Canadians have had legal access to medical aid in dying (MAID), the preferred term there, since June 2016. The Canadian law does not limit MAID to those who are expected to die within six months, as is the case in those USA and Australian states that permit assisted dying, (the ‘Oregon model’). Instead their law uses the phrase “a reasonably foreseeable death” to indicate those who are “terminally ill” in a broader sense. A further safeguard is that a person requesting MAID must have the mental capacity to make such a decision at the time of their assisted death. So where does that leave those suffering from the various forms of dementia?
Dementia is recognised as a terminal illness, though it takes 7 or 8 years after diagnosis, on average, to cause death. Many others die “with” dementia rather than “of” it. A staggering 1 in 8 deaths in England and Wales are caused by dementia – a figure that has been steadily rising. There is no cure. Dementia sufferers therefore have a death that is “reasonably foreseeable”. In the early stages of dementia, patients have the mental capacity to make a life ending choice. An assisted death in Switzerland has been an option for many years, provided the person has mental capacity at the time. On this basis, the criteria seem clear cut regarding the law in Canada. But MAID practice in Canada has been cautious as the implications of the law come into effect.
The Globe and Mail, one of Canada’s most widely read newspapers, has recently published an in depth account of the medically assisted death of Alzheimer’s patient Mary Wilson. The article considers how the doctors involved carefully considered the case, in terms of the requirements of the MAID law. The doctors decided to take the risk that they were acting within the law, and gave Ms Wilson the MAID she wanted. The College of Physicians and Surgeons of British Columbia spent 10 months investigating the death, eventually deciding that the doctors had acted appropriately. Although this is not a judicial ruling, it should still go some way to reassure other doctors that this course of action is permitted under the current Canadian MAID law.
The issues concerning Assisted Dying in cases of Dementia are complex and need to be considered carefully. The topic is the subject of a new book by Dr Colin Brewer. The developing situation in Canada shows how relevant this topic is. When invited to comment on the significance of this new case Dr Brewer responded:
“This case shows that most dementias are recognised as conditions that will inevitably be fatal unless another lethal illness intervenes. Canada’s MAID law had some built-in flexibility. As doctors gained more experience of MAID, judges could take that into account. Britain should follow this lead from the Old Commonwealth and not feel obliged to adopt the ‘Oregon Model’.”
MDMD is watching the Canadian developments with interest. We have always held the view that those suffering from early stage dementia, while they still have mental capacity to make a life ending decision, should have the option of a medically assisted death. This is currently available in Switzerland, Netherlands and Belgium. We are delighted that these recent developments in Canada are leading to the option being available there too.