New papers on Medical Assistance in Dying

Policy capture, ideology, and a failure to understand the law?

1. I’ve published a couple of new papers on Medical Assistance in Dying, one of which received a large number of peer commentaries.
   
   My paper, 'Canadian Medical Assistance in Dying: Provider Concentration, Policy Capture, and Need for Reform’ authored with Trudo Lemmens and Scott Kim appeared in the American Journal of Bioethics. Abstract below.
   
   Canada’s rapid rise in deaths from euthanasia and physician assisted suicide, termed Medical Assistance in Dying (MAID) in the country, now ranks it second only to the Netherlands in terms of MAiD deaths as percentage of overall deaths, with one province already hosting the highest rate of all jurisdictions in the world. Analyzing Health Canada’s annual MAID reports, which show that up to 336 out of 1837 providers are likely responsible for the majority of MAID deaths in a given year, we discuss how the rapid increase likely reflects not a broad Canadian consensus but the capture of a policy-making and implementation process by a small group of activists and clinicians colonizing medicine to become an ideologically driven vehicle for expanding MAID access and delivery. As a remedy and to reprioritize patient safety and protection against premature death, a more transparent, relevant, and safeguarded compliance regime based on evidence-based, multi-perspective policy-making is needed.

   As a Target Article, the journal called for Open Peer Commentaries, which resulted in 14 commentaries from our peers, published with article, most of which are unfortunately paywalled. Most of these commentaries complement or compliment our work, though, expectedly, we did have some detractors who are affiliated with DWDC and CAMAP.
   

2. I’ve recently published an open access reply to a paper in the Canadian Journal of Bioethics, ‘No Loitering: A Response to Disha et al. on Medical Assistance in Dying’s 90-day Assessment Period’. that made some significant factual errors in their grasp of the Criminal Code safeguards around the 90-day Track 2 assessment period. The abstract reads,

   
   Disha et al., in their 2023 paper in this journal, interchangeably frame the Canadian Criminal Code’s 90-day assessment period safeguard for Medical Assistance in Dying (MAID) for people without a foreseeable natural death (Track 2) as a “waiting”, “reflection”, and “assessment” period. However, the law and formal guidance explicitly describe its purpose as an assessment period, only incidentally a reflection period, but not a waiting period. Accordingly, there is an urgent ethical, practical, and legal need to ensure MAID practitioners, their colleagues, and overseers rigorously understand and apply the law to protect patients’ lives from transgressions and stop transgressors.
   

   If clinic-level staff do not understand the legal safeguards around MAID meant to project patients from unlawful death, despite their duty to do so, there is a manifest danger to patients.