who may say something like “you say your life is not worth living because you think that you are worthless, completely. Respectfully, I disagree with you. I think you are person of intrinsic worth no matter what you can contribute to the economy. You contribute just by being here. Im glad you’re here and you are important to me. I know you would like to die by maid and this is an option available to you, but you will need to self-refer or see another member of our team. I cannot personally offer you maid, but what I can do is work with you to see if we can get to the bottom of your suffering. What’s driving your request to die? We can figure out your top three reasons and rank them. Then I ask your doctor can work with you to problem solve if we can help you get to the point where YOU say I think life is worth living because that’s what I want for you here. The research is on our side here - when this kind of counselling is done well it changes people’s minds. It saves lives. I promote health and life. I hold out hope for my patients while respecting their autonomy. I came to serve my future patients, to promote healing and recovery, as well as palliate their suffering so that they can live well as they can until their last breath. I will be with them and keep caring for them no matter what.
In some cases, I think it's fine for physicians to make their case in favour of one option, but given all the worries MAID opponents have about people being pressured *into* MAID, we should also be worried about people being pressured out of it. The problem is the pressuring. I'm against allowing conscientious objectors in healthcare because it interferes with patient-centred care: https://valuejudgments.substack.com/p/conscientious-objection-is-incompatible
I have many posts evaluating anti-MAID arguments on disability grounds. These arguments are from people, such as Liz Carr, who are upset about MAID. Here are some examples from the past six months.
The vast majority of people with disabilities support assisted dying, and it was two people with disabilities—Jean Truchon and Nicole Gladu—who won a Charter challenge so they could access MAID because of their disability. My views support their right to make their own decisions. You might consider reading about them.
I would love to read them because I listen to the voices of people with disabilities. I listen carefully to what they say to me personally as well as what they say publicly. Ultimately, based on my counselling training, I find that people are more interested in having their core needs met and I will continue to use my position to do everything I can to connect them with the things they say they need. I will look up the links you have sent me. In exchange, I would ask you to listen to these two stories: each only 5-10 minutes long related to MAiD.
The article itself sums it up: "Compliance with these standards, Huyer says in the presentation, has overall been excellent: “We don’t see problems in the vast majority of cases.”
These were all reported by MAID providers. The cases were all investigated. There's nothing there.
"Working great," you say? Hmmm........ https://www.thenewatlantis.com/publications/compliance-problems-maid-canada-leaked-documents
Thank you for this, Heidi.
The relevant question arises as to why a member of the public thinks it ethical to write an article about the ‘ethics’ of MAiD using private medical records “stolen” from a regulating authority. Who is going to investigate the leak? Why isn’t the author prosecuted? Why wasn’t analysis instead conducted by scholars with specific ethics approval from their institution and access authorised by the regulating authority?
Maria Cheng and her ilk need to, as Tim Walz might say, "mind your own business". A relative of mine chose MAID and left this world on his own terms. His mobility rapidly declined over a period of 6 months and he despaired of losing his autonomy, of not being able to walk through his woods, enjoying nature, doing everything he loved. Before his diagnosis, he attempted suicide. That accelerated the hospital testing which a month later showed that he had ALS. But, had his condition been a chronic one that left him unable to walk or lift his arms, he would have still chosen MAID. He was a wealthy man and could have arranged for round the clock care by an army of health care providers, but that would not have prevented his own personal agony of losing autonomy. But, the Maria Cheng's of this world would like to see him continue in that agony.
Thank you for taking a breath and clarifying what I struggled to put into words.
Can you also please respond to the question and resource raised by Heidi Janz? Her’s is a voice you need to listen to
I have to politely disagree with you Eric. Do you really think you can confidently say "maid is working great" ... for everyone? I respect you enough to hope you will be able to see that are a great number of people for whom our maid system is not working great for. Your title could use some revision; I can propose some suggestions if you're open to hearing them from me.
Also, I’m not so much concerned with the question of “should euthanasia be legal in Canada?” But the question “what should doctors be doing ?” I came into medical because I personally want to:
1. Promote health
2. Protect life
3. Palliative suffering
I do not want to kill someone (even if they ask me). Based on where I personally come from, giving a lethal injection to a patient will not be within my role. (I'm only a 2year medical student with a lot to learn - I'm open to changing my mind about many things, but I cannot see myself changing my mind on this one). I see my role being to cherish their life until it comes to a natural close, be present in walking with them in their pain and suffering, and doing everything I can to work towards the health of all.
I care about spending my time working towards making the lives of persons with disabilities worth living, instead of ending them. I care about working towards palliating their suffering, working for structural change, and giving their lives meaning instead of throwing in the towel and giving up. I see my role as a doctor as being one of 'holding out hope for my patient's lives' when they are unable to hold out hope for themselves. Guess what? Hope changes things. The research in counselling is clear about that. Hope is a co-created process, but so is despair, which is so often like to call "autonomy."
I care about reminding each person that they are a person of intrinsic worth no matter what society says about them. I care about considering every human being like a person, because I think that are a person. I care not about asking someone if they want to die, but asking someone how I can help them live, and do so well. I care about how people with disabilities live in such a way where they feel like gifts to world, and not just things to be gotten rid of. I care about working towards the fulfillment of their basic needs, like rent and food and meaningful things to do - and also to help them live in such a way where they get to give and receive.
I care about working for what is beautiful, true and good, and in my personal opinion: this is not it. Maid is not working great for every person in Canada, it is actually doing just the opposite for some cases. I will not hold back anything I can reasonably give my future patients that promotes their health, life and wellbeing, but I will never give them a lethal injection, no matter what.
Please reach out to me if you would like to chat. Please ask how you can support me become a family doctor in rural community. I’m currently a 2nd medical school in Canada who sees it as such a privilege and honour to serve patients, I hope I will be seen as a worthy physician in their eyes.
Thanks for sharing. Regarding hope, the evidence is clear that physicians pressure or force patients to accept treatment they don't want and likely won't benefit from. I think it's fine to have hope, but hope at all costs has significant downsides many areas of medicine aren't adequately addressing. Here's a post on this: https://valuejudgments.substack.com/p/psychiatry-has-a-futility-problem
Interesting, I look forward to reading. I wonder if physician lack of hope though has caused patients to receive a lethal injection they otherwise would not have chosen had their physician had more hope. Hope is actually a pre-requisite for working to change things - it opens up more possibilities and ways of thinking. Please let me know if you would benefit from learning from my expertise in hope-counselling.
In fact, there was a direct quote from an article trying to distinguish how maid is different from suicide that says the difference is that “maid is when someone agrees with you.” I will never agree with my patients if they tell me they do not have intrinsic worth and the reason they want to kill themselves is because they think they are worthless, because I think that is untrue.
Ellen Weibe says she's given MAID to people while disagreeing with their choice, so it isn't always true that getting MAID means agreeing with the patient. I've met a few people who would have qualified for MAID but decided to end their lives themselves. In those cases, I agreed with their suicides in that the decisions made sense. I don't think being a good healthcare provider requires agreeing with a patient's decision.
Interesting, so in your world would a good health care provider willingly remove someone’s healthy limb because the patient says they would prefer you do so?
We can change it to “ agrees with you that your life is not worth living if you feel that “ instead of tossing in the towel
Or would you rather have a physician who tosses in the towel prematurely and says yes to death when there could be hope?
In my view, it's an unethical form of paternalism for a physician to say "I'm not going to do this for you because, in my view, you should stay keep trying". Using 'tosses in the towel' implies that the physician is giving up on the patient, but that isn't what's happening.
Is it paternalistic then when I doctor says “I think we should ‘continue trying’ to see if this cold will leave before prescribing you antibiotics? Because it’s likely a virus in which case antibiotics would be of no benefit to your life and health. Is it paternalistic then when a doctor says “I will not remove your healthy limb because there is no medical benefit for it” even though you ask me to? If it is not paternalistic then on the grounds that they do not serve a patients life or health, how is it then also paternalistic to decline a maid request on the grounds that they do not promote a patient’s life or health?
I also would like to ask: would you rather have a physician like me who may say something like “you say your life is not worth living because you think that you are worthless, completely. Respectfully, I disagree with you. I think you are person of intrinsic worth no matter what you can contribute to the economy. You contribute just by being here. Im glad you’re here and you are important to me. I know you would like to die by maid and this is an option available to you, but you will need to self-refer or see another member of our team. I cannot personally offer you maid, but what I can do is work with you to see if we can get to the bottom of your suffering. What’s driving your request to die? We can figure out your top three reasons and rank them. Then I ask your doctor can work with you to problem solve if we can help you get to the point where YOU say I think life is worth living because that’s what I want for you here. The research is on our side here - when this kind of counselling is done well it changes people’s minds. It saves lives. I promote health and life. I hold out hope for my patients while respecting their autonomy. I came to serve my future patients, to promote healing and recovery, as well as palliate their suffering so that they can live well as they can until their last breath. I will be with them and keep caring for them no matter what.
In some cases, I think it's fine for physicians to make their case in favour of one option, but given all the worries MAID opponents have about people being pressured *into* MAID, we should also be worried about people being pressured out of it. The problem is the pressuring. I'm against allowing conscientious objectors in healthcare because it interferes with patient-centred care: https://valuejudgments.substack.com/p/conscientious-objection-is-incompatible
Thanks for the analysis. I've yet to come across an argument against assisted death that I find even close to persuasive.
I have many posts evaluating anti-MAID arguments on disability grounds. These arguments are from people, such as Liz Carr, who are upset about MAID. Here are some examples from the past six months.
https://valuejudgments.substack.com/p/better-off-dead-is-inconsistent
https://valuejudgments.substack.com/p/some-people-with-disabilities-want
https://valuejudgments.substack.com/p/a-look-at-the-recent-charter-challenge
The vast majority of people with disabilities support assisted dying, and it was two people with disabilities—Jean Truchon and Nicole Gladu—who won a Charter challenge so they could access MAID because of their disability. My views support their right to make their own decisions. You might consider reading about them.
I would love to read them because I listen to the voices of people with disabilities. I listen carefully to what they say to me personally as well as what they say publicly. Ultimately, based on my counselling training, I find that people are more interested in having their core needs met and I will continue to use my position to do everything I can to connect them with the things they say they need. I will look up the links you have sent me. In exchange, I would ask you to listen to these two stories: each only 5-10 minutes long related to MAiD.
Story 1 https://youtu.be/yQq5jOMIFLo?si=JJqFq0yF5lswLicz
Story 2
Story 2: https://youtu.be/QdTwB2VwIuQ?si=gcWCWgnEvYgyregS
Please do let me know when you watched them both, and if you can, provide your opinion or reflections on them. I’d like to know what you think.
Can you also please answer the question posed in the comment above?
The article itself sums it up: "Compliance with these standards, Huyer says in the presentation, has overall been excellent: “We don’t see problems in the vast majority of cases.”
These were all reported by MAID providers. The cases were all investigated. There's nothing there.
Here's the entire post with links to the polls: https://valuejudgments.substack.com/p/some-people-with-disabilities-want