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What comes after medical assistance in dying? 

International conference looks to answer questions on the ethics, and practice of medical-assisted dying.

click to enlarge Dalhousie professor Jocelyn Downie will be presenting on palliative sedation at the International Conference on End of Life Law, Ethics, Policy and Practice. - DYLAN CHEW
  • Dalhousie professor Jocelyn Downie will be presenting on palliative sedation at the International Conference on End of Life Law, Ethics, Policy and Practice.
  • DYLAN CHEW

How many people have accessed medical assistance in dying since Canada legalized the practice 15 months ago? What are the laws and experiences in other countries that have permitted assisted dying? What’s the relationship between medical assistance in dying (MAiD) and palliative care?

These and other topics will be discussed this week at the second International Conference on End of Life Law, Ethics, Policy and Practice.

Dalhousie University’s Health Law Institute is co-hosting the event, which runs September 13-15. Jocelyn Downie, one of the conference’s organizers and a professor of law and medicine at Dal, spoke to The Coast in advance of her presentation on palliative sedation about physician-assisted suicide and its potential impact in Nova Scotia.

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How much of a learning curve for medical assistance and dying exists for health and legal practitioners?
Physicians and nurse practitioners have had to learn how to provide MAiD—from how to conduct the necessary assessments to determine eligibility, to how to actually deliver [drugs and dosages]. Governments have had to figure out how to ensure access for eligible individuals, given that not all health care providers and institutions are willing to be involved. They are still working out how to monitor practice to be sure the goals of access and protection of the vulnerable are being met. Much has been learned; much more remains to be learned.

Mature minors cannot get medical help if they’re terminally ill and want to end their life. What’s the thinking behind this?
Mature minors have the legal authority to make some end-of-life decisions. However, parliament decided to limit access to MAiD to adults as they rolled out the new regulatory framework in June 2016. At the same time, parliament instructed the ministers of justice and health to initiate an independent review of the issue of access for mature minors and to report back by December 2018 on the results.

What about mental illness, in terms of physician-assisted suicide?
The inclusion of individuals with mental illness has been the subject of considerable confusion and controversy. The confusion is about whether people with mental illness are automatically excluded. They are not. That said, most people with mental illness as their sole underlying condition will not meet the eligibility criteria. The controversy is about whether people whose sole underlying condition is a mental illness and who do not meet the eligibility criteria should be allowed to access MAiD. The CCA panel has also been tasked with studying this, and the ministers of justice and health are to report back…in December 2018.

Nova Scotia has an older population and the baby boomer cohort is huge. What do these factors mean for end-of-life care here?
These factors mean the provincial government needs to improve access to palliative care, especially in rural communities. They mean Nova Scotians need to prepare clear and comprehensive directives so they are not given end-of-life care they do not want. They mean the provincial government needs to resolve the confusion and controversy over who has the legal authority over stopping or not starting potentially life-sustaining treatment when the patient’s family wants treatment to continue, and physicians believe it should be stopped.

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