Western Standard - December 16, 2022


Challenges with medically assisted death legislation


Episode Stats


Length

15 minutes

Words per minute

169.92876

Word count

2,703

Sentence count

136

Harmful content

Misogyny

8

sentences flagged

Hate speech

1

sentences flagged


Summary

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

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

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 .
00:00:00.000 Mr. Constantine, thank you very much for joining us today.
00:00:03.280 As I said, I've been looking forward to this conversation.
00:00:05.960 It's really going to be coming up in the news pretty soon.
00:00:09.720 Good day to you, Corey, and to your listeners as well.
00:00:13.380 So maybe just to give a bit of background, I spoke a little at the introduction of the show,
00:00:17.720 but for folks who perhaps aren't quite as old as ourselves, it was a huge issue, of course,
00:00:23.520 throughout the 1990s between with yourself and Sue Rodriguez and Sven Robinson did some
00:00:28.680 fantastic work on it.
00:00:30.200 I don't often applaud NDP members of parliament, I have to admit, but in this case,
00:00:33.800 it was, I think he did a fantastic job, but things have changed.
00:00:39.040 But the Sue Rodriguez case, if you could kind of put in a nutshell, what would happen there?
00:00:43.500 Certainly.
00:00:44.220 Sue Rodriguez lived in Victoria.
00:00:46.800 She had ALS, which paralyzes you, essentially.
00:00:50.980 It stops various organs functioning.
00:00:53.580 You end up in a wheelchair, unable to speak, feed for yourself, et cetera.
00:00:57.000 The length of time for which this disease lasts is typically two to three years before death,
00:01:03.400 although there are some exceptions, such as Stephen Hawking.
00:01:07.440 Sue came to me, having worked with other broadcasters across the country, explaining her plight.
00:01:15.700 She knew that she was facing, ultimately, the wheelchair.
00:01:19.900 She knew that she'd find it very difficult to feed herself, have a dignity of quality of life,
00:01:23.840 and wanted to have physician assistants to die in a manner which was not just letting her die from the disease itself, 0.99
00:01:32.340 but gave her some control as to when she could die and her timing and saying goodbye to her family and her friends.
00:01:38.600 We went to, ultimately, the Supreme Court of Canada, where we lost on a 5-4 split,
00:01:43.200 on the basis that the Supreme Court of Canada felt that the government of Canada should address the issue,
00:01:49.500 to allow medical assistance in dying as an option for those who are terminally ill with a physical illness, such as cancer.
00:01:57.900 Yes, and then, I guess, eventually, Ms. Rodriguez managed to find a doctor who anonymously helped her end her life eventually, 0.80
00:02:10.180 and things moved on, but it took until 2016 before it was really actually legalized, right?
00:02:15.140 Yes, that's right.
00:02:16.160 So, many broadcasters, I'm sure including yourself, across the country would periodically revisit the issue.
00:02:22.480 The population account on various polls were approximately 78 to 80-odd percent in favor of having this as an alternative means
00:02:32.300 for people who are at the end stage of life, rather than enduring the ongoing indignities.
00:02:38.300 So, Sue, in a way, she lost the war in the sense of going to the Supreme Court of Canada,
00:02:45.780 but she had opened the door, never been opened before in this country,
00:02:49.060 and it was really the first legal test case in the world on the whole issue.
00:02:54.540 And she, as you say, did have the success with a physician coming forward.
00:02:59.220 At that time, it was illegal to help her with her death, and she was very pleased by that opportunity.
00:03:07.200 Since that time, as you know, for those with physical disease, which meets the definition of the revised terms,
00:03:14.820 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,
00:03:23.880 that they welcome this as an alternative.
00:03:26.320 And it should only be regarded, of course, as an alternative.
00:03:29.020 It should only be regarded as an opportunity for people to have an option.
00:03:32.700 So, options include refusing to have ongoing medical treatment.
00:03:38.440 Options include refusing to be hooked up to machines or asking to be disconnected from machines.
00:03:43.720 And the options are to let the disease take its course.
00:03:48.000 And then, in this particular case, is actual MAID with the proper protocols in place to protect the patients.
00:03:56.020 Yeah, and I mean, it's a sensitive, difficult issue.
00:03:58.660 A lot of us don't even, you know, just like necessarily talk about it,
00:04:01.060 but it's something we will all face end of life at one point or another, and we have loved ones.
00:04:04.820 And there's no, I think, you know, sanctity more important than that of our own bodies,
00:04:09.360 particularly when choosing the end.
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,
00:04:17.540 I mean, it was sort of established, okay, somebody with a terminal illness,
00:04:20.100 that their standard of living was going to be greatly, greatly deprived.
00:04:24.860 And the one part as well, those typically they were of sound mind.
00:04:28.600 But now, what I'm wondering is, where do we go when we're talking about adding it for mental illnesses?
00:04:35.240 I mean, those are some very vulnerable people that you're sort of offering an option to.
00:04:39.500 It kind of opens a whole new bag of worms.
00:04:41.960 Yeah, so you certainly asked some very interesting questions.
00:04:46.540 So remember that this was for a person who was terminally ill.
00:04:50.260 There was no real prospects of a recovery for them.
00:04:53.780 It was they were going to die, and the question was the option in terms of approach to death.
00:04:59.160 There are, however, two issues on the cognitive side or mental side which have arisen recently.
00:05:07.080 First is that, as you correctly say, Corey, to have MAID, you have to be in your cognitive state of mind.
00:05:14.940 You have to be able to consciously say, I understand the situation, and I wish to have MAID,
00:05:20.020 and tell that to the physician administering the MAID. 0.96
00:05:22.300 For a big issue, which has arisen over the last few years, has been that what happens when people express that,
00:05:29.500 but they also become demented or develop Alzheimer's and are no longer able to express that wish at the end?
00:05:40.180 Can they give advanced directives?
00:05:42.220 So that's one issue, and we're still grappling with that as society.
00:05:45.320 The other big issue, which has arisen and is coming up as of March 17, 2023, in terms of implementation,
00:05:52.300 is made for those with mental illness.
00:05:56.300 They're not necessarily physically ill.
00:05:59.460 They're not terminally ill from a physical perspective,
00:06:02.000 but they're finding that life is intolerable due to a mental illness.
00:06:07.620 In Parliament, this government of Canada has said that it is prepared as of March 17, 2023,
00:06:14.600 to permit persons with mental illness, providing they meet certain criteria,
00:06:20.380 to have and seek and have MAID. 0.96
00:06:23.820 But there are a lot of potential problems with that, in my view.
00:06:28.360 Well, yes, absolutely.
00:06:29.680 I was looking at one recent story on this lady named Judy LeBlanc.
00:06:35.540 She has a mental disorder as her primary condition.
00:06:39.600 She has an 11-year-old son, I believe.
00:06:42.860 But she's kind of gone back and forth.
00:06:44.520 At times, she feels it's the appropriate path for her, and at times, she doesn't.
00:06:49.080 And again, when she's suffering from mental illness, which can be debilitating,
00:06:52.360 and certainly people with that are suffering.
00:06:54.880 But are they in a position, then, to make such an irreversible choice?
00:06:59.680 Well, Corey, we need to also look at the big picture of healthcare in this country.
00:07:05.280 Canada, at the present time, does not have adequate mental health resources
00:07:09.220 in order to allow mental health, MAID to go ahead, in my view, in most circumstances. 1.00
00:07:16.680 And as you are aware, 80 psychiatrists approximately a week ago came out as a block and said,
00:07:23.620 we're not ready for MAID for persons with mental illness because there's not the fundamental
00:07:29.360 resources available to them so they can make an informed decision.
00:07:33.080 In medicine, we always advocate, and I'm not a doctor, of course, but I work a lot with doctors
00:07:40.840 and patients, we always advocate for informed decisions.
00:07:44.240 We advocate for that in other professions as well.
00:07:47.820 Here, patients who are mentally ill do not have access to mental health facilities in this country.
00:07:55.920 I have worked with many, many people who can't get in to see a psychiatrist often for upwards of a year.
00:08:03.460 Psychologists often upwards for six months, and they have to pay for it themselves.
00:08:08.280 People who are in remote parts of this country have very great difficulty accessing mental health care.
00:08:14.660 We don't have the resources available by way of facilities if somebody needs to be hospitalized
00:08:19.380 for other than perhaps a few days sometimes.
00:08:22.940 In addition, why is there mental health disorder in certain circumstances?
00:08:28.280 A lot of it relates to a lack of adequate housing, food, happiness with life, and opportunities.
00:08:35.060 And until we address some of those issues, again, it may be an easy way for persons to seek an out
00:08:42.200 from the difficulties they experience, but we're not fixing the problems which are underlying
00:08:47.860 the unhappiness that they have.
00:08:50.260 So I think that only in the most extreme cases should this implementation take place in March.
00:08:58.260 But otherwise, I am very concerned that we will see people who can be cured from their depression
00:09:03.660 with the right resources taking MAID.
00:09:07.880 Well, Sid, with a physiological condition, I think where most people agreed when you're talking about the older polling
00:09:13.200 was when it was pretty much agreed on that the condition was terminal,
00:09:16.160 so there was no treatment available.
00:09:18.220 But as you said, many mental health issues can be stabilized and treated with the proper resources and facilities.
00:09:25.500 So to offer that out rather than examining, being able to give that treatment is not,
00:09:32.560 I guess, a morally acceptable option.
00:09:35.780 And some of that discussion is happening as well, though it's a bit more anecdotal,
00:09:39.300 but some people are saying they can't get the health resources for their physiological condition as well,
00:09:45.000 and it's left their life so intolerable that they want to go for MAID.
00:09:49.100 Well, in that case, shouldn't we be examining how to get those resources to them in a more timely manner?
00:09:53.720 Well, certainly with mental health illness, I have seen so many people who've been very, very depressed,
00:09:58.860 who've talked to me about wanting to die.
00:10:01.840 And when they're directed to the right health care professionals with the right assistance, medication, counseling, etc.,
00:10:08.520 right changes in their life circumstances, they recover from the depression.
00:10:12.940 But if we're not able to provide those options to people,
00:10:16.180 then I'm very, very concerned about permitting to go ahead with MAID.
00:10:19.720 Hopefully, the doorkeepers will be the MAID physicians who will also say there are other potential options out there,
00:10:27.440 and until those have been exhausted and government has given you the options to pursue,
00:10:32.760 we're not prepared to provide MAID. 0.88
00:10:34.560 That's what I hope will take place.
00:10:36.340 Yeah, so that's kind of what I wanted to get to asking.
00:10:38.440 You know, back in the 90s when you were fighting this cause,
00:10:41.660 was what we're looking at today what you were envisioning this evolving to eventually?
00:10:45.820 It's a good question.
00:10:46.840 The Chief Justice Lemaire, who was Chief Justice of the Supreme Court of Canada at the time that I was appearing before him
00:10:52.160 and the court on Rodriguez, had raised that very question.
00:10:55.480 He said, what about those with mental health?
00:10:57.920 And my response to him in court was that we were not yet ready as a Canadian society to go there.
00:11:04.640 We should take MAID with great care as we explore it. 0.70
00:11:09.820 And therefore, I advocated for those with grievous physical illness leading to death, 1.00
00:11:14.700 that they were terminally ill, should be able to have MAID.
00:11:17.560 And he agreed with that, by the way, as did the subsequent Chief Justice, Bev McLaughlin.
00:11:24.980 And ultimately, as you know, everybody agreed with it in the Carter case.
00:11:29.060 As a result of the experiences in the United States, certain states, the United States and in Europe.
00:11:35.740 So I think that was fine.
00:11:37.720 But to go with the mental health at this stage, where we don't have the right resources,
00:11:42.860 can open some real concerns.
00:11:46.500 The other concerns we see is that if we open it up too much,
00:11:50.200 then we can see a repeat of what happened at Veterans Affairs.
00:11:53.560 And you'll remember several weeks ago, there were some of our fine veterans who do suffer from depression,
00:11:59.840 because I've worked with some of them.
00:12:01.460 I know the terrible circumstances they have to confront sometimes.
00:12:05.500 And to be told, well, you can just go get MAID,
00:12:09.400 even though they're not terminally ill from a physical perspective, is unfortunate.
00:12:14.100 It's a cop-out.
00:12:15.400 We need to really think about this very, very carefully and provide the resources,
00:12:19.240 just as those 80 psychiatrists have advocated.
00:12:21.680 Yeah, and I'm glad you brought that up with the veterans,
00:12:24.800 because that sounded almost like a case, even if perhaps well-meaning, but of coercion.
00:12:28.760 And that's a whole other issue as well.
00:12:31.560 I mean, the person's choice should be on their own.
00:12:33.320 They should know the alternatives they have.
00:12:34.920 But I don't think any medical professionals should be necessarily encouraging people
00:12:38.880 to move in that direction in any circumstance.
00:12:40.900 They should just let them know what the alternatives are.
00:12:43.580 Yeah, and I don't think that was a medical professional.
00:12:45.380 I think it was sort of a case officer in Veterans Affairs, from what I can gather.
00:12:49.740 But it becomes such an easy cop-out to say, well, if you're depressed, just take MAID.
00:12:55.420 That's not acceptable, not acceptable in our Canadian society.
00:12:59.820 We have a very fine society.
00:13:01.420 We're regarded as one of the best places in the world to live.
00:13:04.400 And we, therefore, have a responsibility to those who are less fortunate,
00:13:08.360 whether they have mental health issues, which probably many, many people do in our society
00:13:12.720 at one time or another, physical illness issues.
00:13:15.740 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,
00:13:25.440 one of the commenters had mentioned, like, do you foresee legal challenges potentially coming from this?
00:13:30.480 I can see this perhaps from family members who have a family member who's choosing MAID,
00:13:35.800 but is doing so with a mental health disorder.
00:13:39.960 Like, this probably isn't cut and dry as far as the law is concerned.
00:13:43.980 No, I can see in certain circumstances in which a family learns that one of their beloved ones
00:13:49.880 intends to take MAID with a mental health issue,
00:13:53.100 and that those mental health issues alternatives have not been explored properly
00:13:56.760 or made available to the person, that an application could be made for an injunction in a courtroom
00:14:03.000 to say, look, this doesn't meet the criteria and this should stop.
00:14:07.560 So it'll be very interesting to follow that through.
00:14:11.260 Great.
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
00:14:22.820 and that you're still maintaining, you know, it's not an ideologically fixated view on this by any means.
00:14:28.080 I mean, it's a challenging, nuanced issue that's not cut and dry,
00:14:32.340 and we still need to keep talking about it.
00:14:33.920 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.
00:14:39.480 Great. Come on, let's go. 0.84
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