The Plague-Ground — It’s complicated. Life and death always is.

On Monday I wrote about A Bill to Kill You, otherwise called Bill C-7 which proposes big changes in the rules of Medical Assistance in Dying (MAiD).

Today, you can qualify for MAiD if you are in the advanced stage of a serious illness, disease or disability; if it is causing you enduring suffering; and if your “natural death is reasonably foreseeable”.

C-7’s changes include denying MAiD if you’re suffering solely from a mental illness; reducing the number of witnesses to your request from two to one; removing the mandatory 10-day waiting period between your request and its execution; and doing away with the idea that your death must be reasonably foreseeable.

The Bill was meant to be voted on by Parliament three different times this year. Three times it was delayed, from March 11 thto July 11 thto today, December 18 th. But last Friday, Ottawa asked for a further delay. One reason is, Canadians are waking up to the consequences of these changes and think they should be aired and not rushed.

Not just religious groups, some of whom view taking your own life as a mortal sin; and not just disability groups who fear Canadians with disabilities will become victims of death-on-demand.

One of the people saying: “Hold on. Let’s talk about this” is me. But I’m just an interested bystander.

Another is my wife, Jean Marmoreo. As a MAiD doctor, she’s in the thick of this; she lives it. She was one of the founding members of CAMAP, the Canadian Association of MAiD Assessors and Providers, and serves on the medical advisory committee of Dying With Dignity.

So I asked her what she thinks:

Foreseeable Death

“I think removing the ‘foreseeable death’ clause will open the doors to many more people with chronic illnesses, like Parkinson’s or Rheumatoid Arthritis, thinking about MAiD, almost as a treatment option. I don’t think doctors will say that helping you die is a treatment for your terrible illness. But I think patients will.”

“This means that a 35-year old woman living with Lupus may qualify for MAiD.”

Mental Illness

“Not giving mental illness the same standing as physical illness stigmatizes a clinical condition that has the same right to be considered. I recently assessed a woman who met the criteria for treatment-resistant depression. I consulted with a psychiatrist who would assess her eligibility, the same way an oncologist would help me determine how reasonably foreseeable her death would be if she had cancer.”

“I relied on the psychiatrist to tell me that every form of treatment had been tried, without success. Today, it’s possible that she could have been eligible for MAiD. But after Bill C-7 is passed, she couldn’t. As it turns out, she was offered a new treatment and she was willing to still try carrying on.”

One Witness, Not Two

“Right now, neither of the two people who witness your request for MAiD can benefit in any way from your death or be involved with your direct care. But with just one independent witness needed to sign, there’s a greater chance of abuse or mistakes. Asking a single volunteer to be the sole gatekeeper in a legal step in the process is too casual and, at the same time, too burdensome.”

“Two doctors are required to assess a patient because, when it comes to deciding if someone is eligible to be put to death by one of them, two heads are not only better than one, that one doctor isn’t all alone. For much the same reasons, let’s keep those two witnesses.”

No More 10-Day Waiting Period

“The obvious danger here is that your last act will be impulsive. But I can tell you that every one of Canada’s 300 MAiD doctors is going to take a lot longer getting an expert opinion if the patient is pushing to die tomorrow.”

“In my four years of assessing and providing MAiD, I’ve never heard a specialist say: “‘I agree. He’s eligible for MAiD.’ What they’ll say is: ‘In 10 years, this patient with this rare neurodegenerative disease will be in a vegetative state.’ It’s up to me to conclude that he’s eligible for MAiD.”

“Under C-7, I’ll be a canvassing more specialists because, with the loosening of the criteria for MAiD, comes the risk of making a terrible mistake.”

“The Coroner’s on the Line”

“Every province has a different oversight and reporting system. In Ontario, all MAiD deaths are reported to the Coroner’s Office immediately after the patient’s death. I’ve had many calls with them where they ask: ‘How did you determine if this person’s death was foreseeable?’ and I’ve learned to have my answers, full and complete, at the ready. But with C-7, it’s certain there will be more questions and pushback simply because the criteria for MAiD are frankly byzantine.”

* * * * *Ultimately, Jean believes that Canadians have done a stellar job in making MAiD possible, and thus relieving the intense suffering of people at the end of their lives. But also in decriminalizing a process that was deeply covert and unspoken.

She also believes that Bill C-7 is too much, too soon. Looking at the growing divisiveness around this Bill, it should make us pause and reflect, not push harder to ram it through unexamined. Ottawa should open both the door and the debate. This can only be done after we’ve come out the other end of the pandemic which, in her words “has shown us how poorly we really care for our oldest and frailest citizens.”

Last night, Ottawa was given its third extension for Parliament to vote on Bill C-7, until February 26 th.

That’s not long enough.

Originally published at




Bob Ramsay is a Toronto writer, communications consultant and speaker series host: The Plague-Ground is his daily blog.

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Bob Ramsay

Bob Ramsay

Bob Ramsay is a Toronto writer, communications consultant and speaker series host: The Plague-Ground is his daily blog.

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