Toronto’s Sick Kids hospital drafting policy on requests for assisted dying from those over 18
Three years after Canada’s top court decriminalized
doctor-assisted suicide, the federal government is about to
wade into an emerging controversy: How to respond to
requests from children for medical assistance in dying, or
Canada’s largest children’s hospital has already gotten a
taste of this thorny issue.
“We had discussed that there may be a time in the future
that MAID would be available for patients under the age of
18, or a group called ‘mature minors,'” said Dr. Adam
Rapoport, director of the Pediatric Advanced Care team at
Toronto’s Hospital for Sick Children.
“We, as an organization, like to be ready for things that might be coming down the pike.” . . .[Full text]
Carey DeMichelis, Randi Zlotnik Shaul, Adam Rapoport
This article explores the ethical challenges of providing Medical Assistance in Dying (MAID) in a paediatric setting. More specifically, we focus on the theoretical questions that came to light when we were asked to develop a policy for responding to MAID requests at our tertiary paediatric institution. We illuminate a central point of conceptual confusion about the nature of MAID that emerges at the level of practice, and explore the various entailments for clinicians and patients that would flow from different understandings. Finally, we consider the ethical challenges of building policy on what is still an extremely controversial social practice. While MAID is currently available to capable patients in Canada who are 18 years or older—a small but important subsection of the population our hospital serves—we write our policy with an eye to the near future when capable young people may gain access to MAID. We propose that an opportunity exists for MAID-providing institutions to reduce social stigma surrounding this practice, but not without potentially serious consequences for practitioners and institutions themselves. Thus, this paper is intended as a road map through the still-emerging legal and ethical landscape of paediatric MAID. We offer a view of the roads taken and considered along the way, and our justifications for travelling the paths we chose. By providing a record of our in-progress thinking, we hope to stimulate wider discussion about the issues and questions encountered in this work.
DeMichelis C, Zlotnik Shaul R, Rapoport A. Medical Assistance in Dying at a paediatric hospital. J Med Ethics 2019;45:60-67.