The doctor-patient relationship is sacrosanct, and having the courts second-guess the clinical judgment of physicians and nurse practitioners is inappropriate.
That’s the key message that emerges from the high-profile case of an Alberta father trying to block his adult daughter from accessing medical assistance in dying.
In his 31-page ruling, Justice Colin Feasby of the Alberta Court of Queen’s Bench rejected the request for an injunction, saying the harm of infringing on the 27-year-old woman’s autonomy and dignity outweighs the pain that her death would cause her father.
“The choice to live or die with dignity is M.V.’s alone to make,” he wrote. (Per a publication ban, the parties in the case are referred to simply as M.V., the daughter, and W.V., the father.)
The court also gave M.V.’s father 30 days to appeal the ruling because of the legal issues at stake.
The ruling is indeed important in informing the ongoing debate about MAID, especially since the scope of Canada’s current legislation will eventually expand to allow people whose sole underlying condition is mental illness to access assisted death.
In his judgment, Justice Feasby made a couple of key points beyond the importance of patient autonomy.
One is that having a diagnosis of a psychological or psychiatric condition – be it autism, ADHD, depression, or bipolar disorder – does not automatically mean a person is incapable of making medical decisions.
A central argument in the case was that M.V. had a diagnosis of autism and ADHD. Her father, W.V., also claimed she had undiagnosed mental illnesses. The suggestion was that, as a result, M.V. does not have the capacity to make her own medical choices.
It’s interesting to note that those most dogmatically opposed to MAID often argue they are defending the rights of people with disabilities. But, as in this case, that argument can fall flat – the view that, by definition, every intellectual and psychiatric condition makes a person incompetent to make medical choices runs counter to Canada’s important court rulings on MAID, which have instead been about extending the same rights to autonomy, dignity and choice to everyone, regardless of ability.
In this case, the judge rightly dismissed the claim, noting there are legal procedures for declaring a person incompetent. Guardianship laws are used frequently to confer decision-making powers on families of people with dementia, severe mental illness, or other neurological issues.
The family argued they were de facto guardians of M.V. because she lived at home and had never really worked. But the judge said this is not proof that she is not competent or that she can’t make sound medical decisions.
During the proceedings, M.V. did not release any information about her medical condition or her reasons for seeking MAID, saying this is essentially nobody’s business. Justice Feasby agreed.
That, too, is an important point. People seeking medical help are entitled to privacy. This is true whether they are getting a hangnail treated or seeking medical assistance in dying.
It’s painful to watch this case unfold, mostly because it’s about a family torn apart. It tugs at the heartstrings, too – no parent wants to see their child die.
But as M.V.’s lawyer, Austin Paladeau, said: W.V.’s love for his daughter “does not give him the right to keep her alive against her wishes.”
There is much more at stake here than one woman’s life or death.
Both Parliament and the Supreme Court of Canada considered and rejected a supervisory role for the courts in MAID cases, and for good reason. It would be a nightmare.
No one – not family, not friends, not moralistic opponents – should get to override a competent adult’s medical decision.
This is true whether they are seeking MAID, an abortion or any other procedure.
When you make a deeply personal decision a public ordeal, you strip people of their agency and their dignity. This is a well-worn technique in the playbook of anti-choice activists.
There are those who argue that MAID requires special scrutiny because the result is death. But many medical decisions can be fatal: Do not resuscitate orders (DNRs) are commonplace; so too is palliative sedation, or refusing dialysis, blood transfusions or cancer treatment – all potentially deadly choices. The medical system deals with issues of consent and capacity on a daily basis, and it does it well, with few exceptions.
The courts have no place in the hospital rooms and doctor’s offices of the nation.
As Justice Feasby wrote in his decision (quoting a 2017 decision on MAID in the Ontario Superior Court of Justice): “The court is a legal practitioner, not a medical practitioner.”
And we should keep it that way.
André Picard