Response to Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability

Abstract

This report, signed by >170 scholars, clinicians, and researchers in palliative care and related fields, refutes the claims made by the previously published Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability . That report attempted to argue that structural vulnerability was not a concern in the provision of assisted dying (AD) by a selective review of evidence in medical literature and population studies. It claimed that palliative care has its own safety concerns, and that “misuse” of palliative care led to reports of wrongful death. We and our signatories do not feel that the conclusions reached are supported by the evidence provided in the contested report. The latter concluded that the logical policy response would be to address the root causes of structural vulnerability rather than restrict access to AD. Our report, endorsed by an international community of palliative care professionals, believes that public policy should aim to reduce structural vulnerability and, at the same time, respond to evidence-based cautions about AD given the potential harm.

The Strength It Takes to Suffer

“…In fact, the gauntlet of requirements to obtain a MAID prescription in the US are designed to protect vulnerable patients from coercion, mitigate the effects of structural disparities in medicine, and prevent otherwise healthy people from impulsive use toendatemporarilybadsituation.IncountrieslikeCanada, the debate hinges on the urgency to protect diverse populations situated in severely at-risk social determinants of health. 7 Society must invite these far-ranging concerns out of the proverbial closet and invite nonpolarizing discourse on MAID while structural disparities in health care are tackled at all levels. Regardless of controversy, more support and funding for research on MAID is needed.…”

Law not loopholes: Medical aid in dying for those with dementia

“…3 What once began as permission to end the lives of people with diseases where death was reasonably foreseeable has now evolved into a practice where MAID is provided to people where death is not reasonably foreseeable and for reasons like homelessness and loneliness. 4 Guarding against not only abuse but unwieldy expansion of the use of death as a medical intervention is challenging, if not impossible, even if legally sanctioned. The logic that uses death as a medical intervention terminates either in total respect for autonomy or total relief of suffering.…”

“…Canada's MAID program, one of the most permissive in the world, provides a warning for how safeguards are increasingly seen as barriers to access 3 . What once began as permission to end the lives of people with diseases where death was reasonably foreseeable has now evolved into a practice where MAID is provided to people where death is not reasonably foreseeable and for reasons like homelessness and loneliness 4 . Guarding against not only abuse but unwieldy expansion of the use of death as a medical intervention is challenging, if not impossible, even if legally sanctioned.…”