Louis Charland is a Western University professor with a new study attempting to win over politicians’ academic attention, regarding medical assistance in dying (MAID).
Charland and his partner Kyoto Wada come from the Rotman Institute of Philosophy at Western University, and their partner Trudo Lemmens comes from the Faculty of Law at the University of Toronto.
They are pushing for officials to pause MAID discussions to take the time to explicitly explain the details from start to finish. Their fearful reality is that the general public is being left out of the equation.
Charland’s interests have to do with the concern of informed consent. Patients will be requesting this medical intervention, but in order to gain its access it they must be able to give informed consent, and for that they need the proper decision-making capacity.
Charland and his colleagues’ study concerns the possibilities of MAID becoming available to a wider demographic alongside a person’s decision-making ability.
Charland says the questions Canadians need to start asking are:
- When and under what circumstances is a person considered to have the mental capacity to consent to MAID? When exactly does this happen?
- How is mental capacity assessed? Who is making these assessments?
- How do these officials make decisions? What are they using to determine a spectrum?
- What is the context of the procedure?
If you look at these questions in detail they are only mentioned, but never raised in sufficient detail.
His study points out that there is a fairly new science that exists behind determining decision-making capacities. Other scientists have invented instruments, tools, and official psychological tests that we can use when questioning people. There are intensive debates of how we should be assessing capacity and if our existing instruments are even acceptable as accurate. None of these nitty gritty details have been looked into before this and Canadians need to know that before moving forward with the legislation.
Charland shares that decision making capacity is exempt by physicians in most of these cases in the existing laws, but physicians don’t get any training in this official science. So, how do they assess it?
The worry is that this is just a subjective matter of opinion; that a physician may say the person is capable while another physician might say the person is not. Charland explains that if there’s no science involved, or even considered, then people become vulnerable to differences in opinion. Where is the reliability that people are being assessed in the same way?
Charland’s opinion is that our existing instruments cannot accommodate for our values and emotions; all they are testing patients on is their ability to think logically.
What if you’re deciding to end your life because you have insufficient hope? What if you have a system of values that says it’s morally wrong to receive an assisted death?
We’re focusing too much on logic and what we know, when it’s proven that our emotions are largely what drives our decision-making abilities. We make decisions based on emotional reasons.
Why did you send her the flowers? Because I love her.
Why are you crying? Because I’m sad.
Why are you going to the hospital? Because I’m concerned.
Our lives are governed by emotions and so are the decisions we make.
“When patients make decisions of course they make choices based on their values and emotions but when it comes to decision-making capacity and the science we have in that area we don’t know really how to handle this aspect of decision making.” Louis Charland. “This is the elephant in the room.”
Charland says this has been conveniently ignored because the only cases we have been talking about are circumstances where it’s clear the patient has the decision-making capability. Problems arise when the discussion includes minors and individuals with mental disorders; mature minors, may be intellectually mature but emotionally unstable. These are the kind of issues that address the elephant in the room.
“It’s easy to get caught up in heated debates about who is right and who is wrong, but no matter where we are going to go it’s not a bad thing to review our current practices in this area anyway. “ Says Charland.
When it comes down to values there will always be conflicting ethical issues.
So, Charland is asking, in a dramatic way to simplify things: is it really ethically appropriate to put patients in these treatment conditions and paint them as only cognizers to treat them like Mr. Spock and ignore their emotional sides.
They’re other countries that have been conducting medical assisted death for years, such as Belgium and the Netherlands. Charland outlines that these countries supply sufficient examples of evidence to help conduct Canada’s legislation. With the great possibility for abuse we need to be sure to ask the right questions and understand the procedures thoroughly.
Below is a short audio documentary with multiple expert opinions on the magnitude of the topic and difficulty inflicted when forcing this law into our legislation.