April 16th, 2018
Two Years After Carter, MAiD Monitoring Remains an Unfulfilled Promise

The VPS Blog " Why Monitoring Matters" brings the perspective of a palliative care physician this week in the latest addition to an important and wide-reaching series. Dr. Eric Wasylenko, a VPS advisor, educator, clinician and ethicist, tackles questions of fairness and equity in an essay titled " Reporting on and monitoring of medical assistance in dying". 

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.


  • Old age alone shouldn't be considered a justification for physician-assisted death, by Tom Koch, Globe and Mail, April 9, 2018.  Responding to the controversial report of a married couple in their nineties who died together by MAiD in Toronto in March, the author raises critical questions about the "dangerous precedent" of offering an early death to aging patients who dread their own fragility, rather than supporting them to face those fears and adapt to new conditions of life.
  • Medical Assistance in Dying: Will Our Voices Count? ARCH Alert, April 2018. This is the third in a series of features about MAiD by VPS advisor Catherine Frazee for ARCH Alert. The article, which begins at page 20, focuses on the "growing urgency" for a nationwide system of MAiD monitoring to "ensure that MAiD is not exploited or misused as a 'quick fix' to human suffering rooted in poverty, stigma, discrimination and exclusion, especially as these factor in the lives of disabled people".

Highlighting recent peer-reviewed research and scholarship of interest to VPS supporters.

Medical assistance in dying is available to every Canadian who meets the requirements of the law. On the other hand, only 16% to 30% of Canadians who die are reported to have access to hospice palliative and end-of-life care services.

The Vulnerable Persons Standard was developed by a group of more than forty advisors with expertise in medicine, ethics, law, public policy and needs of vulnerable persons. The Standard is a series of evidence-based safeguards intended to help ensure that Canadians requesting assistance from physicians to end their life can do so without jeopardizing the lives of vulnerable persons who may be subject to coercion and abuse. 

To learn more about the Standard and the many Canadians and organizations endorsing the Standard, please visit us at www.vps-npv.ca.
Vulnerable Persons Secretariat

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