'Canada’s Medical Assistance in Dying system can enable healthcare serial killing'

New MAID paper in HEC Forum

I’ve recently published an open access paper in the journal HEC Forum where I assess parallels in Canada’s Medical Assistance in Dying (MAID) system with features of healthcare serial killing. It’s a long read, but the main takeaways are:

• MAID is a form of healthcare serial killing, separated from serial murder (culpable killing) by the ‘non-culpable’ carve-out for MAID in the Criminal Code - meaning that the healthcare system must now tolerate homicidal clinicians

• Wide variation is regional and individual clinicians’ approaches to MAID raise may conceal criminal homicides (MAID approvals and homicides of patients who did not meet eligibility criteria are recorded in BC and Alberta but so far unprosecuted)

• Reports of illegally assisted deaths, facilitated by the main MAID lobby group were frequent in the 1990s, with some accounts suggesting they continued up to the enactment of MAID legislation in 2016, without prosecution

• Words and actions of some well-known MAID clinicians arguably share similar themes to criminal healthcare serial homicide

• If MAID remains legal, a radical restructuring of its approval process and oversight is necessary to improve patient safety and reduce the risk of abuses
  

  Absract
  The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically target patients with the same clinical features as MAiD-eligible patients. They may draw on similar rationales, e.g., to end perceived patient suffering and provide pleasure for the clinician. HSK can remain undetected or unconfirmed for considerable periods owing to a lack of staff background checks, poor surveillance and oversight, and a failure by authorities to act on concerns from colleagues, patients, or witnesses. The Canadian MAiD system, effectively euthanasia-based, has similar features with added opportunities for killing afforded by clinicians’ exemption from criminal culpability for homicide and assisted suicide offences amid broad patient eligibility criteria. An assessment of the Canadian model offers insights for enhancing safeguards and detecting abuses in there and other jurisdictions with or considering legal EAS. Short of an unlikely recriminalization of EAS, better clinical safeguarding measures, standards, vetting and training of those involved in MAiD, and a radical restructuring of its oversight and delivery can help mitigate the possibility of abuses in a system mandated to accommodate homicidal clinicians.