Interpreting Canada's Medical Assistance in Dying Legislation

Downie, Jocelyn; Chandler, Jennifer A.

doi:10.2139/ssrn.2976521

Cited by 47 publications

(18 citation statements)

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“…The legislative language that guides the implementation of MAiD in Canada is unclear, which leaves room for variable clinician interpretation of who is eligible for MAiD. In a comprehensive report on the challenges of interpreting Canada's MAiD legislation, Downie and Chandler () expounded on six key phrases from the legislation that are particularly difficult to interpret. In this paper, we will discuss the three that are most relevant for nursing practice.…”

Section: Law and Safeguardsmentioning

confidence: 99%

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Shades of gray: Conscientious objection in medical assistance in dying

2019

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With the advent of legalized medical assistance in dying [MAiD] in Canada in 2016, nursing is facing intriguing new ethical and theoretical challenges. Among them is the concept of conscientious objection, which was built into the legislation as a safeguard to protect the rights of healthcare workers who feel they cannot participate in something that feels morally or ethically wrong. In this paper, we consider the ethical complexity that characterizes nurses' participation in MAiD and propose strategies to support nurses' moral reflection and imagination as they seek to make sense of their decision to participate or not. Deconstructing the multiple and sometimes conflicting ethical and professional obligations inherent in nursing in such a context, we consider ways in which nurses can sustain their role as critically reflective moral agents within a context of a relational practice, serving the diverse needs of patients, families, and communities, as Canadian society continues to evolve within this new way of engaging with matters of living and dying.

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Section: Law and Safeguardsmentioning

confidence: 99%

“…In this paper, we will discuss the three that are most relevant for nursing practice. The first is that ‘natural death has become reasonably foreseeable’ (Downie & Chandler, . p. 5).…”

Section: Law and Safeguardsmentioning

confidence: 99%

Shades of gray: Conscientious objection in medical assistance in dying

2019

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“…Sophia : I think what we have learned over the past three years, both through practice and court challenges, is that these concepts rely essentially upon the judgement of individual clinicians (Downie & Chandler, ). The courts have been clear that the time left until death is not a significant consideration in whether someone is eligible for MAiD but many clinicians still interpret the legal language as requiring such a determination.…”

Section: Nurses’ Legal and Ethical Obligations Regarding Maid: A Convmentioning

confidence: 99%

But it’s legal, isn’t it? Law and ethics in nursing practice related to medical assistance in dying

et al. 2019

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In June 2015, the Supreme Court of Canada struck down the Criminal Code's prohibition on assisted death. Just over a year later, the federal government crafted legislation to entrench medical assistance in dying (MAiD), the term used in Canada in place of physician‐assisted death. Notably, Canada became the first country to allow nurse practitioners to act as assessors and providers, a result of a strong lobby by the Canadian Nurses Association. However, a legislated approach to assisted death has proven challenging in a number of areas. Although it facilitates a degree of accountability, precision and accessibility, it has also resulted in particular challenges negotiating the diverse perspectives of such a morally contentious act. One of these challenges is the tendency to conflate what is legal and what is moral in a modern liberal constitutionalism that places supreme value on autonomy and choice. Such a conflation tends to render invisible the legal and moral/ethical considerations necessary for nurses and nurse practitioners to remain ethical actors. In this paper, we introduce this conflation and then discuss the process of lawmaking in Canada, including the legalization of MAiD and the contributions of nursing to that legalization. We then engage in a hypothetical dialogue about the legal and moral/ethical implications of MAiD for nursing in Canada. We conclude with an appeal for morally sustainable workspaces that, when implementing MAiD, appropriately balance patient choices and nurses’ moral well‐being.

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“…In response, they are exploring three pathways to access MAiD: first, arguing in court that the provision breaches their Charter rights [7]; second, advocating for interpretations of "reasonably foreseeable" that are broader than those being used in their denials; 2 and third, taking steps to make their deaths "reasonably foreseeable" even on a narrow interpretation of the phrase. 3 In this paper, we explore this third potential pathway to access MAiD, i.e., competent patients refusing care so that their death will become reasonably foreseeable on any of the leading interpretations of that phrase (if the patient is likely to remain steadfast in their refusal), as it will be predictable that, when, and how the person will die [10,12]. In these cases, the word "natural" requires attention.…”

Section: Introductionmentioning

confidence: 99%

“…Nova Scotia, Prince Edward Island, Quebec, Ontario, British Columbia, and Yukon have relevant legislation but none of the statutes displace the common law right to refuse care. Rather, they reinforce the duty to respect refusals of care[18] 12. It must be noted that, in some provinces (e.g., British Columbia), patients who are involuntary confined under mental health legislation but who have decisionmaking capacity can nonetheless be treated for their mental disorder against their will.…”

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confidence: 99%

Refusing care as a legal pathway to medical assistance in dying

Downie

Bowes²

2019

bioethics

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Article abstractCan a competent individual refuse care in order to make their natural death reasonably foreseeable in order to qualify for medical assistance in dying (MAiD)? Consider a competent patient with left-side paralysis following a right brain stroke who is not expected to die for many years; normally his cause of death would not be predictable. However, he refuses regular turning, so his physician can predict that pressure ulcers will develop, leading to infection for which he will refuse treatment and consequently die. Is he now eligible for MAiD? Consider a competent patient with spinal stenosis (a non-fatal condition) who refuses food (but not liquids in order not to lose capacity from dehydration). Consequently, her physician can predict death from starvation. Is she now eligible for MAiD? Answering these questions requires that we answer three sub-questions: 1) do competent patients have the right to refuse care?; 2) do healthcare providers have a duty to respect such refusals?; and 3) are deaths resulting from refusals of care natural for the purposes of determining whether a patient is eligible for MAiD? If a competent patient has the right to refuse some particular care, and healthcare providers have a duty to respect that refusal, and if the death that would result from the refusal of that care is natural, then that refusal of care is a legal pathway to MAiD. However, if the competent patient does not have the right to refuse some particular care, or if healthcare providers do not have a duty to respect that refusal, or if the death that would result from the refusal of that care is not natural, then that refusal of care is not a legal pathway to MAiD. In this paper, we explore this complex legal terrain with the most profound of ethical implications -access to MAiD. RésuméAbstract Une personne compétente peut-elle refuser des soins afin de rendre son décès naturel raisonnablement prévisible pour être admissible à l'aide médicale à mourir (AMM)? Prenons l'exemple d'un patient compétent atteint d'une paralysie du côté gauche à la suite d'un accident vasculaire cérébral droit qui ne devrait pas mourir avant de nombreuses années ; normalement, la cause de son décès ne serait pas prévisible. Cependant, il refuse de se retourner régulièrement, de sorte que son médecin peut prédire que des plaies de pression se développeront, entraînant une infection pour laquelle il refusera le traitement et mourra par conséquent. Est-il maintenant admissible à l'AMM? Prenons l'exemple d'un patient compétent atteint d'une sténose spinale (affection non mortelle) qui refuse de manger (mais pas de boire pour ne pas perdre sa capacité à cause de la déshydratation). Par conséquent, son médecin peut prédire la mort par famine. Est-elle maintenant admissible à l'AMM? Pour répondre à ces questions, nous devons répondre à trois sous-questions : 1) les patients compétents ont-ils le droit de refuser des soins ; 2) les prestataires de soins de santé ont-ils l'obligation de respecter ces refus ; et 3) les décès résultant de re...

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Interpreting Canada's Medical Assistance in Dying Legislation

Cited by 47 publications

References 5 publications

Shades of gray: Conscientious objection in medical assistance in dying

Shades of gray: Conscientious objection in medical assistance in dying

But it’s legal, isn’t it? Law and ethics in nursing practice related to medical assistance in dying

Refusing care as a legal pathway to medical assistance in dying

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