In Western society, we spend a lot of time celebrating and welcoming new life, but very few cultures celebrate when a person dies. While death is not as taboo as 50 years ago, death is still a topic that many individuals are not comfortable speaking about in conversations. Even more off-limits, people are less likely to talk about physician-assisted suicide in their social circles. There are many reasons to this phenomenon such as religious beliefs, personal beliefs, and advocacy for life. In fact, an ethical challenge is the conundrum of ending a life, as these professionals strive to enhance the quality of life and cure or alleviate illness, rather than to end it.
What constitutes a good death? To answer this question, several common responses include: being surrounded by family and friends, avoiding the prolongation of death, not being in pain, and achieving control. But what happens to the patient when the suffering becomes too much? Who determines the suffering is great enough to warrant suicide? How does the medical community ensure an individual is cognizant of their choice to end their life? These questions can be considered in conversations about Medical Assistance in Dying.
Medical Assistance in Dying (MAiD), as described by Noushon Farmanara, is a process that permits individuals with grievous and incurable physical or psychological suffering to voluntarily end their life in the presence of medical and health professionals. At present, MAiD is legally available in Europe, South America, Australia, and North America. Particularly in Canada, the passing of Bill C-14 on June 17, 2016 permitted MAiD as a legal procedure for Canadians who meet rigid requirements. Although Bill C-14 advocates the legalization of assisted suicide in Canada, there are ethical implications to consider in the perspective of the patients, the medical and healthcare professionals, as well as the community, who may be affected by the legislation.
Music therapy, an allied healthcare discipline that is growing in its awareness and significance in hospice and palliative care, is essential in helping patients explore the meaning of a good death as they move through their decline. Music therapists may be called to provide music and holistic care for the patients prior to MAiD, as it is a logical extension to include music therapists in the discussions and procedures of MAiD.
The clinical interventions facilitated by certified music therapists are spread across a continuum of passive to active interventions such as lyric discussion and analysis, songwriting, improvisation, guided imagery and music, and musical life review. The techniques that assist in the realization of patient-directed goals exist in spiritual, psychosocial, cognitive, emotional, and physical domains. As well, patients can create legacy songs to convey an important sentiment for their loved ones to cherish and listen to after their passing, such as “I love you.”
Music can also offer potential interventions which can keep a patient calm and relaxed at the time of injection. While Bill C-14 does not include music therapists as a valid healthcare professional in MAiD, having these holistic approaches can allow the patient to feel safe and celebrate their life. In fact, the absence of music therapy could increase the potential for harm as music therapy can contain and support emotions that might be very intense at this time.
A hypothetical case example followed a patient in a Canadian public-hospital who was considering live music by a music therapist during her MAiD procedure. As her physical symptoms worsened and despite the intake of medications, music therapy potentially offered healing and autonomy for her physical suffering in this difficult time. As music is non-invasive, it provides a creative outlet for patients to document their internal feelings, relationships, and stories prior to their death.
When integrating music therapy with MAiD, ethical considerations should be explored, such as recommended policies and guidelines that could promote music therapists as an essential to legalized death. As these professionals use music as a holistic intervention to clients, the facilitator may experience emotional hardship similar to the medical professionals in MAiD. This may result in immediate replacements and strain in the client-healthcare relationship. Further, limited resources are currently available to healthcare professionals to engage in circumstances around MAiD.
To provide these viable solutions, a team of music therapists and psychiatrists have written a set of clinical guidelines for music therapists to effectively engage with patients interested in MAiD. These guidelines explore the potential of music therapy in MAiD through an evidence-based methodology of qualitative studies and recommended practices that were designed to address the dynamic nature of Bill C-14 and the Code of Ethics of the Canadian Association of Music Therapists. This included suggested interventions and clinical goals for the patient, as well as supportive roles in the music therapy sessions. Further, annual hospital training and education for re-certification of any healthcare profession may be viable options to explore resources available for patients at their time of death.
Music therapy is a natural fit with MAiD as this healthcare discipline has demonstrated significant impact in work with the dying. In Canada, while Bill C-14 has provided patients with a degree of autonomy, it has created ethical concerns for the medical and healthcare professional and their community. To address these concerns, policies and guidelines have recommended music therapy as a crucial practice in the dying process and have provided viable solutions to combat these restrictions through empirical research. By continually creating resources about MAiD, the conversations about this topic will diminish its taboo and, ultimately, visualize death as a celebration of life and care.
Featured image: “Piano Music Score” by stevepb