It's been about a year since Canada made it legal for doctors and other medical workers to help some very sick patients end their lives.
In that short stretch of time, medical assistance in dying (or MAID) has become "normalized" to an unexpected degree across the country, which is surprising given the controversy surrounding it when the practice was legalized last June, says a new report looking into the program at the country's biggest hospital network, the University Health Network (UHN) in Toronto.
People around the world, not just in Canada, have been pushing for greater control over how they die. Canada is the latest of a handful of places to legalize some form of assisted dying, including five European countries (like Switzerland and Germany), six US states (including California and Vermont), and Colombia, the report says. In Canada, a patient can either choose to have a doctor or nurse practitioner directly administer a substance or drug that brings about death, or to get a drug (often through a prescription) that she takes herself.
But Canada doesn't have a a federal monitoring system right now to track who is choosing a medically assisted death. (One should come into effect in 2018.) In the meantime, this new data from UHN, which was published today in the New England Journal of Medicine, gives a snapshot of how these programs are actually working on the ground, within one hospital network.
It turns out a lot of Canadians are exercising their right to an assisted death—even if many doctors still aren't comfortable providing one, and it's voluntary for them to do so.
Between March 2016 and 2017, 74 patients asked about assisted dying at UHN, which includes four hospitals, according to the new report. Of those, 25 were approved, and 19 completed a medically assisted death. (Some died naturally before they could go through with it.)
"We were surprised," lead author Madeline Li, a psychiatrist who works with cancer patients at UHN, and who oversees the MAID program there, told me. "We did not think there would be as many requests as there were."
In fact, in just the first six months the procedure was legally available in Canada, there were 803 medically assisted deaths across the country—that's 0.6 percent of all deaths here, according to a separate government report that came out in April. If you include Quebec, which has slightly different laws, the number jumps to 970 Canadians.
At UHN, patients who completed the procedure "tended to be white and relatively affluent," the study says. They were mainly suffering from cancer (Canada strictly limits who can seek a medically assisted death, and patients have to be terminally ill). Patients said that "loss of autonomy" was the main reason for making a request to end their lives.
Of the 19 people who had a doctor-assisted death at UHN, 53 percent were male, 58 percent were married, and they had a median age of 70 years.
"This is Canada. We have universal healthcare, and everyone has access," Li said when I asked her why wealthier white people might have been more likely to have a medically assisted death. Her study includes only a small sample size, so it's hard to say much about why the results came out like this—although understanding who's accessing MAID services will be crucial to figuring out how the legislation and its implementation should evolve.
Meanwhile, a growing number of patients, including those who suffer from mental illness, are pushing for the right to die in Canada. The BC Civil Liberties Association is behind a constitutional challenge on the basis that patients who are in great pain, but may not be facing an imminent death, are excluded right now from accessing MAID.
The debate is reshaping the way we think about end-of-life—Li's article calls it "public dying," the open discourse that increasingly surrounds end-of-life medical practices, which has largely been prompted by a debate on how much choice a patient should have. But to truly incorporate end-of-life decisions in our healthcare system, we will need more data.
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