Robert Munsch’s Dementia Diagnosis Raises MAiD Safety Concerns

Children’s author Robert Munsch has sparked significant discussion regarding the safety of Canada’s medical assistance in dying (MAiD) system for individuals with dementia. Munsch, who has publicly shared his diagnosis of dementia, expressed his fears about potentially becoming a “turnip in bed,” a phrase that reflects his concerns about cognitive decline. While his words may be seen as insensitive, they resonate with many Canadians who share similar fears regarding their own health and dignity.

As Munsch navigates his condition, his daughter has reassured the public that he still enjoys life. His approval for MAiD dates back to 2021, raising questions about the complexities surrounding assisted death for those with cognitive impairments. The conversation surrounding dementia and MAiD is increasingly relevant, particularly as the Ontario Chief Coroner recently released a report titled “Navigating MAiD with Persons with Dementia.”

The report highlights the challenges of assessing capacity in patients with dementia, particularly regarding memory and judgment. As a family physician, I have witnessed the struggles faced by families dealing with dementia. My father, who suffered from advanced dementia, experienced a misdiagnosis that could have significantly impacted his quality of life. After receiving appropriate treatment for pneumonia, he lived several more months, which I deeply cherished.

The MAiD report indicates that while dementia cases represent a small portion of total MAiD deaths, they are often intertwined with family concerns and require input from the coroner’s office to clinicians. The suffering that leads patients with dementia to seek MAiD often stems from feelings of loss of dignity, emotional distress, and a fear of being a burden. Alarmingly, the report reveals that only 13.6 percent of dementia patients received palliative care before opting for MAiD, suggesting a significant gap in support.

Cases documented in the report illustrate the potential risks involved. For instance, one patient, identified as Mr. 6D, received MAiD during an acute illness without adequate consideration of his long-term care options. Moreover, instances where family members initiated MAiD requests raise serious ethical concerns, particularly in light of high rates of elder and financial abuse in Canada.

The eligibility assessments for MAiD also present challenges. In one case, a provider conducted an assessment with minimal interaction with the patient and only one family member present. This lack of thorough evaluation raises serious questions about informed consent, especially in patients with advanced dementia where cognitive impairments can preclude meaningful decision-making.

Fear of future decline plays a pivotal role in many decisions surrounding MAiD. This concern is evident in the case of Mr. 6E, whose caregiver noted that barriers to navigating the system may have influenced his choice for an earlier death. Current legislation stipulates that individuals must be experiencing intolerable suffering at the time of assessment, yet many requests for MAiD stem from anxiety about potential future suffering.

The report also raises ethical questions regarding the timing of MAiD requests. For example, Mrs. 6A, an elderly woman with moderate Alzheimer’s, requested MAiD during a period of health decline and low mood. Family members expressed concern that her depression and other potentially reversible conditions were not fully evaluated before her life was ended.

Compounding these issues is the inconsistent classification of dementia within the MAiD assessment framework. Some patients with mild dementia are classified under a pathway that allows for expedited MAiD, despite possibly having years left to live. Clinicians must navigate biases that may lead to superficial assessments, where diminished cognitive ability is viewed as justification for assisted death rather than an opportunity to explore supportive care options.

The current landscape of dementia care in Canada often leaves patients and families without adequate guidance on prognosis and available support. This gap creates a troubling environment where MAiD can proceed without fully informed decision-making, raising serious concerns about the safety and ethics of the system.

Reflecting on my father’s journey, I recall how he thrived in a supportive environment, surrounded by loved ones and excellent care. His passing was peaceful, a stark contrast to the distressing scenarios outlined in the MAiD report. Munsch’s beloved stories celebrate human dignity and the joy of togetherness, reminding us of the importance of compassion for those facing cognitive decline.

If Canada cannot ensure the safety of individuals with dementia within its MAiD framework, it raises fundamental questions about the integrity of the system. Ensuring that the most vulnerable among us are protected must remain a priority, as the stakes are profoundly high.

Dr. Ramona Coelho is a family physician whose practice focuses on marginalized individuals in London, Ontario. She is also a senior fellow at the Macdonald-Laurier Institute and co-editor of the book “Unravelling MAiD in Canada,” published by McGill University Press.