Maroc - NEWSDAY.CO.TT - A la Une - 20/Oct 09:28

My problems with MAID

I WAS having dinner with a group of friends when the topic of medical assistance in dying (MAID) came up. MAID is a human rights issue, everybody must have the freedom to choose, everybody deserves a dignified death, they said. Their comments echoed the motto of the lobby group, Dying with Dignity Canada: “It’s your life. It’s your choice.” The issue of life and death seemed like a simple one, as clear as day and night. I felt uneasy about it. As a practising geriatrician, I had interacted with many dying people. Conversations around dying were never easy, never simple. They were not black-and-white – even at the terminal stage. I remembered the time I had spent on a palliative care service, and how difficult it had been to predict death – how difficult it had been to come to a common understanding of what the future may look like. That my friends spoke about dying as though it was black-and-white suggested to me that they had limited exposure to dying humans. Is it a religious decision? One of them asked in response to my saying that I would never perform MAID. I said no. I just don’t think I’ll ever have the level of certainty that I need to intentionally deliver a lethal dose of anything to any human. And plus, delivering death feels antithetical to the reason I got into medicine in the first place – I can’t reconcile it. Would you perform MAID? I asked him. If all the boxes on the government form were checked, would you deliver the lethal medication? He said no. I believe someone who has a mental health problem and does not want to live should have the right to end their life in a dignified way, another friend added, quite confidently. (In 2027, Canada intends to allow people suffering with only a mental illness to access MAID.) How would you differentiate between someone who is suicidal from someone who is desiring a dignified death? If I ever get dementia, unable to care for myself, don’t know who I am, I would want MAID – yes for sure put me down, another one added. You’ve never experienced dementia, you’ve never lived as a person with dementia, how do you know that you would prefer death over dementia? What if living with dementia is not exactly what you imagined it to be? What worried me was that they all spoke about MAID – medical assistance in dying – not from a medical point of view, with all the nuances and uncertainties that are inherent in everything related to medicine, but from a…human rights point of view? We talk about nothing in medicine in such an unambiguous way. Uncertainty is at the core of everything we do in medicine. The slogans – MAID is a human rights issue, everybody deserves a dignified death, the right to choose – suggested that perhaps MAID had become, for them, an ideology. Ideologies have no place in medicine. An ideological doctor is no different from any other crazy ideologue. My other problem is the phrase itself. The phrase "medical assistance in dying" is misleading and does not accurately describe what is being done. MAID is not actually about dying – it is about death. Assisted death, assisted suicide, euthanasia are perhaps more accurate terms. Medical assistance in dying means something completely different to me. If someone has advanced COPD, for example, they are dying from a terminal, irreversible condition. Managing the symptoms of COPD so that the person is as comfortable as possible is medically assisting the person through the process of dying – basically palliative care. But palliative care is not MAID, and MAID is not palliative care. Palliative care – I memorised this definition from a palliative care specialist I previously worked with – is allowing the body to take its natural course, not intervening to hasten death, neither intervening to prolong it, only intervening to provide comfort. MAID is hastening death. So why not describe it as such? The messy terminologies and simplistic understanding have consequences. Literally speaking, if medical assistance in dying is our actual aim, then our focus should be on providing supports to dying and vulnerable people, and improving palliative care access. How can a society allow assisted death (MAID) if social supports and palliative care access are sorely lacking? If this is the case – as it is in Canada – is it not then fair to say that legalised assisted death (MAID) is just another kind of Darwinian survival of the fittest ideology disguised as something medical? Taureef Mohammed is a physician from TT working in Canada E-mail: taureef_im@hotmail.com The post My problems with MAID appeared first on Trinidad and Tobago Newsday.