Proposal for the extension of rights to medical assistance in dying (MAiD) to mature minors in Canada.

Abstract

Individuals suffering intolerably from a medical condition are legally able to request medical assistance in dying (MAiD) under certain circumstances. MAiD can either entail a physician or nurse practitioner prescribing fatal drugs for the patient to self-administer (physician-assisted suicide) or a physician directly administering lethal drugs (euthanasia). Whereas laws regulating MAiD have been in effect in different areas of the world since 1942, Canada only recently decriminalized MAiD in 2016. Individuals under the age of 18 years are not permitted to receive MAiD in Canada. Because legislation exists in other countries that permit MAiD, the current review aims to (a) review legislation and data pertaining to MAiD in Canada and other countries with particular attention on legislation for minors; (b) address important ethical considerations for extending MAiD services to minors in Canada; and (c) provide recommendations for amendments to current MAiD legislation in Canada based on the findings. Combining data from other countries with ethical implications for offering all options to relieve suffering, it is recommended that Canada extend MAiD legislation to mature minors with the inclusion of psychologists in the assessment of decision-making capacity and informed consent.

Re-examining medical assistance in dying for mature minors in Canada: Reflections for health leaders

“…6 In addition, very few clinical studies have explored how the quality of end-of-life care, and other health issues tied to the end-of-life care, is experienced by children. 6 Patton and Dobson completed a review of recent evidence related to MAiD for mature minors in 2021, 7 which confirmed that there remains a lack of primary data collection on this topic.…”

“…7 This position has been criticized by Patton and Dobson, who argue that utilizing age as a criterion for competency undermines both the need to respect dignity of mature minors as well as the significance of responsible caring outlined in the Canadian Code of Ethics for Psychologists. 7 They further argue that there is a need to balance the ethical concerns related to the vulnerability of children and their ability to determine what is in their best interests with allowing people to die with dignity and make choices. 7 Similarly, legal arguments have been made that the exclusion of mature minors from the MAiD legislation is an "act of age discrimination," whereby it exposes mature minors to unjustifiable suffering and inaccurately positions them as incapable.…”

“…7 They further argue that there is a need to balance the ethical concerns related to the vulnerability of children and their ability to determine what is in their best interests with allowing people to die with dignity and make choices. 7 Similarly, legal arguments have been made that the exclusion of mature minors from the MAiD legislation is an "act of age discrimination," whereby it exposes mature minors to unjustifiable suffering and inaccurately positions them as incapable. 8 Accordingly, mature minors may be able to make a case that their rights to "life, liberty, and security of the person" (Section 7 of the Canadian Charter of Rights and Freedoms) and to equality without discrimination based on age (Section 15) have been violated by their ineligibility to access MAiD.…”

Maid in Canada: Controversies, guidelines, and the role of psychologists in relation to Bill C-14.

“…However, in Columbia, the legal age for PAD is 7, and in Belgium, there is no specified age limit (Jones & Simpson, 2018). As will be discussed in detail later, the practices and debates in these jurisdictions have ramifications for MAID practices in Canada, as Canada is currently looking into extending MAID criteria to include the above-mentioned populations (e.g., Patton & Dobson, 2020).…”

An Educator’s Reflection on the exploration of the ethical issues of Medical Assistance in Dying (MAiD) with Nursing and Healthcare Students

“…As stipulated in the text of Canada's MAiD legislation, eligibility criteria for termination of life with medical assistance include intolerable suffering, an irremediable medical condition, foreseeable death, mental competence, and age of at least 18 years (Nicol & Tiedemann, 2018;CNA, 2022). Of these, foreseeable death, age restrictions, and mental competence continue to be raised as areas of concern (Buote et al, 2022;Charland et al, 2016;Patton & Dobson, 2020;Variath et al, 2022).…”