Discussion The latest report on MAID in Canada should reassure the naysayers

[Alexei_Kirillov]

Here are some highlights from the recently released report on MAID in Canada; overall, I think these results fly in the face of the most common criticisms of MAID, ie. that it's a slippery slope and that it's discriminatory against disabled/racialized/low-income/otherwise marginalized groups. Rather, what the data suggest is that legalizing assisted death simply gives people another option for how they want to spend the last years of their life.

- The vast majority of MAID recipients (95.9%) had a physical illness causing a "reasonably foreseeable" death, despite MAID being legal for those without foreseeable deaths. (Take this with a grain of salt though, as the expansion to those without foreseeable deaths has only been in effect since 2021, so people may just not be aware that it's an option. With that said, the report from last year showed similar numbers, with 96.5% having a reasonably foreseeable death.)

- Growth has slowed down from previous years, with only a 15.8% increase between 2022 and 2023 (compared to around 30% in years prior). This may indicate that a stabilization/peak has been reached (though the report hedges on that question).

- Almost all (95.8%) MAID recipients were white (for context, Canada's total population is about 67% white, though that number goes up in older demographics, who are obviously the main demographic accessing MAID).

- Less than 0.1% said that they needed palliative care services but were unable to access it.

- The average age was 78 years old.

- The most common reason for a MAID request being rejected, representing 24% of rejections, was that the practitioner considered the patient to be "incapable of making decisions with respect to their health."

- "people who receive MAID do not disproportionately come from lower-income or disadvantaged communities"; interestingly, the disparity was actually lower for people who died by MAID than by natural causes, with the exception of those who lived in areas of "residential instability," which is defined as neighbourhoods where there are high proportions of renters and a high turnover rate.



@EvisceratedJester @TAW122 @FadingDawn

 

[TAW122]

This is interesting data here, and while I'm not a Canadian, but rather US citizen, this definitely does help with countering some of the criticisms and misinformation by pro-lifers, anti-choicers, and various DRAs (Disability Rights Activists) who try to paint MAID in a bad light. I would say that hopefully more people are aware of MAID being available for those who have conditions that don't have foreseeable deaths (within half a year or less). I do think that even MAID in it's current state is still far ahead of the US Death With Dignity (DWD) program and it may be many years (if ever) that the US, especially the states that already have DWD policies in place to expand on them. It would certainly be a major step for the US if they expanded DWD for those who aren't solely terminally ill, because the people who really benefit the most are those who are chronically suffering yet have many years of life (often in poor quality and full of anguish and suffering - that many people don't hear about let alone talk about) remaining. Anyways, thanks for sharing this graph to illustrate your point, I'm sure I may include it in one of my future megathreads down the road.

 

[Forever Sleep]

That's interesting. Overall, it looks encouraging. That- like you say, it ought to satisfy the critics that their fears aren't being realised in the data.

I wonder just how unsound of mind those people were that they rejected for being: 'incapable of making decisions with respect to their health.' I wonder if that covers all mental illness.

Also, I kind of chuckled when they mentioned illnesses causing a 'reasonably foreseeable' death. Obviously, I get what they're meaning but, you have to admit, life itself causes a 100% guaranteed foreseeable death. Maybe not in the timespan they'd prefer though.

 

[Alexei_Kirillov]

That's interesting. Overall, it looks encouraging. That- like you say, it ought to satisfy the critics that their fears aren't being realised in the data.

I wonder just how unsound of mind those people were that they rejected for being: 'incapable of making decisions with respect to their health.' I wonder if that covers all mental illness.

Also, I kind of chuckled when they mentioned illnesses causing a 'reasonably foreseeable' death. Obviously, I get what they're meaning but, you have to admit, life itself causes a 100% guaranteed foreseeable death. Maybe not in the timespan they'd prefer though.

Haha yeah, but this speaks to one of the thorniest problems for MAID implementation, which is a definitional one: what exactly is a reasonably foreseeable death? What does it mean to be sound of mind? How exactly can you establish someone's capacity for making decisions about their health? On that front, I sympathize with the critics (though my solution as someone who is pro-choice is to remove such nebulous criteria, like the foreseeable death one). It makes me despair for the expansion of MAID for mental illness though, because if it's this hard for empirically observable illnesses, how much harder will it be for ones that exist only within someone's subjective experience?

 

[-Link-]

It makes me despair for the expansion of MAID for mental illness though, because if it's this hard for empirically observable illnesses, how much harder will it be for ones that exist only within someone's subjective experience?

I wonder as well how accessibility might play into all of this.

A patient's documented medical history will obviously be an important factor in any application for MAID, but I'm guessing it will be especially so for mental illness. Meanwhile, 20% of all Canadians (notably 35% of the 18-29 age group) don't even have a family doctor, let alone regular access to mental health treatment.

I see a lot of stories from people without family doctors who can't even get a disability application done because they don't have a doctor who's consistently associated with them. At least there is a legal requirement that anyone asking to apply for MAID be referred to a doctor for that purpose, so they cannot refuse these people as they would refuse a disability applicant. But this isn't much help to someone who's only had limited access to mental health treatment (if any at all) because the doctors assessing their MAID application are still going to want to see some consistent documented medical history, probably spanning over multiple years' time.

As an aside, I wonder how often a MAID application will be a patient's entry point for mental health treatment...

More to the specific topic here, I'm also wondering what being "most deprived" might mean in terms of a person's access to healthcare and their ability to amass the documentation required for a MAID application, and how that might affect the stats (if at all) outlined in this report. This, mostly concerning "Track 2" where natural death is not reasonably foreseeable. (With "Track 1," a documented history seems mostly redundant to assessing the current status of a patient's terminal illness.)