0:09 I'm Dan Driego and welcome to a new podcast from RSJ radio. This is The Lead. 0:20 In 2015, a landmark ruling by the Supreme Court of Canada struck down the federal prohibition on physician assisted dying. Justice is argued that the old law violated the Canadian Charter of Rights and Freedoms. Bill C. 14 was then introduced in 2016 to amend the Criminal Code and legalized medical assistance and dying. This new legislation now provides Canadians with the right to die. But who gets to choose which Canadians are afforded this right? 0:47 Remember, the Canadian population is deciding this right? This isn't, you know, health care professionals or emphasis on lawyers and really is the state of the nation right. 0:58 Ethicist Rosanna Macri is employed by the Humber River Regional Hospital, and is a lecturer at the University of Toronto's Dalla Lana School of Public Health. 1:07 Them being capable of deciding how they want to their death to happen, right. So we see it sometimes we don't see it often. But you'll see it with individuals who choose to have elective c sections, for instance, they decide when they want to give birth. And this is kind of the end stage of all that deciding when you want to die if you're eligible to make that decision. 1:32 Macri provides hospital staff with an empirical view of health issues and has played a key role orientating physicians on relevant legislation like Bill C 14, and the process and entails. 1:41 So once the formal application for made is submitted, that's when the 10 clear days that you'll hear about they start. And so what these 10 clear reflective days hours for the patient to reflect if this is appropriate, but during that time, other things are happening. So now we have to assess eligibility for MAiD. Right. So there's the eligibility criteria, the first physician or nurse practitioner will assess eligibility, if they feel the patient is eligible to go on to a second assessment. And once they've been assessed twice, and they been found eligible, then they set up the process for MAiD it is an injection. So there's two you'll see in the legislation, it could be self administered or administered by nurse practitioner or a physician, the self administer would be would not be an injection. Right. But we were there's only been one case in Canada since the start of medical assistance in dying. So across Canada, we've pretty much only provided except for this one instance. physician or nurse practitioner led injections. 2:48 Level two, CT, room four. Level two CT, room four. 3:00 Code Blue is an alert of cardiac arrest similar to other alerts that go through the hospital. For some Canadians who don't meet the criteria of MAiD a lifetime of medical treatment awaits them. This is when some come to a crossroads. 3:16 You know there is somebody and there are many patients like this who've tried what they feel is everything and even some of their healthcare professionals will say yes, we don't really know what else to try. There there isn't an option, I guess, at that point, the only option would be self inflicted. Right? So that's where the debate comes in. So instead of medically assisted death it would wouldn't be medically assisted. 3:53 While I'm a big believer in autonomy. I also believe that sometimes there are situations prompting a desire to die that could be changed that would therefore alter the person's quality of life. 4:09 Dr. Justine Dembo is a psychiatrist on the clinitiary board of Dying with Dignity Canada, an inactive physician member of Compassion and Choices in California. An expert on OCD and anxiety disorders, she holds the position of clinical associate and lecturer at the Thompson Centre for Anxiety Disorders at Sunnybrook Hospital. 4:28 I can't emphasize enough how cautious physicians are about this. Both those who agree with the idea and those who don't. We are very careful. You don't want to end someone's life prematurely if there's any way around it any reasonable way around it. 4:45 Following the legislations introduction in 2016, the Canadian government asked the Council of Canadian academies to look into the three remaining qualities of an eligibility for MAiD and produce an independent report by 2019. 4:58 Advance requests and mature minors are currently still against the law. So Bill C 14 expressly states that right now we cannot have advanced requests and right now, you must be above 18 years of age to request assistance in dying to be eligible for it. The Canadian Council of academies is meant to be reviewing those two plus the mental illness issue. When it comes to mental illness, it's a little different, because although bill C14 states that that is under review by the CCA, bill C14 does not state that someone cannot request for sole mental illness. However, the issue, the place where you get stuck is the reasonably foreseeable natural death. Someone with sole mental illness if they don't have a reasonably foreseeable natural death from other causes is ineligible, just because they don't have a reasonably foreseeable natural death. 6:00 Interpretation of the legislation is a point of debate for some, viewing some of the language in a way that lacks concrete methods. 6:07 There's nowhere that that Bill C 14 would deem someone with a mental illness to be ineligible is purely because they have a mental illness. But that's how several government branches interpreted Bill C 14, which has subsequently been corrected. But I think I think a lot of people still misinterpret Bill C 14 to me and no one with mental illness is eligible. And that's not true. 6:31 For those eligible under MAiD, the main part of the process is undergoing two independent assessments. 6:36 The capacity under the College of Physicians and Surgeons of Ontario, which is very similar to all Canadian law that to what the Canadian Psychiatric Association states on capacity has two main branches, there's the ability to understand is the phrase that they use. But the other requirement for capacity is the ability to appreciate how that how the facts relate to the self, where the other the other two aspects of capacity are the ability to communicate a choice, and the ability to show reason, the ability to rationalize and reason. 7:16 Denbo has conducted capacity assessments both under the California end of life option act, and since the Carter ruling came into effect in 2016. Determining one's capacity when choosing to their life is a serious methodical procedure. Medical assistance in dying is still a point of controversy in the medical community. Some physicians believe that despite the new legislation, the Hippocratic Oath does not account for death and the duty of care afforded to patients. 7:44 Right, it's very foreign especially to older school physicians, but not all of them. 7:50 I have a right to die by whatever means we decide on. I don't care whether it's death with dyring with dignity or shooting yourself or jumping off a you know, the skyline tower. My body my life. I am Ken Walker, and I've been using the name W Gifford Jones for 63 years. 8:34 Dr. Ken Walker, also known by his pen name, Dr. Gifford Jones is 95. The University of Toronto and Harvard Medical School graduate and an outspoken advocate on the right to die. 8:49 If a critic opposed to dying in my terms I believe they should say to them look, sign an affidavit under absolutely no no circumstances do I ever want to have it medically assisted death. All right, so go ahead and die anyway, you want to. Go down to the last drop of blood if you want, or suffer as long as you want. But you can do that, let me do this. In other words freedom of choice. total freedom 99% total. 9:26 Throughout his career. His articles have been a successful medium for advocating for abortion rights, heroin use for terminal cancer patients and medical assistance in dying. 9:36 I would like to have a committee on my own, namely my children and my wife. But I would want a veterinarian to be one member, important member of that committee who would tweet me with the same tender loving care that he would treat an animal. If I was in severe pain, right he would be there to say look, it's time for you to leave this planet. 10:00 Known for his radical views, Dr. Walker, a former member of the Swiss organization, Dignitas believes there to be no reasonable limit on an individual's right to die. 10:11 But if I was, say 70 years of age, and I would like to be perfectly healthy and happy and happily married and children that are happy and everything. If I want to write a note saying that if I be come, unable to request this 20 years from now, I have a sudden stroke and can't request it, please here it isn't writing end my suffering. 10:40 That's The Lead for today. I'm Dan Driego. See you tomorrow.