Canada is constantly working to increase the number of euthanasia deaths. The latest development is proposed guidelines which practically require doctors and nurse practitioners to recommend medical aid in dying to people who might qualify.

The Model Practice Standard for Medical Assistance in Dying (MAID) was released in March, but the most controversial of its proposals was only came to light recently. Section 6 says that patients must be informed of MAiD if “MAID is consistent with the person’s values and goals of care”.

How a doctor knows if patients would consider euthanasia unless they are asked is difficult to say. Perhaps if they are clutching a Qur’an or Rosary beads in their bed. The proposed guidelines say that doctors “must not assume all persons potentially eligible for MAID are aware that MAID is legal and available in Canada”.

The trickiest clause is this: “When advising persons on their potential eligibility for MAID, [physicians/nurse practitioners] must take reasonable steps to ensure the person does not perceive coercion, inducement, or pressure to pursue or not pursue MAID. Advising persons of potential eligibility for MAID is distinct from counselling persons to consider MAID.” However, as critics have pointed out, making people aware is a first step in counselling them. This is why other jurisdictions, such as the Australian state of Victoria and New Zealand, forbid doctors to raise the topic unless they are asked.

Psychiatrist Sonu Gaind, of Sunnybrook Hospital, who is also a former member of a MAID team, is worried about the new guidelines.

“(The practice standards) basically say that you need to inform the person they can have MAID as an option if it could be an option,” he told iPolitics.

The guidelines say that doctors must have “reasonable grounds that a patient may be eligible for MAID” before raising the topic. Dr Gaind commented: “Does that not mean pretty well, anyone who’s in a state of suffering and even hospitalized?”

“The reality is that there’s somebody in front of you that is suffering and coming to the medical professional for help, so they’re in a vulnerable state…and they’re seeking help from someone that they perceive as having expertise to help them,” he said.

The iPolitics website also interviewed Dr Scott Kim, an American bioethicist at the at the University of Michigan who has been critical of Canada’s liberal euthanasia legislation.

“When that person then says, ‘Oh, have you thought about (MAID),’ it’s impossible to pretend that doesn’t also risk coming across as a suggestion,” he said. “It is telling healthcare professionals to be essentially vigilant in finding ways to provide (MAID) by saying you have a professional obligation to bring it up in some situations in the context of a law that does not require that it be provided only in last resort situations. So when you combine those, it’s a potent implementation system — probably accounting for the massive uptake in the country.”

Health Canada told iPolitics that the proposed guidelines are not mandatory. They had been developed by a six-member task force for which it was not responsible. However, it is available on its website and as a PDF, which seems to imply that Health Canada has endorsed it.