Canada is expanding categories for medically assisted death…

Canada is expanding categories for medically assisted death
Canada is expanding categories for medically assisted death
NPR's Michel Martin Speaks with Dr. Madeline Li about how Canada is set to expand the categories of those who can request medical assistance to end their lives to include people with mental illness.
MICHEL MARTIN, HOST:
Canada has allowed terminally ill patients to end their lives with medical assistance since 2016. And eventually, even as early as next March, Canadians living with severe mental illness could also be eligible under the law known as medical assistance in dying, or MAID. But as you might imagine, that has raised many difficult ethical and moral questions, both about the motivations of health care workers who might offer the option and also about the competence of patients who might request it.
We suspect that this is the kind of dilemma that might resonate across borders. So we called Dr. Madeline Li to walk us through some of these thorny issues. She is a cancer psychiatrist who works in end-of-life care. And Dr. Li actually developed the medical assistance in dying program for the University Health Network in Toronto, Canada. And she is with us now. Dr. Li, welcome. Thank you so much for joining us.
MADELINE LI: Hello. And thank you for the invitation to speak on this really challenging topic.
MARTIN: It certainly is. So can you just kind of just set the table for us? Who can currently request medical assistance in dying in Canada? And do you have any sense of how many people actually do in the course of a year?
LI: The issue in Canada is that it's actually never been clear who assisted dying was intended for, whether it was meant for those with terminal illness who are suffering from how they were about to die or whether it was intended for people with chronic illness who are suffering with how they're currently living. It's unlike the States where - in the States where it's legal, assisted dying is only for terminal illness and people who have less than six months left to live. So their deaths would occur whether they were medically assisted or not.
In Canada, it was always the case, from the beginning in 2016 when it was legalized, that people with chronic diseases who still naturally could live for several years were qualifying for assisted dying. And in March of 2021, the Canadian law changed. It really opened up to allow for more chronic conditions for things like chronic pain. And so that's who is qualifying now, both people who will be dying shortly and those who are living longer but really suffering with how they're living.
MARTIN: Well, I thank you for the distinction between the Canadian program and the U.S. program because it - medically assisted dying is very rare in the United States as an option. And so do you have a sense of how many people in Canada have taken advantage of this option since it became legalized?
LI: There have been - over 30,000 people have received assisted dying since it was first legalized - 10,064 patient (ph) in 2021. That accounts for 3.3% of all deaths in Canada.
MARTIN: Is it accepted as a right in Canada? Or is it still controversial?
LI: So I would say assisted dying for people who are dying, who have terminal illness, is widely accepted. I'm surprised at how quickly it became normalized - and that's the term I would use - that in clinical practice, people accept it as a routine option at the end of life now. I think it is less normalized, less accepted for people who actually aren't facing end of life. So for people who are choosing MAID because of a chronic condition and still have several years to live, I think that is - there have been many more concerns raised about that as the eligibility criteria are expanding in Canada.
MARTIN: Oh, I see. Can you just talk a little bit about the role of the medical professional?
LI: In some ways, the law has placed medicine in the role of safeguarding the practice and establishing eligibility criteria. And the doctors are required to make sure patients meet those eligibility criterias (ph) and assess their suffering from their medical condition. And so in terms of the actual practice, it's the role of the doctor to assess whether a patient is capable, whether their condition is reversible or not, whether they've adequately considered the alternatives to MAID in terms of relieving their suffering. Clinicians also play a role or should be trained to play a role in helping patients make the best decisions for themselves.
MARTIN: What is being contemplated here in expanding the program? And how does mental illness play into it?
LI: Assisted dying has been legal since 2016. And then, in March of 2021, it expanded so that you no longer needed what was called a reasonably foreseeable natural death. They excluded, specifically excluded, situations where a mental disorder was the only medical condition that was causing the suffering. And it was introduced originally because they felt that this wa…