Medical assistance in dying: A paediatric perspective

Area of Science:

• Medical Ethics
• Canadian Law
• Paediatric Palliative Care

Background:

• The Supreme Court's Carter v. Canada decision (2015) legalized physician-assisted death for adults with grievous and irremediable conditions.
• Bill C-14 (2016) further defined medical assistance in dying (MAID) eligibility for adults whose death is reasonably foreseeable.
• Legislation mandates a report on MAID eligibility for 'mature minors' by December 2018, but discussions extend to all minors.

Purpose of the Study:

• To describe the current Canadian legal and medical context of MAID.
• To articulate a paediatric perspective on MAID, informed by consultations.
• To highlight the growing need to examine MAID for minors of all ages.

Main Methods:

• Analysis of the Canadian legal framework surrounding MAID post-Carter v. Canada and Bill C-14.
• Review of paediatric end-of-life care standards and evolving duties of care.
• Consideration of consultation processes in Canada and internationally regarding MAID for minors.

Main Results:

• Canadian healthcare professionals are increasingly approached by parents and youth regarding MAID issues.
• A Canadian Paediatric Surveillance Program (CPSP) survey indicates parents raise MAID questions with paediatricians more frequently than minors do.
• Current legislation prohibits MAID for incapable individuals, but parental requests for MAID on behalf of a child are a consideration.

Conclusions:

• There is a compelling need to examine MAID for minors, including 'never-competent' children and adolescents.
• Physicians and allied professionals have a responsibility to provide thoughtful, respectful end-of-life care tailored to individual needs.
• The discussion of MAID policy must balance suffering and autonomy, with evolving considerations for paediatric populations.