'These are complex issues': Federal government's survey on medically assisted death raises concerns

Canadians have less than a week to weigh in on possible changes to legislation around medically assisted death — and some say they're not happy with what they see in the federal government's online survey, or the idea of expanding eligibility for medically assisted death.

The federal government began consultations on medically assisted dying — including the online survey and in-person consultations with experts across the country — on Jan. 13. The online questionnaire closes on Jan. 27.

When the consultations were launched, Justice Minister David Lametti said they would allow the federal government "to hear directly from Canadians and guide the path forward." But one Winnipegger says she's disappointed by what's not in the online survey.

"There is a huge imbalance on the site," said Ruth Enns, 72, who lives with disabilities resulting from childhood polio. 

"There are so many things [in the survey] that promote [medical assistance in dying]. I could find nothing that discourages it. There was no place that I could find where people could complain about undue influence."

She also says there's not enough room on the survey for response. The survey has three fields, each with a limit of 500 characters, in which people can leave comments.

"These are complex issues," said Enns. "You can't really comment on them in that."

CBC has asked the federal justice department for a response to Enns's comments.

The federal justice minister says the survey has been overwhelmed by thousands of responses. Speaking to reporters before a Liberal cabinet retreat in Winnipeg on Sunday, Lametti said more than 150,000 have already participated in the government's online survey.

He also said he plans to table new legislation in February to amend the criteria for Canadians to have medical assistance in dying.

That comes after a Superior Court of Quebec ruling last September, which found that the federal government's rules around medically assisted death are too restrictive. Specifically, the court ruled that the requirement that death be "reasonably foreseeable" is unconstitutional.

The court ruling only applies in Quebec, but the federal law was already facing a required review in the summer of 2020, five years after it came into effect.

The federal government has accepted the Quebec ruling, and Lametti said the government is using the opportunity to update the legislation across the country.

The government's consultations are focused on whether medically assisted death should be allowed in three different cases:

• So called "mature minors" — people under age 18 considered by doctors to be capable of directing their own care.
• Cases involving "advance requests" where a patient stipulates they would like their life to end at a later time when they are no longer competent to give consent. 
• Those who want to end their lives solely because of mental illness. 

MAID 'doesn't sit well with me': doctor

Winnipeg family doctor Larry Rados says there is concern among some physicians about expanding medical assistance in dying, or MAID.

"I don't speak for all of them, but many have a discomfort, an angst, if not an emotion more serious than that about this whole issue," he said.

"We went into this to wear the white coat of the healer. I heard one person say we are now being asked to wear the black robe of the executioner. That does not sit well with a lot of physicians. It doesn't sit well with me."

In Manitoba, those seeking a medically assisted death must be referred to the provincial MAID team, which can be done by the patient, a family member or a health-care provider.

CBC has requested an interview Dr. Kim Wiebe, the administrative lead of the provincial MAID clinical team. A request was also made to speak with the registrar of the College of Physicians and Surgeons of Manitoba. 

Rados said he's particularly concerned about expanding medically assisted death to include people with mental illness.

"Let's take depression, for example. Psychiatrists will tell you there is a triad involved in depressive illnesses — the triad being the patient telling himself or herself 'I am no good, the world is no good, the future is no good.'

"Well, if a person has that mindset that the future is no good, they can easily be taken advantage of," Rados said.

'Is this the best we can do?'

He thinks there should be expansion of palliative care, rather than MAID.

Cam MacDonald, the interim director of Life's Vision in Winnipeg — a non-profit which opposes medically assisted death — agrees.

"Is this the best we can do for the disabled community?" asks MacDonald, 27, who lives with cerebral palsy.

The message we need to give is we know you are disabled but you still have value, intrinsic value.- Cam MacDonald

He doesn't agree with expanding advance requests for medically assisted death.

"What message does that send to the disabled community? We need to do more to help those who are suffering — to do all that is in our power to help those who are suffering."

MacDonald, 27, is a competitive swimmer in addition to his full-time work. He says people with disabilities need messages of hope.

"When I am going through a tough time, what I really need is peace, what I really need is hope and what I really need is purpose. What we really need is to try and help people see their purpose," said MacDonald.

"The message we need to give is we know you are disabled but you still have value, intrinsic value."

'MAID couldn't come fast enough for him'

Debra Mason, though, is grateful medically assisted death is a legal choice in Canada and would like to see it include advance requests.

Mason is a volunteer with the Manitoba chapter of Dying with Dignity, a non-profit which promotes the right to medically assisted death. Her 94-year-old father received MAID in December 2017. 

"He had leukemia, a brain tumour. MAID couldn't come fast enough for him. He chose to die at home in Rapid City. He didn't want any treatments. He was starting to fail and decided to have it," she said.

"His death was peaceful because he was getting what he chose. He knew he was going to die. He never wanted to be one of those people who lingered in a bed."

She took the federal government's online survey on MAID eligibility. While she found it complicated and said she had to go through it twice, she supports the idea of expanding MAID eligibility.

"I think advanced requests would be a very positive step for me. The whole dementia thing is scary for our generation. I am 64 years old and tons of boomers could be facing this.

"I would like to pre-book if I am faced with a diagnosis that will affect my capability."