Juno News - February 24, 2024


Doctor warns MAiD expansion is being prioritized over healthcare access

Topics
geographic variation in MAID access
Mentioned
Andrew Lawton Show Ramona Coelho Gabrielle Peters Jocelyn Downey Rosina Camas Mona Gupta
Poilievre continues to push back against trans ideology P.E.I. councillor faces removal for sharing the wrong opinion

Episode Stats


Length

10 minutes

Words per minute

166.15

Word count

1,813

Sentence count

90

Harmful content

Misogyny

6

sentences flagged

Hate speech

2

sentences flagged


Summary

Summaries generated with gmurro/bart-large-finetuned-filtered-spotify-podcast-summ .

MAID is increasingly being used by people who have run out of options because of the healthcare system, not because they are dealing with a terminal and irremediable condition (as the legislation is supposed to restrict it to), but because they have had troubles accessing adequate care. And for all that we hear about healthcare equity, and people who are unable to access healthcare for a number of reasons, why are we seeing such an expansion of MAID? This is something that was put out in a piece by a doctor in my neck of the woods in London, Dr. Ramona Coelho.

Transcript

Transcript generated with Whisper (turbo).
Misogyny classifications generated with MilaNLProc/bert-base-uncased-ear-misogyny .
Hate speech classifications generated with facebook/roberta-hate-speech-dynabench-r4-target .
Topics generated with Qwen2.5-3B-Instruct.
Hosts, guests, and mentioned names generated with spaCy (en_core_web_sm), reconciled against Wikidata.
00:00:00.000 You're tuned in to the Andrew Lawton Show.
00:00:09.180 MAID is increasingly used by people who have run out of options because of the healthcare system,
00:00:14.360 not because they are dealing with a terminal and irremediable condition as the legislation is
00:00:19.400 supposed to restrict it to, but because they have run out of options, they have had troubles
00:00:23.620 accessing adequate care. And for all that we hear talk about healthcare equity and people
00:00:28.920 who are unable to access healthcare for a number of reasons, why are we seeing such an expansion
00:00:35.460 of MAID? This is something that was put in a very, very important piece in the McDonnell-Laurier
00:00:41.880 Institute by a doctor in my neck of the woods in London, Dr. Ramona Coelho.
00:00:46.600 Barriers to care persist, but access to MAID keeps expanding. She joins me now. It's been many years
00:00:51.900 since we've spoken, Dr. Coelho, but it's good to speak to you again. Thanks for coming on today.
00:00:56.420 My pleasure.
00:00:56.900 So explain to me, first off, this apparent double standard here. On one hand, we hear people say
00:01:02.980 that there are these health equity challenges. People in marginalized communities, people with
00:01:07.700 disabilities, they all have issues navigating the system, but many of those people are the ones 1.00
00:01:11.880 that are being directed by practitioners at many points towards MAID.
00:01:17.820 Yeah, it's very disturbing. Right now in Canada, the laws for medical assistance and dying are so
00:01:24.300 permissive aiming and considering only the narrow lens of accessibility when we are in fact talking
00:01:33.420 about suicide. And so actually we need to protect Canadians by having many safeguards and we need to
00:01:40.620 have strict eligibility criteria, which we do not have. And so although MAID is supposed to be a
00:01:49.740 compassionate service apparently for people who have nothing, we have nothing left to offer, it can
00:01:55.820 easily be offered or be used when people have no other options. I was recently interviewed for an Al
00:02:03.820 Al Jazeera documentary on the life of Rosina Camas. And you can see she had her own recordings and
00:02:11.580 writings near the end of her life. You can even see part of her MAID assessments and how callous that 0.86
00:02:18.220 whole experience was. You know, the MAID assessor offering to kill her on the weekend if she had time 1.00
00:02:24.700 and the real poverty and loneliness that she experienced that led to her desperation. So the
00:02:33.340 potential for abuse of people being taken advantage of by a government system is real. As the stats
00:02:45.740 currently stand, you know, you have MAID assessors and providers that are speaking out in Health Canada
00:02:51.500 saying that, no, this is actually mostly like wealthy, privileged people who are choosing this.
00:02:58.060 We don't have to worry. Most of our cases are for people who are near death. My article talks about
00:03:04.940 how the Canadian Association of MAID assessors and providers actually has created policies to seemingly
00:03:14.060 circumvent those safeguards so that even if you have just a disability, you're not dying, if you state your
00:03:20.700 intention to refuse care, they can treat you as if you have a terminal illness and end your life
00:03:26.860 immediately. And so you have even less time to recover, even less time for sober second thought.
00:03:32.700 And really that changes how we can interpret the Health Canada reports and stats because people
00:03:38.060 with disabilities who are marginalized can be hidden under track one as if they had a terminal illness
00:03:43.100 just because they were refusing to eat and drink. I mean, a lot of Canadians have heard, if not,
00:03:47.980 they certainly should. The famous case of the woman who needed a chairlift in her home and was offered
00:03:53.500 assisted suicide instead. But there are a number of examples of this and you allude to this in your
00:03:58.780 piece where people in the disability community are sounding the alarm about this. And the tragic reality
00:04:04.140 is when you have MAID being pushed on people that have disabilities that aren't in a terminal illness,
00:04:10.140 it's because their life is being valued at less than that of someone without the disability by many of
00:04:17.100 these practitioners, is it not? Absolutely. So basically, you're making my friend and excellent
00:04:25.740 author Gabrielle Peters always talks about how our government has created a killable class, 1.00
00:04:31.100 a class of people that are seen as having lives less worthy, maybe not even less worthy, but that is
00:04:37.980 merciful to help them end their lives. And really that's based on bias and stigma, the ideas, the false
00:04:45.500 idea is that somehow they don't, first of all, they don't enjoy their lives. Most studies show that
00:04:51.420 our society and physicians rate people's quality of lives with disabilities as quite low when they do not.
00:04:59.100 And also so that you have this kind of idea that we're offering them a mercy and a way out because
00:05:06.380 really, wouldn't they rather just be dead, which couldn't be farther from the truth. But when you have
00:05:11.420 a program that targets people like that, basically, when they're suicidal, like Andrew, you shared that
00:05:16.540 you were suicidal at some point in your life, I have also been, but if we appear able-bodied, then all
00:05:23.020 of a sudden we develop, we deserve suicide prevention services, although it looks like MAID will potentially 0.99
00:05:29.020 expand even for people like us. But for now, if you have a physical disability, if you are suicidal, and
00:05:34.460 it's a little bit more longstanding, you might get MAID. One thing that I've always struggled with on
00:05:41.820 this is that it seems like a lot of MAID providers are already operating well outside the legislation
00:05:48.700 as it's spelled out. I mean, we've heard a number of cases about this, and I'm wondering how that was
00:05:54.780 allowed to happen. Is this coming from regulators that aren't really caring or checking up? Or is it just,
00:06:00.780 you know, like these MAID assessors and MAID providers are just knowing that no one is going
00:06:06.300 to prosecute them? Because I've personally been aware of cases where someone who would not have
00:06:10.620 been eligible in one province was eligible in another, and this is not supposed to be the case
00:06:16.780 because it's a federal law. So I'm wondering what's gone so wrong here already, even before this liberal
00:06:22.540 government expansion kicks in. I have like 10 answers to that, but just quickly-
00:06:26.780 I'll say like, first of all, very concerning. There is geographic variation across Canada,
00:06:33.980 which shows that there are different cultural practices. Quebec has the highest rate in the
00:06:37.980 whole world right now. As they mentioned in the article, BC, I think also, certain areas of BC,
00:06:45.420 and even certain areas of Ontario. So the geographic changes should alarm us. It means that there's a lack
00:06:52.700 of standardization. Two, the legislation is meant to protect MAID assessors and providers. It hasn't thought
00:07:00.860 enough about patient protection. Like I said, they've talked about accessibility and protecting the MAID
00:07:06.860 assessors and providers, but not enough thought has been given about patient protections. Three, you have a
00:07:13.500 government that has allowed Health Canada to kind of use our most ideologically, I would say, out there leaders on this
00:07:25.740 issue to guide our policy. That's not usually how we develop policy. We usually try to find a balance.
00:07:32.620 But you have people like Jocelyn Downey, Mona Gupta, people who have basically expressed that they want the kind of widest
00:07:39.740 open MAID regime who are leading our Canadian policies, which is dangerous for everybody. And 1.00
00:07:46.460 then fourth, I would say that, you know, a lot of MAID assessors and providers that I know are actually
00:07:50.940 very concerned about MAID outside the end of life context, and they do refuse cases. But all you need
00:07:57.500 to have is a few people who are willing to kill or end the lives of many people. And you have a big problem
00:08:05.260 given the way our system is set up. That is itself jarring, because I think that for the current time
00:08:12.540 anyway, and I fear that this could be under threat with a different government, physicians have the
00:08:16.140 right to object. And you talk about this in your piece, they're conscientious objectors. But even that
00:08:21.260 you have an issue with and how that's applied. I was wondering if you could elaborate on that.
00:08:25.980 Yeah, I have a big issue with and actually, this is what we've interviewed with me for a few years ago,
00:08:32.380 is that initially in Ontario, the CPSO came up with this wacky policy, and I'll call it that
00:08:37.740 called effective referral, where a physician needs to again, considering accessibility, and timeliness
00:08:46.540 needs to make an effective referral to another provider who will do do the service.
00:08:53.420 And that basically puts patients on a very dangerous path. If everyone has to
00:08:59.820 funnel people onto a death regime pathway, that partly, I think, explains why we have
00:09:06.860 such high numbers in Canada, 16,000 estimated for 2023, 13,000 reported in 2022.
00:09:12.780 This is the problem of having only a few people that do it, right? Because now,
00:09:16.620 if everyone has to, everyone has to direct them to those people.
00:09:19.420 Yeah. So even actually, if you're a maid provider who is not comfortable with the case,
00:09:25.500 and that's what I highlight in my policy piece for McDonald's lawyers. So even if you're a maid 0.98
00:09:30.700 provider who is uncomfortable, so one of the people, the trainees said they were uncomfortable with
00:09:35.660 made for poverty. And the experts said, well, okay, fine, your conscience says you can't do this,
00:09:40.380 but you need to make a referral. And hopefully, hopefully, someone else will do it. So if you keep
00:09:45.500 putting someone on a pathway, they're going to find a maid provider who, if they continue on that path, 0.96
00:09:52.620 which technically our physician keeps putting them on that path, they're going to find somebody who
00:09:56.460 will eventually do it. And there was a story, I think it came out in the Ottawa Citizen, but an Ottawa
00:10:01.340 paper about a woman who basically was referred on six or seven times until she finally found someone in
00:10:07.740 Brampton who would complete her maid case. And they were talking about how sad it was that she had to go
00:10:13.820 through seven providers. And I guess the real question is like, why were those six providers
00:10:20.300 who are okay with MAID not okay with giving her MAID? Like, could it be that this should have been stopped?
00:10:27.100 Yeah, that's tragic. If at first you don't succeed, try, try again at its macabre end. Dr. Ramona
00:10:34.140 Coelho, fantastic piece, very grim, but I think important in the McDonald Laurier Institute,
00:10:38.860 barriers to care persist, but access to MAID keeps expanding. Thank you so much for coming on today.
00:10:44.620 Thank you for having me. Have a great day.
00:10:46.460 Thanks for listening to The Andrew Lawton Show. Support the program by donating to True North at www.tnc.news.