Considerations for assessing frail older adults requesting medical assistance in dying

In 2016, medical assistance in dying (MAiD) was decriminalized in Canada with the passage of Bill C-14. Under Bill C-14, competent adults with a serious and incurable condition in an advanced state of irreversible decline who were experiencing intolerable physical or psychological suffering and whos...

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Published in:Canadian Medical Association journal (CMAJ) Vol. 194; no. 2; pp. E51 - E53
Main Authors: Engelhart, Sarah, Stall, Nathan M., Quinn, Kieran L.
Format: Journal Article
Language:English
Published: Canada Elsevier Inc 17.01.2022
CMA Joule Inc
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CMA Impact Inc
Subjects:
Aged
Assisted suicide
Canada
Care and treatment
Charter of Rights-Canada
Conscientious objectors
COVID-19
Eligibility Determination
Euthanasia, Active, Voluntary - legislation & jurisprudence
Evaluation
Frail Elderly
Frailty
Geriatric Assessment
Humans
Internal Medicine
Legislation
Medical ethics
Medical prognosis
Older people
Patients
Social isolation
Canada
ISSN:0820-3946, 1488-2329, 1488-2329
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Abstract In 2016, medical assistance in dying (MAiD) was decriminalized in Canada with the passage of Bill C-14. Under Bill C-14, competent adults with a serious and incurable condition in an advanced state of irreversible decline who were experiencing intolerable physical or psychological suffering and whose death was reasonably foreseeable could be eligible for MAiD. After its passage, legal challenges were brought before the Superior Court of Quebec, who ruled that the original legislation was too restrictive and in violation of the Canadian Charter of Rights and Freedoms. This led to the passage of Bill C-7 in Mar 2021, which amended Canada's criminal code to remove "reasonably foreseeable death" as an eligibility criterion, thus creating 2 distinct pathways for MAiD, where death either is or is not reasonably forseeable. One patient population likely to be affected by these changes is older adults considered to be frail. Clinicians should consider whether factors contributing to frailty are reversible when considering requests for MAiD. MAiD for those in whom death is not reasonably forseeable is subject to additional safeguards including a minimum 90-day period for assessing eligibility and mandatory assessment by a clinician with expertise in the patient's condition.
AbstractList In 2016, medical assistance in dying (MAiD) was decriminalized in Canada with the passage of Bill C-14. Under Bill C-14, competent adults with a serious and incurable condition in an advanced state of irreversible decline who were experiencing intolerable physical or psychological suffering and whose death was reasonably foreseeable could be eligible for MAiD. After its passage, legal challenges were brought before the Superior Court of Quebec, who ruled that the original legislation was too restrictive and in violation of the Canadian Charter of Rights and Freedoms. This led to the passage of Bill C-7 in Mar 2021, which amended Canada's criminal code to remove "reasonably foreseeable death" as an eligibility criterion, thus creating 2 distinct pathways for MAiD, where death either is or is not reasonably forseeable. One patient population likely to be affected by these changes is older adults considered to be frail. Clinicians should consider whether factors contributing to frailty are reversible when considering requests for MAiD. MAiD for those in whom death is not reasonably forseeable is subject to additional safeguards including a minimum 90-day period for assessing eligibility and mandatory assessment by a clinician with expertise in the patient's condition.
Audience Professional
Author Stall, Nathan M.
Engelhart, Sarah
Quinn, Kieran L.
Author_xml – sequence: 1
  givenname: Sarah
  surname: Engelhart
  fullname: Engelhart, Sarah
  organization: Department of Medicine, University of Toronto, Toronto, Ont
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  givenname: Nathan M.
  surname: Stall
  fullname: Stall, Nathan M.
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  givenname: Kieran L.
  surname: Quinn
  fullname: Quinn, Kieran L.
  email: kieran.quinn@mail.utoronto.ca
  organization: Department of Medicine, University of Toronto, Toronto, Ont
BackLink https://www.ncbi.nlm.nih.gov/pubmed/35039389$$D View this record in MEDLINE/PubMed
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CitedBy_id crossref_primary_10_3389_ijph_2024_1606962
crossref_primary_10_1016_j_jagp_2024_08_002
crossref_primary_10_1080_07481187_2024_2330011
crossref_primary_10_1093_ageing_afaf028
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Snippet In 2016, medical assistance in dying (MAiD) was decriminalized in Canada with the passage of Bill C-14. Under Bill C-14, competent adults with a serious and...
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StartPage E51
SubjectTerms Aged
Assisted suicide
Canada
Care and treatment
Charter of Rights-Canada
Conscientious objectors
COVID-19
Eligibility Determination
Euthanasia, Active, Voluntary - legislation & jurisprudence
Evaluation
Frail Elderly
Frailty
Geriatric Assessment
Humans
Internal Medicine
Legislation
Medical ethics
Medical prognosis
Older people
Patients
Social isolation
Title Considerations for assessing frail older adults requesting medical assistance in dying
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