Bioethicist Alarmed New MAID Guidance Could Encourage People to Die to Give Organs to Loved Ones

A file photo of a healthcare professional with a patient. (Pascal Pochard-Casabianca/AFP)

New policy guidelines for medical assistance in dying (MAID) in Canada suggest patients be allowed to donate their organs to loved ones, an incentive some MAID opponents say could encourage more people to end their lives who otherwise wouldn’t.

Usually when organ donors die, the organs go to recipients most in need and the best match without the donor being able to choose a recipient ahead of time. Only in the case of living donations, such as a healthy person donating a kidney to a relative, is a “directed donation” permitted.

The guidelines suggest that MAID patients instead be allowed to make directed donations. But bioethicist Trudo Lemmens worries this creates an incentive for disabled people to end their lives prematurely to help a friend or family member.

“This policy reflects the most extreme instrumentalization of disabled persons’ lives I’ve ever encountered,” Lemmens said in a June 27 Twitter thread commenting on the guidelines.

He gives the hypothetical example of a disabled person struggling to get by, lacking adequate support. Then her niece or nephew needs an organ donation—“No pressure there, of course... Just ‘choice,’” Lemmens said.

The guidelines were published June 26 by Canadian Blood Services (CBS) in the Canadian Medical Association Journal. The guidelines were formed with the help of 63 experts, including those from professional societies such as the Canadian Society of Transplantation and the Canadian Association of Critical Care Nurses.

Lemmens noted that disability advocacy groups were not part of the consultation.

CBS included “core principles” in its guidelines that seek to separate a patient’s MAID decision from his or her decision to donate an organ.

Healthcare workers must not approach patients with information about organ donation before a patient is found eligible for MAID, CBS said. However, if a patient initiates the inquiry about organ donation before being found eligible, that patient may be referred at any time to organ donation organizations.

The principles also state that directed donation should not take place if there’s any sign of monetary exchange or coercion involved.

But Lemmens argues that even if direct “coercion” is not involved, there’s often a good deal of pressure. He cited Health Canada data showing that in 2021, more than 35 percent of those receiving MAID felt they were a burden on friends, family, and caregivers.

Allowing MAID patients to make directed organ donations creates “heightened concerns for undue pressure toward death,” he said.

“There are widely recognized limits and rules around organ donation for a reason,” he added.

Isabel Grant, a law professor specializing in mental health law at the University of British Columbia, agreed with Lemmens in a responding tweet. “We are setting up multiple incentives for MAiD. Add this to the insurance company position that MAiD is not suicide. Canada has profoundly lost its way.”

CBS’s new guidelines are an update to its previously existing ones in light of changes to Canada’s MAID law in 2021 that opened MAID to patients whose “natural death is not reasonably foreseeable.”