Letter: Reader concerned about how MAID decisions are reached

To the editor:

I’ve been writing about the issue of MAID literally since the issue first surfaced. And of course, it's hot again, with reports that people are opting, or being "encouraged" to opt for MAID for other than health reasons (poverty, etc.)

I don’t have a problem with people with a mental illness that they can’t deal with anymore having a MAID option. As long as it truly is an informed decision. That part is just my opinion, as a citizen.

What I have serious and continuing concerns about is the process by which approval for a MAID decision is reached.

To my knowledge, and based on my experience with my dear husband’s opting for MAID just over two years ago, a GP or other physician makes a referral to another physician in the community who is authorized to perform MAID.

That’s NOT GOOD ENOUGH.

Physicians, again to my knowledge, have little to no training in the full range of considerations ESSENTIAL for a fair and appropriate MAID approval.

Some background: my husband was a PhD Clinical Child Psychologist, with decades of clinical experience.

When the Rae government came into Ontario, one of the things they did was remove the decision of competence from physicians as the gatekeepers, and establish sound and research-based criteria for approval or denial of competence.

Practitioners were recruited from across the province. They had to have specific education, training, and experience, and at least one referral from a credible colleague. Then they were trained, in person, in Toronto for two intensive weeks, as I recall. And tested. And then the expanse of their authority to conduct competence assessments was granted.

The usual four quadrants were involved, and not everyone was approved for all four quadrants in assessments. My husband was one of those. He was one of only two in NE Ontario.

My background is in social work—largely at the systems and structures level, but requiring the full educational BSW spectrum, including clinical and justice issues.

I typed all his reports. They were immaculate.

The bottom line in competence decisions was that you could make any decision you chose, as long as you were competent to do so. Many family members, and vultures, were most disturbed by this. And so was the physician community, who protested en masse.

It was, from my observance, the very best time to be examined for mental competence in the province.

And then Harris came in, with others of the same voice, and all that went away.

Establishing the appropriateness of a MAID option, or choice, for physical issues, is fairly straightforward.

Establishing for mental, and now social, issues are not—and obviously it’s rife with hazards.

I don’t know that those who are authorized to approve a MAID request have any of those “secondary” issues.

How equipped—educated, trained, experienced, evaluated—are they to establish anyone’s intractable mental and personal pain, and the decision it has brought them to?

At the absolute minimum, I believe each practitioner should be required to walk through the process and content of a structured advanced directive with the patient, before making a decision. At the very very very least. That should be incorporated into the criteria and process that authorizes a practitioner to work with a patient, to come to a decision.

But we have a provincial government now that is, to put it mildly, averse to scientific, medical, and human consideration.

And we have a provincial government now which is determined to empty the lifeboats, for financial reasons.

Perfect storm.

I don’t know how to turn this wreck around in Ontario, but dear heaven, we must try.

Please continue to advocate for JUST MAID.

Please.

Kathleen Kilburn

 Redbridge, Phelps Township