Medical assistance in dying legislation must protect kids; further consultation needed

As the federal government considers extending medical assistance in dying (MAID) to mature minors, the Canadian Paediatric Society (CPS) is urging policymakers to develop safeguards that protect kids. 

“Minors are vulnerable to the unique risks and potential harms of medical assistance in dying,” said Dr. Dawn Davies, chair of the CPS Bioethics Committee. “Assessing a minor’s personal capacity to make health decisions is complex, and when death is the possible outcome of the assessment, procedures to do this need to be clearly understood by the patient’s clinical team, parents and other experts.”

The CPS also encourages further consultation to understand the possible benefits and risks of extending MAID to children and youth. Although it is prudent to learn from current policies and experiences for adult patients, consultation with youth, parents, and paediatric health care professionals should be initiated to learn from their experiences and to inform any potential policy.

“A safe and open national dialogue that engages people with a range of backgrounds and diverse customs, beliefs and experiences, is essential for an optimal policy response on this sensitive and complex issue,” added Dr. Davies.

Until recently, there were no Canada-specific data on the frequency of requests for MAID for minors. Nor were there data reflecting the opinions of Canadian paediatricians on MAID issues or their willingness to participate. To close this critical knowledge gap, the CPS surveyed members and associates using two methods.

• A one-time survey by the Canadian Paediatric Surveillance Program (CPSP) revealed that Canadian health care professionals are increasingly being approached by the parents of infants and children, including those too young to make a reasoned decision.
   
• A survey of the attitudes of CPS members revealed that almost one-half of respondents were in favour of extending the MAID option to mature minors experiencing progressive terminal illness or intractable pain.

“Ensuring that newborns, children and youth receive the highest possible standard of care as they are dying is a privilege and a responsibility for physicians and allied professionals,” said Dr. Davies. “We urge governments to ensure that high quality palliative care is made accessible to all children, youth and families who need it. Bringing a thoughtful, respectful and personal approach to every end-of-life situation is an essential and evolving duty of care.”

The CPS continues to support a physician’s right to participate in MAID or not, especially where children and youth are involved, within the evolving legal framework.

Related Links

• Medical assistance in dying: A paediatric perspective
• Canadian Paediatric Surveillance Program (CPSP) 2016 annual results

About the Canadian Paediatric Society

The Canadian Paediatric Society is a national advocacy association that promotes the health needs of children and youth. Founded in 1922, the CPS represents more than 3,300 paediatricians, paediatric subspecialists and other child health professionals across Canada.