Canadian Author Raises Concerns Over MAiD for Dementia Patients

Children’s author Robert Munsch, known for his beloved children’s stories, has sparked a significant discussion regarding the implications of medically assisted dying (MAiD) for individuals diagnosed with dementia. Munsch, who publicly revealed his plans for MAiD in light of his own dementia diagnosis, expressed his fear of becoming a “turnip in bed,” highlighting a distressing perspective on cognitive decline. While his language has drawn criticism for being unkind, his sentiments resonate with many Canadians who share similar fears about the impact of dementia on quality of life.

As the conversation surrounding MAiD continues, it raises critical questions about the safety and ethical considerations of this practice for dementia patients. Munsch’s situation is not isolated; it reflects a broader trend where individuals with dementia face unique challenges when contemplating end-of-life options. His approval for MAiD dates back to 2021, yet he still enjoys life, as reassured by his daughter.

The complexities of assessing capacity in dementia patients cannot be understated. A recent report from the Ontario Chief Coroner titled “Navigating MAiD with Persons with Dementia” emphasizes the need for thorough evaluations. While dementia cases constitute a small percentage of MAiD deaths, they often involve significant family concerns and require insights from the coroner’s office to inform clinicians.

The report reveals that the suffering prompting dementia patients to seek MAiD often stems from a perceived loss of dignity, feelings of being a burden, and emotional distress. Alarmingly, only 13.6 percent of dementia patients received palliative care prior to their decision for MAiD. This lack of support raises concerns about whether patients are fully informed of their options before making such a monumental decision.

Several case studies highlighted in the report illustrate the potential risks associated with MAiD for individuals with advanced dementia. One case involved a man with Alzheimer’s who received MAiD during an acute illness. This raises questions about the appropriateness of the decision, particularly when family members initiate MAiD requests. With the prevalence of elder and financial abuse in Canada, these situations underscore the ethical implications of allowing caregivers to influence such significant choices.

The eligibility assessments for MAiD also warrant scrutiny. In some instances, these evaluations lack depth, as demonstrated by a case involving a woman with advanced dementia. Her assessment was conducted during a brief interaction with a family member present, raising concerns about the thoroughness of the evaluation process. Given the serious nature of MAiD, the literature emphasizes the necessity for rigorous capacity assessments.

Moreover, the role of fear regarding future decline significantly affects the decision-making process. For instance, one man’s caregiver questioned whether his difficulties navigating the MAiD system led him to opt for an earlier death. Legislation mandates that individuals must be experiencing intolerable suffering at the time of assessment, which complicates matters when patients express concerns about hypothetical future suffering.

The report also outlines cases where requests for MAiD arose during periods of new health declines, prompting questions about whether reversible conditions were adequately explored before proceeding. Ageism and ableism can hinder proper diagnoses, leaving patients without the necessary information to make informed health decisions.

In situations involving mild dementia, inconsistencies in classification as either “track one” or “track two” in the MAiD pathway have been observed. Many patients are assigned to track one, allowing for expedited access to MAiD despite potentially having years of life ahead. This classification system can reflect negative clinician biases, as diminished cognition may lead to the assumption that patients would be “better off dead.”

Despite the challenges presented by dementia, the experiences of families can differ significantly. In Dr. Ramona Coelho‘s personal account, her father lived joyfully for years, supported by family and excellent care providers, ultimately passing away naturally in the company of loved ones. Such experiences contrast sharply with the troubling patterns observed in the MAiD process for those with dementia.

Munsch’s stories celebrate the unique qualities of individuals, emphasizing dignity and joy in simply being present. If Canada cannot ensure the safety and dignity of those with dementia within the MAiD framework, significant ethical concerns remain regarding the current system. The ongoing discourse around MAiD and dementia requires careful consideration to balance compassion and ethical responsibility.