Challenges with medically assisted death legislation
Episode Stats
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Summary
In this episode, Dr. Michael Constantine talks about the landmark Supreme Court case of the "Sue Rodriguez Case" and how it led to the legalization of medical assistance in dying (MAID) as an option for terminally ill patients with a physical or mental illness.
Transcript
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Mr. Constantine, thank you very much for joining us today.
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As I said, I've been looking forward to this conversation.
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It's really going to be coming up in the news pretty soon.
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Good day to you, Corey, and to your listeners as well.
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So maybe just to give a bit of background, I spoke a little at the introduction of the show,
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but for folks who perhaps aren't quite as old as ourselves, it was a huge issue, of course,
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throughout the 1990s between with yourself and Sue Rodriguez and Sven Robinson did some
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I don't often applaud NDP members of parliament, I have to admit, but in this case,
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it was, I think he did a fantastic job, but things have changed.
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But the Sue Rodriguez case, if you could kind of put in a nutshell, what would happen there?
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You end up in a wheelchair, unable to speak, feed for yourself, et cetera.
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The length of time for which this disease lasts is typically two to three years before death,
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although there are some exceptions, such as Stephen Hawking.
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Sue came to me, having worked with other broadcasters across the country, explaining her plight.
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She knew that she was facing, ultimately, the wheelchair.
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She knew that she'd find it very difficult to feed herself, have a dignity of quality of life,
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and wanted to have physician assistants to die in a manner which was not just letting her die from the disease itself,
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but gave her some control as to when she could die and her timing and saying goodbye to her family and her friends.
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We went to, ultimately, the Supreme Court of Canada, where we lost on a 5-4 split,
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on the basis that the Supreme Court of Canada felt that the government of Canada should address the issue,
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to allow medical assistance in dying as an option for those who are terminally ill with a physical illness, such as cancer.
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Yes, and then, I guess, eventually, Ms. Rodriguez managed to find a doctor who anonymously helped her end her life eventually,
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and things moved on, but it took until 2016 before it was really actually legalized, right?
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So, many broadcasters, I'm sure including yourself, across the country would periodically revisit the issue.
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The population account on various polls were approximately 78 to 80-odd percent in favor of having this as an alternative means
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for people who are at the end stage of life, rather than enduring the ongoing indignities.
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So, Sue, in a way, she lost the war in the sense of going to the Supreme Court of Canada,
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but she had opened the door, never been opened before in this country,
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and it was really the first legal test case in the world on the whole issue.
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And she, as you say, did have the success with a physician coming forward.
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At that time, it was illegal to help her with her death, and she was very pleased by that opportunity.
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Since that time, as you know, for those with physical disease, which meets the definition of the revised terms,
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I've heard from many people who've said from their families or from themselves when they're about to have the assistance of MAID,
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And it should only be regarded, of course, as an alternative.
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It should only be regarded as an opportunity for people to have an option.
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So, options include refusing to have ongoing medical treatment.
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Options include refusing to be hooked up to machines or asking to be disconnected from machines.
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And the options are to let the disease take its course.
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And then, in this particular case, is actual MAID with the proper protocols in place to protect the patients.
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Yeah, and I mean, it's a sensitive, difficult issue.
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A lot of us don't even, you know, just like necessarily talk about it,
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but it's something we will all face end of life at one point or another, and we have loved ones.
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And there's no, I think, you know, sanctity more important than that of our own bodies,
00:04:11.580
But now, as you'd said, I mean, as well, in the case of Ms. Rodriguez and a lot of others,
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I mean, it was sort of established, okay, somebody with a terminal illness,
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that their standard of living was going to be greatly, greatly deprived.
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And the one part as well, those typically they were of sound mind.
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But now, what I'm wondering is, where do we go when we're talking about adding it for mental illnesses?
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I mean, those are some very vulnerable people that you're sort of offering an option to.
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Yeah, so you certainly asked some very interesting questions.
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So remember that this was for a person who was terminally ill.
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There was no real prospects of a recovery for them.
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It was they were going to die, and the question was the option in terms of approach to death.
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There are, however, two issues on the cognitive side or mental side which have arisen recently.
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First is that, as you correctly say, Corey, to have MAID, you have to be in your cognitive state of mind.
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You have to be able to consciously say, I understand the situation, and I wish to have MAID,
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and tell that to the physician administering the MAID.
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For a big issue, which has arisen over the last few years, has been that what happens when people express that,
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but they also become demented or develop Alzheimer's and are no longer able to express that wish at the end?
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So that's one issue, and we're still grappling with that as society.
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The other big issue, which has arisen and is coming up as of March 17, 2023, in terms of implementation,
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They're not terminally ill from a physical perspective,
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but they're finding that life is intolerable due to a mental illness.
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In Parliament, this government of Canada has said that it is prepared as of March 17, 2023,
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to permit persons with mental illness, providing they meet certain criteria,
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But there are a lot of potential problems with that, in my view.
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I was looking at one recent story on this lady named Judy LeBlanc.
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She has a mental disorder as her primary condition.
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At times, she feels it's the appropriate path for her, and at times, she doesn't.
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And again, when she's suffering from mental illness, which can be debilitating,
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But are they in a position, then, to make such an irreversible choice?
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Well, Corey, we need to also look at the big picture of healthcare in this country.
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Canada, at the present time, does not have adequate mental health resources
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in order to allow mental health, MAID to go ahead, in my view, in most circumstances.
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And as you are aware, 80 psychiatrists approximately a week ago came out as a block and said,
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we're not ready for MAID for persons with mental illness because there's not the fundamental
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resources available to them so they can make an informed decision.
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In medicine, we always advocate, and I'm not a doctor, of course, but I work a lot with doctors
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and patients, we always advocate for informed decisions.
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We advocate for that in other professions as well.
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Here, patients who are mentally ill do not have access to mental health facilities in this country.
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I have worked with many, many people who can't get in to see a psychiatrist often for upwards of a year.
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Psychologists often upwards for six months, and they have to pay for it themselves.
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People who are in remote parts of this country have very great difficulty accessing mental health care.
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We don't have the resources available by way of facilities if somebody needs to be hospitalized
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In addition, why is there mental health disorder in certain circumstances?
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A lot of it relates to a lack of adequate housing, food, happiness with life, and opportunities.
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And until we address some of those issues, again, it may be an easy way for persons to seek an out
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from the difficulties they experience, but we're not fixing the problems which are underlying
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So I think that only in the most extreme cases should this implementation take place in March.
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But otherwise, I am very concerned that we will see people who can be cured from their depression
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Well, Sid, with a physiological condition, I think where most people agreed when you're talking about the older polling
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was when it was pretty much agreed on that the condition was terminal,
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But as you said, many mental health issues can be stabilized and treated with the proper resources and facilities.
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So to offer that out rather than examining, being able to give that treatment is not,
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And some of that discussion is happening as well, though it's a bit more anecdotal,
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but some people are saying they can't get the health resources for their physiological condition as well,
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and it's left their life so intolerable that they want to go for MAID.
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Well, in that case, shouldn't we be examining how to get those resources to them in a more timely manner?
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Well, certainly with mental health illness, I have seen so many people who've been very, very depressed,
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And when they're directed to the right health care professionals with the right assistance, medication, counseling, etc.,
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right changes in their life circumstances, they recover from the depression.
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But if we're not able to provide those options to people,
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then I'm very, very concerned about permitting to go ahead with MAID.
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Hopefully, the doorkeepers will be the MAID physicians who will also say there are other potential options out there,
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and until those have been exhausted and government has given you the options to pursue,
00:10:36.340
Yeah, so that's kind of what I wanted to get to asking.
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You know, back in the 90s when you were fighting this cause,
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was what we're looking at today what you were envisioning this evolving to eventually?
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The Chief Justice Lemaire, who was Chief Justice of the Supreme Court of Canada at the time that I was appearing before him
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and the court on Rodriguez, had raised that very question.
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And my response to him in court was that we were not yet ready as a Canadian society to go there.
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We should take MAID with great care as we explore it.
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And therefore, I advocated for those with grievous physical illness leading to death,
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that they were terminally ill, should be able to have MAID.
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And he agreed with that, by the way, as did the subsequent Chief Justice, Bev McLaughlin.
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And ultimately, as you know, everybody agreed with it in the Carter case.
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As a result of the experiences in the United States, certain states, the United States and in Europe.
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But to go with the mental health at this stage, where we don't have the right resources,
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The other concerns we see is that if we open it up too much,
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then we can see a repeat of what happened at Veterans Affairs.
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And you'll remember several weeks ago, there were some of our fine veterans who do suffer from depression,
00:12:01.460
I know the terrible circumstances they have to confront sometimes.
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And to be told, well, you can just go get MAID,
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even though they're not terminally ill from a physical perspective, is unfortunate.
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We need to really think about this very, very carefully and provide the resources,
00:12:21.680
Yeah, and I'm glad you brought that up with the veterans,
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because that sounded almost like a case, even if perhaps well-meaning, but of coercion.
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I mean, the person's choice should be on their own.
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But I don't think any medical professionals should be necessarily encouraging people
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They should just let them know what the alternatives are.
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Yeah, and I don't think that was a medical professional.
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I think it was sort of a case officer in Veterans Affairs, from what I can gather.
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But it becomes such an easy cop-out to say, well, if you're depressed, just take MAID.
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That's not acceptable, not acceptable in our Canadian society.
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We're regarded as one of the best places in the world to live.
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And we, therefore, have a responsibility to those who are less fortunate,
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whether they have mental health issues, which probably many, many people do in our society
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at one time or another, physical illness issues.
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And we need to provide those alternative resources so they can be properly explored.
00:13:21.140
So just to wrap it up sort of and getting back to your area of specialty, though,
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one of the commenters had mentioned, like, do you foresee legal challenges potentially coming from this?
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I can see this perhaps from family members who have a family member who's choosing MAID,
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Like, this probably isn't cut and dry as far as the law is concerned.
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No, I can see in certain circumstances in which a family learns that one of their beloved ones
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intends to take MAID with a mental health issue,
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and that those mental health issues alternatives have not been explored properly
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or made available to the person, that an application could be made for an injunction in a courtroom
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to say, look, this doesn't meet the criteria and this should stop.
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So it'll be very interesting to follow that through.
00:14:11.840
Well, we've got a lot to examine and think about as we come into this,
00:14:15.820
I guess, this issue in these legislative years.
00:14:18.600
I really appreciate the work that you did on this in the 1990s
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and that you're still maintaining, you know, it's not an ideologically fixated view on this by any means.
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I mean, it's a challenging, nuanced issue that's not cut and dry,
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So I thank you very much for coming on to talk to us today about it.
00:14:36.980
My pleasure, Corrie, and thank you for your interest in the subject.
00:14:40.520
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