The Individuals Deciding on Medically Assisted Termination
Should individuals legally have the option to seek medical aid in dying in specific situations? This question often sparkes intense emotional responses and debates.
As more states in the United States and countries worldwide legalize or expand the practice of medical aid in dying (MAID), also known as assisted dying, a contentious discussion arises around the loosening of eligibility criteria and potential risks. MAID involves permitting medical professionals to prescribe a patient lethal medication, enabling him/her to end their own life. Misconceptions about MAID often confuse it with euthanasia where a doctor deliberately takes a patient's life, a less practiced procedure.
MAID programs typically require individuals to meet specific criteria, like being diagnosed with a severe illness predicted to have a prognosis of less than six months. Common cases often involve those suffering from late-stage cancer. However, critics worry about relaxing these criteria and expanding further, fearing negative consequences. In the Netherlands, for example, some individuals have obtained MAID or euthanasia due to mental suffering alone or conditions that cause immense pain, although not considered terminal.
Critics raise concerns over medical providers in MAID-approved countries potentially advocating MAID to those who may be disabled, poor, or vulnerable, rather than focusing on those who would benefit most, such as terminally ill patients. On the other hand, proponents argue that strict guidelines may unfairly limit access to MAID, causing unnecessary suffering for eligible individuals, including those with disabilities.
Canada recently postponed the planned expansion of MAID to include those with only mental illness until 2027 due to concerns about complex cases evaluation and adequately managing increasing normalized demand.
In late 2021, researchers analyzed records from 20 different jurisdictions where MAID is practiced to explore the positives and potential negatives of the practice, specifically focusing on who is seeking and being granted MAID. Their findings highlighted that while cancer patients were more likely to choose MAID (around 3-4%), those with ALS (also known as motor neuron disease) were most inclined, with approximately 17% requesting MAID. Contrastingly, heart disease patients were far less likely (<1%).
A heated debate still persists over the potential slippery slope effect when it comes to MAID eligibility. While the study suggests underlying disease or disease-related factors as the primary determinant for seeking MAID, the fear of coercion and unequal access to services remains an ongoing concern.
Enrichment Data:
- Canada: Eligibility criteria for MAID require a patient to have an incurable illness, disease, or condition causing enduring, intolerable suffering with no feasible treatment. Safeguards, such as independent assessments and waiting periods, are in place to ensure that requests are enduring and not coerced.
- United States: Eligibility in states like Oregon and California restricts MAID to patients with terminal illnesses expected to result in death within six months, who must also be mentally competent and self-administerable. The U.S. has implemented strict safeguards, including multiple requests and assessments, to prevent misuse.
- Belgium: MAID eligibility is more liberal than other countries, allowing patients with terminal illnesses or incurable suffering. Integration of palliative care with assisted dying ensures comprehensive end-of-life care, though potential for exploitation remains an issue.
- New Zealand: New Zealand allows MAID for patients with terminal or incurable suffering. The country removed the waiting period between the request and MAID provision, increasing access but posing potential exploitation concerns.
General Observations:
- Safeguards: Jurisdictions implement safeguards, such as independent assessments and multiple requests, to protect against potential misuse.
- Palliative Care: Integration of palliative care within assisted dying contexts ensures access to comprehensive end-of-life care, reducing the need for MAID.
- Vulnerability: Concerns exist about potential exploitation of vulnerable groups, such as people with disabilities, the elderly, and marginalized communities, urging balanced access and robust safeguards for protection.
In the future, advancements in science and technology could potentially lead to more effective treatments for life-threatening illnesses, reducing the need for medical aid in dying (MAID). However, as the debate around MAID continues, it's crucial to prioritize individual health and well-being, ensuring that any future changes in eligibility criteria for MAID are made with careful consideration and robust safeguards to protect vulnerable populations.
