Medical Assistance in Dying (MAID)

Written for CMS by Dianna Eaid, BSW and Retired Medical Social Worker
 Dying from natural causes or because of disease progression, is recognized as the expected path to pass away. Some people decide to take their own lives because of unbearable pain and suffering. Although suicide, is a person’s right to chose, it presents ethical challenges and is very controversial for most. In 2015, the families of Kay Carter, a woman suffering from degenerative spinal stenosis, and Gloria Taylor, a woman suffering from ALS, requested the Supreme Court of Canada to support their decisions for assisted suicide. The court rendered a unanimous decision, giving mentally competent Canadian adults, “suffering intolerably and endurably,” the right to physician assistance in dying. The Criminal Code of Canada underwent revisions to enable healthcare practitioners to legally provide information and participate in assisted death. The legislation became known as, Medical Assistance in Dying: MAID. 
As you can imagine, MAID was controversial, but its core value is quality vs. quantity of life and a person’s right to choose. There are clear guidelines and criteria: 
Eligibility: 
  • Person is eligible for Canadian and provincial healthcare 
  • Person is 18 years of age and mentally competent (able to make own decision and give informed consent at time of MAID assessment) 
  • Person has a grievous and irremediable medical condition, causing pain and suffering that cannot be relieved 
  • Person can make a voluntary request for MAID, without outside influence 
Process: 
  • Person makes request to physician or healthcare team for MAID assessment 
  • Person must sign written consent with an independent witness 
  • Person undergoes an assessment by 2 independent practitioners to assess eligibility 
  • If approved, the person selects the date to receive MAID (usually takes 2 weeks) 
  • At time of MAID is administered, person gives final consent 
MAID options: 
  • A provider, physician or nurse practitioner, administers a substance to cause death 
  • The person is provided with the substance to self administer 
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In my experience as a medical Social Worker (recently retired), I assisted several patients with MAID information. The concept of MAID supports a person’s right to determine when disease/disability becomes unbearable. However, many families struggle with MAID, as do some healthcare providers. MAID excludes patients who lack capacity and suffer mental health disorders. The later will be included in 2023. I have met with many people who feel patients with Personal Directives, indicating request for MAID in the future and later deemed to lack capacity should be able to receive MAID. The legislation had a recent revision, introducing Waiver to Final Consent. For final consent to be waive at time of MAID, the person had to have capacity when approved for MAID. If final consent is waived, MAID will be cancelled if the person demonstrates refusal or resistance to administration of the substance. As MAID process can take several weeks to complete, patients who are terminal and actively dying will not benefit from MAID. This has caused many families to express anger and frustration as they feel lack of intervention to end life is inhumane for the patient. Many families feel euthanasia of family pets is more dignified than what is offered their loved one. 

MAID is an individual choice and not for everyone. There are many levels of ethical controversy. For those I have assisted, most participants felt it was a dignified experience. Anyone making this choice, the process ensures that all consideration is given to alternatives. I have heard many beautiful stories of opportunity to plan and say goodbyes. If you want more information, ask your physician or healthcare team.