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A Canadian medical assistance in dying (MAID) provider told Maclean's that she believes laws surrounding the controversial procedure are not fleshed out enough, adding that they missing "fundamental safeguards for vulnerable people." As the head of the University Health Network, a research hospital affiliated with the University of Toronto, Li says that she oversaw "hundreds of cases," and that she "personally provided MAID numerous times."
Li writes about how she regrets providing MAID to a young person with cancer that had a 65 percent chance of cure. The person refused treatment, and two other MAID assessors agreed that they had met the criteria for eligibility. The person had a "grievous irremediable condition," which she says was only irremediable ebcause the person refused the treatments available.
"This person organized a goodbye party. They invited all their friends to the hospital atrium and ordered pizza, calling it a reverse birthday party. It was a large gathering of friends... The whole thing usually takes about five minutes, although it took longer than usual in this case because the patient was otherwise young and healthy. Eventually their heart stopped," she said.
"I didn’t regret it at first. But when I started thinking deeply about how to better safeguard this process, I regretted ending this young person’s life. I just parachuted in, I didn’t know this patient. And I didn’t take the time to have a meaningful discussion with them. I didn’t sit down and say, 'Why don’t you just try this treatment? If it’s as bad as you think it’s going to be, MAID will be available.' MAID was so new then, and we were all so focused on patient autonomy. The current law has no place for clinical judgement, and no stipulation for meaningful conversation. If it did, this person may be alive today."
Those who wish to pursue MAID must meet several criteria, though critics, including Dr. Madeline Li, say that the laws are lacking.
Li describes how she does not allow her personal values effect how she assess patients for MAID, but notes that she does not believe that MAID should be provided for mental disorders. The Trudeau Liberals recently moved to delay the expansion of MAID for people suffering solely from mental illness.
"My opinion is that we shouldn’t be providing MAID for mental disorders—and more broadly than that, for chronic illness. I don’t think death should be society’s solution for all forms of suffering," Li writes. " If someone is suffering because they can’t afford housing, do we think that death is the appropriate solution for that? If your suffering is because you can’t afford your medication, or other structural vulnerabilities, is that a good reason for MAID? I personally think this is the medicalization of suffering, but I’m a servant of my country, and I will do what the public mandate demands. I’m just not sure we have that mandate."
Li also writes about her concerns over whether certain "crucial safeguards for patients" are in place, noting that she was happy the government is seeking a one-year delay in the expansion to those seeking MAID for mental illness. Li explains how she felt that the stakes were higher when giving MAID to someone "who wouldn't otherwise die." She served a patient who had a complex "medical and psychiatric history" who applied for MAID.
"I did my best to advocate for getting this person into a study for psychedelic-assisted psychotherapy, which I thought could be very helpful, but I wasn’t successful. There was no way they could afford it privately, since it costs thousands of dollars. This was so morally distressing to me. This person was willing to have the treatment, but couldn’t access it. I think it would be a tragedy if this lovely person went ahead with MAID. As far as I know, this person is now applying for MAID. I have no doubt in my mind that when they apply, they could be found eligible and receive it," Li writes, saying that the case causes her disterss.
Li writes that while she is not trying to deny patient autonomy, she doesn't "think I should blindly defer to autonomy," saying that she still needs to keep her personal value system "out of it."
"Helping someone die, especially when they wouldn’t otherwise, shouldn’t be a matter of checking things off a list," she concludes.
Li writes about how she regrets providing MAID to a young person with cancer that had a 65 percent chance of cure. The person refused treatment, and two other MAID assessors agreed that they had met the criteria for eligibility. The person had a "grievous irremediable condition," which she says was only irremediable ebcause the person refused the treatments available.
"This person organized a goodbye party. They invited all their friends to the hospital atrium and ordered pizza, calling it a reverse birthday party. It was a large gathering of friends... The whole thing usually takes about five minutes, although it took longer than usual in this case because the patient was otherwise young and healthy. Eventually their heart stopped," she said.
"I didn’t regret it at first. But when I started thinking deeply about how to better safeguard this process, I regretted ending this young person’s life. I just parachuted in, I didn’t know this patient. And I didn’t take the time to have a meaningful discussion with them. I didn’t sit down and say, 'Why don’t you just try this treatment? If it’s as bad as you think it’s going to be, MAID will be available.' MAID was so new then, and we were all so focused on patient autonomy. The current law has no place for clinical judgement, and no stipulation for meaningful conversation. If it did, this person may be alive today."
Those who wish to pursue MAID must meet several criteria, though critics, including Dr. Madeline Li, say that the laws are lacking.
Li describes how she does not allow her personal values effect how she assess patients for MAID, but notes that she does not believe that MAID should be provided for mental disorders. The Trudeau Liberals recently moved to delay the expansion of MAID for people suffering solely from mental illness.
"My opinion is that we shouldn’t be providing MAID for mental disorders—and more broadly than that, for chronic illness. I don’t think death should be society’s solution for all forms of suffering," Li writes. " If someone is suffering because they can’t afford housing, do we think that death is the appropriate solution for that? If your suffering is because you can’t afford your medication, or other structural vulnerabilities, is that a good reason for MAID? I personally think this is the medicalization of suffering, but I’m a servant of my country, and I will do what the public mandate demands. I’m just not sure we have that mandate."
Li also writes about her concerns over whether certain "crucial safeguards for patients" are in place, noting that she was happy the government is seeking a one-year delay in the expansion to those seeking MAID for mental illness. Li explains how she felt that the stakes were higher when giving MAID to someone "who wouldn't otherwise die." She served a patient who had a complex "medical and psychiatric history" who applied for MAID.
"I did my best to advocate for getting this person into a study for psychedelic-assisted psychotherapy, which I thought could be very helpful, but I wasn’t successful. There was no way they could afford it privately, since it costs thousands of dollars. This was so morally distressing to me. This person was willing to have the treatment, but couldn’t access it. I think it would be a tragedy if this lovely person went ahead with MAID. As far as I know, this person is now applying for MAID. I have no doubt in my mind that when they apply, they could be found eligible and receive it," Li writes, saying that the case causes her disterss.
Li writes that while she is not trying to deny patient autonomy, she doesn't "think I should blindly defer to autonomy," saying that she still needs to keep her personal value system "out of it."
"Helping someone die, especially when they wouldn’t otherwise, shouldn’t be a matter of checking things off a list," she concludes.
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