Toronto’s Sick-Children’s hospital (Sick Kids) has published policies and procedures for Medical Assistance in Dying (MAID) that include scenarios where parents aren’t informed until after their child dies.
The article by Sick Children’s doctors, administrators and ethicists and backed by the University of Toronto’s Joint Centre for Bioethics was published last month in British Medical Journal’s J Med Ethics.
In December this year, The Canadian Council of Academies is due to report to Parliament and to the public on the medical consensus about extending voluntary euthanasia in circumstances currently forbidden by law.
The main question the Canadian Council of Academies is specifically looking at is:
“What is the available evidence on, and how does it inform our understanding of, … MAID in the case of mature minors, advance requests and where mental illness is the sole underlying medical condition, given the clinical, legal, cultural, ethical and historical context in Canada?”
In a flowchart that outlines how a medically induced death would occur at Sick Kids, the authors don’t mention discussing with family or parents how the child dies until after the death occurs in the “reflection period.”
The authors say patient confidentiality is the deciding factor in whether to include parents in assisted death choices.
In general, the authors say families are involved in end-of-life decisions.
“If, however, a capable patient explicitly indicates that they do not want their family members involved in their decision-making, although health care providers may encourage the patient to reconsider and involve their family, ultimately the wishes of capable patients with respect to confidentiality must be respected.”
The Sick Kids’ proposed policy and procedures argue there is no meaningful ethical distinction between a patient choosing to refuse burdensome treatment and accepting an inevitable death versus patients who choose to die by chemical injection before the disease brings on death.
The authors point out that legally, the state of Ontario (and therefore its provincial capital Toronto) does not require parents to be involved in a capable minor’s decision to refuse further treatment.
This being the case, they say there is no legal reason to require parent involvement in an assisted death.
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