Juno News - Doctor warns MAiD expansion is being prioritized over healthcare access

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.

Juno News - February 24, 2024

Doctor warns MAiD expansion is being prioritized over healthcare access

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