Dr. Wasylenko reminds us that when the Government of Canada amended the Criminal Code in 2016 to permit medical assistance in dying, it undertook three explicit assurances to Canadians:
- MAiD would be accessible to persons who met the legal criteria;
- MAiD would be practised in ways that respect the conscience rights of practitioners; and
- MAiD would incorporate "strong measures" to protect the lives of persons who might otherwise succumb to vulnerable circumstances or moments of weakness.
Monitoring the practice of MAiD, he reasons, is crucial to the fulfilment of each of these assurances. For practitioners who ardently support the practice, and equally for those who vehemently oppose it, it is only human that "decisional judgment could easily favour one's firm position". This, Dr. Wasylenko asserts, is not a criticism but "a recognition of human bias and the limits of objectivity".
"In part because we recognize those decisional biases, society expects to be able to evaluate how an important, new and morally-laden practice is actually being carried out. We do not leave such clinical events completely unmonitored. And rightly so."
Dr. Wasylenko concludes that simply tabulating gross numbers of MAiD deaths will not be sufficient "to deeply inform clinical practice, law-makers, policy-makers, regulators, prospective patients, and society at large". He lays out detailed recommendations about what information, including narrative description, is essential to collect and report publicly to ensure that our MAiD regime is functioning in keeping with the foundations of the law.