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Thread on Bill C-7, from the non-expert perspective of a health care professional, belatedly inspired by @UBC_SB's much more thoughtful thread.
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A lot of what I am going to say has to do with the possible impacts of C-7 on people with disabilities. I do not have a disability and I do not speak for people who do.
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My opinion on this bill has changed dramatically as a result of listening to disability justice advocates like @SarahJama_ and @mssinenomine. If you don't follow them, please put this thread down and read their work.
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My goal here is not to crowd out the voices of people who are affected by this proposed legislation, but to provide a secondary perspective to support the points that they have made.
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As a physician practicing mostly acute care inpatient medicine, I spend a lot of time observing people making difficult decisions, and helping them with these decisions.
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Some of these decisions have to do with medical treatments that may or may not help someone to live longer in the face of a serious threat to their life. Some of them have to do with where to live, or how to obtain the supports needed to live safely.
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On occasion, I have referred a person for assessment for MAiD, on that person's free and unprompted request. I have never offered or obliquely suggested MAiD to a person on my own.
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I have (twice) performed a second independent medical assessment to determine eligibility for MAiD, as required by current law. I have approached this work with the utmost seriousness.
I have never been directly involved in providing MAiD.
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I have never been directly involved in providing MAiD.
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The bottom line of this rambling monologue is that I have a certain familiarity with various situations in which some people consider MAiD, and also with the decisions faced by the majority of people who don't ask for MAiD.
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I want to talk about coercion in the healthcare system.
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Coercion is a word that for many people may raise associations of malice, or deliberately unethical practice. And I think many people would think it is a rare and dramatic occurrence.
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With respect to the possibility of coercion under C-7, I think a lot of people imagine cases like that of Roger Foley, who seems to have been "offered" MAiD in the face of an impasse in discharge planning.
https://www.ctvnews.ca/mobile/health/chronically-ill-man-releases-audio-of-hospital-staff-offering-assisted-death-1.4038841
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https://www.ctvnews.ca/mobile/health/chronically-ill-man-releases-audio-of-hospital-staff-offering-assisted-death-1.4038841
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This case is indeed shocking, but I think it risks distracting us from the major way in which coercion operates in our health care system.
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Most coercion is not attributable to individual actions or malice. It arises from the complexity of the health care system itself. It rarely has to do with pressure to make a specific choice; rather, it derives from the absence of other viable choices.
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The hundreds of Ontarians who died of Covid-19 in poorly managed retirement homes and long-term care facilities weren't forced to go to those places. They simply had no other plausible option.
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When the only alternative to moving into such a facility is staying in a hospital ward indefinitely, most people will eventually agree to sign papers.
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(The long term care application system is deliberately opaque, but to the best of my understanding, if you're waiting from hospital and aren't willing to take the next available bed, you don't get to be on the "crisis" list.)
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(And the non-"crisis" list is a bit like being in the list for a car in Kiev in 1985. I think it has been years since anyone got a bed in my community from the regular list.)
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Again, it's largely impossible to attribute coercion here to any single person or institution other than the broader health-and-social-services system as a whole. For the system, that's probably a feature, not a bug.
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Anyway, the case which I think is much more representative of how C-7 will lead to coercion is that of Archie Rolland.
https://montrealgazette.com/news/local-news/saying-goodbye-to-archie-rolland
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https://montrealgazette.com/news/local-news/saying-goodbye-to-archie-rolland
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No one tried to talk him into MAiD. The province just closed down the specialized respiratory unit in which he'd been living, and gave him no option but regular long-term care, which couldn't meet his needs.
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He eventually chose MAiD because society had not provided the means he needed in order to live well.
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This is how coercion operates for mundane decisions that have nothing to do with MAiD. It will be no different for MAiD. For every Roger Foley, there will be a hundred Archie Rollands. Except that most of them will never know that that respiratory ward ever existed.
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And the notion that governments led by people like Doug Ford and Jason Kenney are going to identify these unspoken (and largely unplanned, unconscious) means of coercion, and spend more money to give people real choices ... is not even laughable.
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Like @UBC_SB, I have a lot of respect for my colleagues who provide MAiD. This isn't a criticism of them.
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I am trying to speak to people who are interested in this issue, but who think that the arguments about coercion are esoteric edge-cases, or a kind of thought experiment.
They're not. This is how our system already operates for things other than MAiD.
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They're not. This is how our system already operates for things other than MAiD.
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