What is going on with MAID in Canada? Bill Gardner, Leonie Herx, & Sonu Gaind

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GeriPal - A Geriatrics and Palliative Medicine Podcast 52 min 3 speakers 8 chapters transcribed 8 hours ago

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What is Medical Assistance in Dying (MAID) and why is it a growing issue in Canada?

Alex Smith 0:00

Hey listeners, this Jerry Powell episode is eligible for CME. Eric, how do our listeners claim credit for CME?

Eric Widera 0:07

Go to the jerrypal.org website, look at the top menu, click the CME menu item, and a link to the post that will describe exactly what you should be doing to claim CME credit and to register and on to the show. Welcome to the Jerry Powell podcast. This is Eric Quadera.

Alex Smith 0:24

This is Alex Smith.

Eric Widera 0:26

And Alex, we got a really important, interesting topic today. What's up with medical aid in Canada? Medical aid and die in

Alex Smith 0:35

Canada.

Eric Widera 0:36

Medical aid and die. What did I say?

Alex Smith 0:38

You said medical aid in Canada.

Eric Widera 0:42

It's gonna be one of those days, listeners. I apologize. Who do we have with us to talk about this topic?

Alex Smith 0:47

We are delighted to welcome back to the Jerry Pell podcast, Bill Gardner, who's a psychologist, professor of psychiatry and epidemiology at the University of Ottawa. And he writes about his experience living with cancer at BillGardner.substack.com. Bill, welcome back to JerryPal.

Bill Gardner 1:03

Thank you.

Alex Smith 1:04

We're delighted to welcome Leone Herx, who's a palliative care physician and clinical professor at the University of Calgary. Leone, welcome to JerryPal.

Leonie Herx 1:12

Thanks for having me.

Alex Smith 1:14

And we're delighted to welcome Sonu Gan, who is a chief of psychiatry and professor at the Sony Brook Health Sciences Center at the University of Toronto. I think I mispronounced your last name. Gan.

Sonu Gan 1:25

Uh you got it the second time. Appreciate that. Thanks for having me and covering this challenging topic.

Eric Widera 1:30

So I again the topic is gonna be medical aid and dying in Canada. But before we go into that topic. Bill, I think you have a song request for Alex. Yeah,

Bill Gardner 1:41

I would like to hear Cortez the Killer

Eric Widera 1:43

from Alex. And why did you choose this song, Bill?

Bill Gardner 1:47

Uh, because I've been um a near young person since I was about uh thirteen. So what can I say?

1:54

Yeah.

Alex Smith 1:55

Great Canadian singer, songwriter, band leader. I saw Neil Young perform this in Israel outside of the Apha Gate in the Old City in the Sultan's Pool, natural amphitheater. His backing band was Pearl Jam. It was amazing. Oh my gosh. Amazing. At night, you know, lit up. People were sitting on the walls of the old city looking in. It was just Just an experience. Um, I'm gonna play it with one finger on my guitar, so it will not be the same. But uh here's a little bit 'cause my hand is still broken, listeners, those of you have been keeping track. Here's a little bit of the song.

Unknown 2:49

He came dancing cross the water. With his galleons and his guns. Looking for the new world and their palace in the sun on the shore lay Montezuma. With his cocoa leaves and pearls in his halls he often wandered. With the secrets of the world.

Eric Widera 3:38

Harmonica Alex.

Leonie Herx 3:40

Lovely.

Eric Widera 3:41

Alex I I imagine Alex in like two years. He's gonna have like a harmonica, a guitar, a piano y you know those one man bands with like everything happening. Kick drum with my foot. Kick drum with my foot. Yeah, yeah, Yeah, yeah, exactly.

Alex Smith 3:53

exactly. We'll see. Making the most I can do. I can use my mouth, even though I only have six fingers here. So figure I'd add a little harmonica.

Eric Widera 4:05

So we're gonna be talking about this complicated topic that a lot of people have differing opinions too and potentially very strong opinions, medical aid and dying. Maybe before we go into this kind of heavy topic, but I'm gonna jump to Sonu, how did you get interested in this as a topic for yourself from an academic or personal standpoint?

Sonu Gan 4:29

You know, it's a That's a great question. And it actually reflects a an unexpected journey, as I think it does for many people, actually, because it is not something which I entered medicine thinking that I would be getting heavily involved in. Uh what happened is that firstly, in terms of my clinical background, my background is psycho oncology. So that's working with patients with cancer and their families, including when they're going through periods of being well and also potentially periods of dying. But that was separate from me. The main issue then came on the table in Canada after the twenty fifteen Supreme Court reading in Carter v. Canada. And In that ruling, it basically laid out the requirement that some form of assisted dying.

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Chapters

8 chapters

1 What is Medical Assistance in Dying (MAID) and why is it a growing issue in Canada? 0:00–6:00 2 How did the guests become involved in MAID policy and what are their professional perspectives? 6:00–12:53 3 How does Canada’s MAID framework differ from the United States and why are the numbers so much higher? 12:53–19:40 4 What legal milestones (Carter v. Canada, Bill C‑7) shaped the current MAID eligibility criteria? 19:40–26:15 5 How will the planned expansion to mental‑illness and mature‑minor patients change MAID practice? 26:15–32:40 6 What personal experiences did Bill Gardner and Sonu Gaind share about being offered MAID? 32:40–38:46 7 Why are access to palliative care, housing, and disability services critical to the MAID debate? 38:46–45:26 8 What solutions or safeguards do the experts propose to protect vulnerable patients while preserving autonomy? 45:26–52:42

Speakers

3 identified

Eric Widera 7 min Alex Smith 4 min Bruno Satin

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Topics in this episode

Canada 7 California 2 Ontario 1 Alex Smith 1 Eric 2 ketamine 1 ALS 1 Ed Martin 1 Elizabeth Chung 1 Harry Hahn 1 Neil Young 2 Susan Nelson 1

Source

Recorded11 Jan 2024

Publisherrss.libsyn.com ↗

Transcriptspeaker-named · 100+ languages

Handlerec:20524571

Show notes

Four percent of deaths in Canada are due to Medical Assistance in Dying (MAID). Four percent. The number of people who have used MAID in Canada since it was legalized in 2016 has increased year on year from about 1,000 people in the first year to over 13,000 people in 2022. California, which has a similar population size as Canada and legalized MAID around the same time, has fewer than 1000 deaths per year from MAID. In further contrast to the United States, MAID in Canada is almost entirely administered by a clinician, whereas in the United States patients must self administer. To be eligible in Canada patients must have a "grievous and irremediable" condition, including disability; they do not have to have a terminal illness with a prognosis of less than 6 months. They could have a prognosis of years, or decades. A planned expansion of MAID to include people with mental illness was placed on hold until March 2024. The Canadian parliament will soon hear a report on potentially expanding MAID to "mature minors." A recent Human Rights podcast discussed the story of a Canadian seeking MAID because he could not afford to stay housed. Today we talk about these issues with Bill Gardner, a psychologist at the University of Ottawa who is living with cancer, Leonie Herx, a palliative care physician at the University of Calgary, and Sonu Gand, a psychiatrist at the University of Toronto and former president of the Canadian Psychiatric Association. We talk about how Canada got to this point, including the degree to which offering MAID to anyone who is eligible has become standard practice in many places. We hear Bill Gardner's experience being told that his cancer could not be treated and immediately offered two options: palliative care or MAID. We talk about the role of palliative care and lack of access for many people living with serious illness in Canada. We go in depth about ethical issues raised by the planned expansion of MAID to people with mental illness. Much of the criticism of the explosion of MAID in Canada is coming from people like, our guests, who feel that MAID should be an option for a select few, rather than coming from under-no-circumstance opponents. To many this rapid expansion will represent autonomy run amok. It is the slippery slope made real. To others MAID represents a seemingly easy and inexpensive mechanism to address failures of the system to address potentially reversible sources of suffering on a systemic level, from difficult conversations at the bedside, to meeting basic needs like housing. For those listening to the podcast, credit to Kai for guitar on Neil Young's Cortez the Killer (my left hand is still broken at the time of this recording). You get me with one-finger-chords on the guitar if you're watching on YouTube (best I could manage). -@AlexSmithMD Overview of MAID in Canada Bill Gardner's article about MAID in Comment Magazine https://comment.org/death-by-referral/ Bill Gardner's articles about living with terminal cancer in Mockingbird Magazine: https://mbird.com/art/cancer-in-advent/ https://mbird.com/religion/testimony/in-the-electors-school/

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