The ethics of assisted suicide is heavily debated; while some view it as a way to die painlessly on one’s terms, some argue that it is unethical because it gives medical professionals power they should not have. However, the issue of Medical Assistance in Dying policies is not one of the individual opinions on morality, but rather one of healthcare access and quality care. Everyone deserves the right to medical autonomy, including at the end of their lives. If MAiD is a part of the healthcare system, it should be equally accessible and safe for all citizens to make informed decisions about their care. Canada has shown it can create a cohesive and adaptable policy surrounding a controversial issue while the US lags at the detriment of medical efficiency.

What is Medical Assistance in Dying?

Medical Assistance in Dying (MAiD), also known as Physician-Assisted Suicide (PAS), refers to a medical professional aiding in ending a person’s life “to relieve persistent suffering,” either through passive or active means. PAS administration can entail the withdrawal of life-saving medications or the use of lethal substances to end the person’s life. The practice is illegal in most countries, but the 21st century has seen a wave of legalization around the world–beginning with the Netherlands in 2001. Canada legalized PAS for terminally ill adults in 2016, and recently expanded upon the law with Bill C-7 on October 5, 2020, easing restrictions and expanding access to MAiD services. This puts Canada leagues ahead of the United States, which still has neglected to create a federal MAiD policy.

MAiD in the United States

The United States has complex and contradictory policies surrounding MAiD. According to the American Medical Association, everyone has the right “to make decisions about the care the physician recommends and to have those decisions respected.” The freedom to choose what happens to your body is essential to the healthcare system, as it creates a bond of trust between doctor and patient. While the US government has ensured that every American has the right to refuse life-saving medical treatment, so long as they are able to consent, it has declined to create federal MAiD policy. “Death with Dignity” laws vary state-by-state, with some form of MAiD allowed in 11 jurisdictions. Assisted suicide remains completely illegal in 40 states, despite the fact that almost three-quarters of Americans support the right to die if someone is terminally ill, according to a 2020 Gallup Poll. In states where it is legal, all except Montana require that the patient’s deathーdue to physical, terminal illnessーis foreseeable and will take place within 6 months. Patients also must give informed consent for MAiD, which is a necessary safeguard to ensure they are making the decision willingly. In the US, they are required to give consent two or three times, and once immediately before MAiD is implemented. They have to make multiple requests to receive medical assistance, and most states require a 15-day waiting period between the first and second MAiD request. Unnecessary barriers to patient access diminish the quality and efficiency of medical care, as well as detract from the patient’s right to “courtesy, respect, dignity, and timely, responsive attention.” Not only do the current MAiD policies in the US elongate the process, but they rob the patient of agency by forcing them to make several requests and wait long periods of time before they can receive care. And since there is no federal policy, patients in 40 out of 50 states have no access to MAiD at all. The federal government’s lack of control over healthcare policy delegates the specifics of care to the states, preventing any sweeping policy changes that could streamline the process and provide the same medical benefits to all citizens. The United States needs to look no further than its neighbour, Canada, as an example of a nationwide policy that provides access for all patients as well as allows for policy development.

MAiD in Canada

Canada has created a MAiD policy that is applicable in every province which balances efficiency and patient safety. On March 17, 2021, Canada’s new Medical Assistance in Dying policies came into effect. The new laws will now allow those whose death is not “reasonably foreseeable” to pursue MAiD, along with relaxed restrictions for those whose death is more immediate. In a controversial move, the law deems mental illness as a valid reason to seek MAiD, although this will not take effect until 2023 after “expert review”. Since the legality of assisted suicide is determined by the federal government, the service is available in every Canadian province, simplifying the patient’s ability to request care from their medical provider. Consent procedures have also been adjusted with the removal of the 10-day waiting period between requesting and receiving MAiD for those whose death is foreseeable, and waiting periods for people with longer life expectancies may be shortened if they will soon lose decision-making capacity. Medical professionals retain the right to refuse to provide MAiD if it goes against their personal moral standards. Thus Canadian policy expands access to MAiD while maintaining safeguards that ensure patients and medical professionals are protected.

Why the US should follow Canada’s lead

Canada’s MAiD policy proves that it is possible to create a cohesive federal policy that provides patients with options and ensures their safety. The federal involvement with end-of-life care has allowed for the development and expansion of MAiD while providing equal access to people from every province. While individual opinions on the right to die may vary, medical care should always be accessible for every patient, and should not be weighed down by unnecessary bureaucratic procedures. The US government’s neglect to take policy action deprives millions of Americans of the ability to dictate their care. The US should take note of Canada’s practical and equitable approach to end-of-life care by creating a federal MAiD policy so every American can receive the treatment they deserve.