Abstract
Dear Editor:
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Their study cites the reluctance of physicians to discuss cancer diagnoses with patients >50 years ago, that discussion of Do-Not-Resuscitate Orders with patients and families was not included in 1975 guidelines, and that advance directives first became legal in California in 1975. However, this medico-legal review may illustrate the evolution of medicine from paternalistic guardianship to medical care based on informed consent and shared decision-making.
Downar claims that PC by limiting life-sustaining measures shortens survival and is unacceptable to many patients and families, for example, “palliphobia.” No references are given for these assumptions, but Chochinov's “Platinum Rule” 2 is (mis)used as the core ethos of MAID.
The Platinum Rule is an ethical guideline building on the Golden Rule: “Do not do to others what you do not want done to yourself.” It recognizes that individuals may have different preferences and needs and encourages health care professionals to tailor their approach to the preferences of each individual patient.
Assisted dying practices have gained recognition in 18 jurisdictions, expanding the reach of euthanasia and/or physician-assisted suicide to a population exceeding 200 million individuals. 3 MAID in Canada has increased since its legalization from ∼1000 individuals in 2016 by over 13,000 in 2022. 4
Eligibility criteria in Canada include having a “grievous and irremediable” condition without the necessity of a terminal illness prognosis. Patients may have prognoses from years to decades. MAID could reduce annual health care spending across Canada exceeding between $34.7 and $136.8 millions. 5
In a podcast episode on www.geripal.org, the conversation delves into Canada's journey. A psychologist at the University of Ottawa shares his experience of being presented with the options of PC or MAID ultimately upon receiving a terminal cancer diagnosis. Additionally, ethical concerns arising from the planned expansion of MAID to individuals with mental illness are discussed, also a case of a Canadian seeking MAID due to housing affordability challenges.
It is reprehensible to accuse PC of being in opposition here because these are independent facts.
While many medical professionals still struggle to deal with “conventional” dying, MAID is increasingly favored, even emphasizing it to become part of medical curricula. 6 This is confusing, and if we as health professionals lack inner clarity, how are our patients supposed to get clarity?
Downar's conclusion evokes the similar development of PC and MAID, which should work hand in hand. However, MAID is a unique practice, without parallel in any medical discipline, because the goal of MAID is the death of a person.
To end with a quote by Thomas Jefferson “When injustice becomes law, resistance becomes duty.”
PC is of great importance in terms of symptom management and ethical issues for patients with serious illness. MAID is the act of deliberately helping someone to end their life, often because of terminal illness or unbearable suffering. PC, on the other hand, focuses on providing comprehensive medical care, pain management, and emotional support to people with serious illnesses, with the aim of improving their quality of life. The challenges of the MAID Act in relation to PC are complex and often revolve around ethical, legal, and societal concerns.
Our response critically examines the postulates of James Downar et al. The authors would be grateful if this letter could further motivate a critical discussion of MAID.