Don’t confuse advance health directives with MAID

Opinion

Hey there, time traveller!
This article was published 19/02/2025 (235 days ago), so information in it may no longer be current.

I read Ruth Enns’ Feb. 3 Think Tank piece in the Free Press (Medical assistance in dying and advance directives) with great interest, because these are topics that interest me.

However, while it’s good to see these issues become part of a broader conversation, some clarification is required.

Ms. Enns is clearly passionate about her subject matter, but I believe she is confounding advance health directives with advance requests for medical assistance in dying, and these are two very different tools.

Advance directives (ADs) — also known as health-care directives — express the decisions you’ve made about the kind of health care you want in the future should you become incapacitated. In Canada, you can set out detailed wishes for yourself and name a trusted person as your substitute decision-maker in the event that you cannot communicate.

For example, an AD might stipulate that if you were gravely injured in an accident and were comatose with catastrophic and irreversible brain damage, you would not wish to continue being fed through a tube.

The government webpage on Manitoba health directives explains that while such ADs are binding and will be honoured by the courts, “health -care professionals treating you are not obliged to search for or ask about a signed directive.”

So, “It is important to be sure that family, friends, your doctor and your proxy know you have a directive and know where it can be found.”

ADs are not the same as advanced requests for medical assistance in dying (MAID). The former is about a person’s wishes for care that could prolong life or allow it to ebb; the latter is a directive about ending their life at a certain definitive point.

While a substitute decision-maker is responsible for conveying a person’s wishes in terms of AD, they cannot request MAID on another person’s behalf.

As Dalhousie University’s Health Law Institute makes clear, “It is not possible to request MAID through a provincial or territorial advance directive.”

Advanced directives and MAID are different things, but both involve personal choices and both also require conversations that some people find uncomfortable. As a rule, we don’t like to think of ourselves as being no longer in control or helpless to tell people what we want.

Currently, Quebec is the only place in Canada where advance requests for MAID are available.

People in that province have been able to make the requests under certain prescribed circumstances as of Oct. 30, 2024. If a person is diagnosed with a serious and incurable illness that will eventually leave them incapacitated, they can apply — while they are still able to consent — to receive MAID when they reach a point in their deterioration that they find personally unacceptable.

For example: if I lived in Quebec, was diagnosed with Alzheimer’s disease and was still mentally competent (a period that can last for years), I might decide that when I was no longer able to recognize my children, spouse or siblings — or even myself — that I wished to receive MAID.

It’s not exactly a mechanism that allows us to “order up a beautifully scripted death like a latte-to-go,” as Ms. Enns writes of advance directives in her piece; indeed, anyone who has watched a loved one’s steady decline through dementia can tell you there is nothing beautiful or scripted about the multitude of small deaths a person experiences as the disease robs them of themselves.

While advanced requests for MAID are still in contradiction of the Criminal Code of Canada, the federal government has said it won’t challenge what is happening in Quebec for now.

On Feb. 14, the Canadian government wrapped up the online survey portion of a countrywide consultation on advanced requests for MAID. The results of its findings are expected this spring.

You can find Health Canada’s comprehensive 2023 report on MAID here: bit.ly/4hsoPQA.

It offers insights on exactly how MAID is administered and regulated in this country.

It also outlines the rigorous conditions that have to be met before MAID is approved and the considerations taken into account by medical providers. No one is being “‘helped’ into the nearest hearse,” as Ms. Enns suggests, without due care and consideration for their unique circumstances, their wishes and the law.

And people can, and do, change their minds after requesting MAID. In 2023, for example, 496 people did so.

Finally, to suggest that no one “has time, resources and patience for such conversations these days,” as Ms. Enns did, does a disservice to the people making difficult choices about their health and their lives only after a great deal of contemplation, as well as to the thoughtful, ethical and compassionate medical professionals who are willing to help them achieve a measure of autonomy over their own lives — and deaths.

Pam Frampton is a freelance writer and editor who lives in St. John’s.

pamelajframpton@gmail.com

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