Thank you.
Good evening. Thank you to the committee joint chairs and members for the invitation. I am deeply honoured by the opportunity to speak with the committee on this very important topic.
I am a philosopher, having completed my Ph.D. in applied philosophy at the University of Waterloo last year. My dissertation research considers moral arguments regarding mature minor eligibility for medical assistance in dying, MAID. The scope of this work is focused on cases of minors who have a reasonably foreseeable natural death—that is, track one.
I also bring the perspective of a practising health care ethicist at a large hospital network in Ontario, where our service supports patients, families and health care teams who encounter challenging situations regarding informed consent, capacity and quality end-of-life care. As part of my clinical ethics role I support one of four specialized pediatric hospitals in Ontario. Our service also supports the institution's MAID team, where I had the privilege of doing MAID coordination during my ethics fellowship.
The views I bring to the committee are my own and do not represent the views of the organization I work for.
MAID for mature minors is an emotionally challenging topic presenting unique challenges when it comes to core values outlined in the Carter decision. Society has an interest in protecting vulnerable persons, and children are often perceived as vulnerable, entailing stronger duties to child well-being than that of adults. However, at the same time, there are societal duties to autonomy, especially respecting capable persons to make decisions about their own medical care and avoiding forcing persons to endure intolerable suffering against their will.
Children have a legal right to decision-making autonomy corresponding to their level of maturity. This tension between welfare and autonomy puts significant scrutiny on a mature minor's capacity to make such a serious decision.
I wish to present three considerations to the committee, which I believe provide compelling reasons for mature minors to be eligible for MAID under track one. The first is the concern that excluding minors from accessing MAID is discriminatory. The 2016 report of the Special Joint Committee on Physician-Assisted Dying articulates that mature “minors can suffer as much as any adult”. It is also conceivable that minors with a grievous and irremediable medical condition who are prohibited from MAID can experience the same harms as adults.
This differential treatment is challenging to justify in the same way we would justify age distinctions in other contexts, including decisions to marry, drive, drink alcohol, smoke tobacco or use cannabis. After all, in the context of treatment decisions, decision-making authority is usually based in presumptions of capacity rather than a firm age distinction.
Secondly, child well-being is not always synonymous with prolonging life. In end-of-life decisions, well-being can be informed by dignity and quality of life, and should take into account the harms of forcing mature minors to endure intolerable suffering against their will.
Lastly, it's important to acknowledge that mature minors already make incredibly high-stakes medical decisions, including the decision to refuse life-sustaining treatment. I argue that refusing life-sustaining treatment—that is, a decision to die when one could otherwise live—is a far more serious type of decision than the decision for MAID under track one, which is choosing to control how one dies when death is unavoidable. In this sense, mature minors are already treated as meeting the threshold of capacity and maturity required to understand the implications of MAID.
It is challenging to reconcile these considerations under track one with the recent expansion of the law to include persons without a reasonably foreseeable natural death—that is track two—and anticipated inclusion of mental illness as the sole underlying condition. While at face value track two and mental illness as the sole underlying condition requests carry a similar weight to the decision to refuse life-sustaining treatment, there is considerable uncertainty regarding the particular vulnerabilities of these patient populations. I would be concerned at the prospect of extending eligibilities to these groups at this time.
I will close by emphasizing that the uncertainties raised by track two and mental illness as the sole underlying condition should not undermine the case for a mature minor to access MAID under track one.
Again, I thank the committee members for their attention and consideration.