7. State any wishes should requests for medical assistance in dying be legalized in the event of loss of capacity
The new federal legislation on medical assistance in dying (MAiD) prohibits requests for assistance as a component of any advance care plans and advance directives. A discussion on the constitutional and ethical validity of such exclusions is beyond the scope of this paper. However, this legislation is already being challenged in British Columbia, and may change in the future.
If MAiD becomes a treatment option at the end of life similar to any other treatment that falls within the standard of care, clients should conceivably be able to express their wish for assistance similar to any wishes with respect to life-sustaining treatments and palliative care. Clients who are writing advance directives now and who would wish to receive assistance in dying if this is ever legalized once capacity is lost could express such a wish in anticipation of future changes in legislation:
“If I develop dementia or cognitive dysfunction from any cause, and I have lost and will not regain any ability to understand, process information or communicate in a meaningful way, contingent on the future legalization of medical assistance in dying in such situations I direct that, once I have become incapacitated, my wish is to receive such assistance in dying.”
The author wishes to encourage and engage in discussion regarding the directives she proposes here. Please take a moment to express your thoughts and critical commentary in the comments section below.
About the Author
LAURA HAWRYLUCK received her MD in 1992 from the University of Western Ontario where she also served her Internal Medicine residency. She completed a Fellowship in Critical Care at the University of Manitoba in 1997 and received her MSc in Bioethics in 1999 from the Joint Centre for Bioethics and the Institute of Medical Science at the University of Toronto. From 1999-2001 she was Assistant Professor of Critical Care/Internal Medicine, Queen’s University, Kingston, Ontario. In March 2000 she was appointed Physician Leader of the national Ian Anderson Continuing Education Program in End-of-Life Care at the University of Toronto and is currently Associate Professor of Critical Care Medicine at the University of Toronto. In 2002, she was awarded the Queen’s Golden Jubilee Medal for contributions to Canada in recognition of her work in creating the Anderson Program and improving end of life care for Canadians. Dr. Hawryluck is co-author and editor of “Law of Acute Care in Canada” to be published shortly by Carswell, a division of Thomson Reuters.
Dr. Hawryluck is deeply involved in international humanitarian projects. She has worked with critical care and burn units in Indore India and Cote d’Ivoire on a variety of quality improvement and educational initiatives. She was co-creator and co-Director for RCCI of the first Doctorate in Medicine Program in Critical Care in the entire country of Nepal. She worked with the Nepal Medical Council as an international consultant to enact a Code of Ethics and Professionalism for all physicians in Nepal.