This article was published by Dying Will on November 3, 2021.
In their 2020 qualitative study, Matthews and Colleagues interviewed palliative care physicians and nurses who practiced in healthcare settings where patients could access Medical Assistance in Dying (MAiD) in Southern Ontario. Their findings conclude the negative impact that MAID has on palliative care in Canada:
- All clinicians spoke about a conflict between maintaining Medical Assistance in Dying eligibility and effective symptom control. Clinicians felt they must withhold symptom control medications that could cause sedation or confusion and therefor jeopardise MAID eligibility, even if the medication could significantly alleviate their patient’s pain. This difficulty in providing optimal symptoms management created by the Medical Assistance in Dying legislation resulted in increased providers and patients’ distress.
- Many clinicians described the prevalence of ethical and moral dilemmas regarding the appropriateness of certain discussions regarding MAID with their patients, such as introducing MAID to patients who did not initiate these requests. Clinicians were concerned that introducing the topic of Medical Assistance in Dying might be misinterpreted as an invitation to request for it, and may add to the burden of vulnerable patients and erode families’ trust. Participants also described challenging conversations around supporting patients and resolving tension with families around Medical Assistance in Dying.
- Medical Assistance in Dying has a significant emotional and personal impact on palliative care providers. Many of the clinicians described a large emotional toll created by exposure to Medical Assistance in Dying.
- Medical Assistance in Dying changes the patient palliative care provider relationship. The clinicians described how patients thought that palliative care included assisted death, which complicated their relationships with these patients. Further, clinicians with moral or religious objections to Medical Assistance in Dying described substantial challenges with building trust with patients pursuing assisted death.
- The clinicians felt that the providing of assisted suicide led to more palliative care resources being dedicated to assisted deaths that would have otherwise been allocated to palliative care.
This study should serve as a warning to the UK as Parliament debates the legalisation of assisted suicide. If Canada serves as any example, the implementation of assisted suicide will have a profound negative impact on palliative care.
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Policymakers should give priority to standardizing Palliative Care in Canada.
In BC, the NDP government failed to fulfill their promise to British Columbians to develop and implement Dementia and Palliative provincial policy by April 2018. To date, the provincial policy is still in this draft stage.
The province of BC developed and approved the implementation of the Medical Assistance in Dying Provincial Policy on July 2018.
It is really a problem in BC that MAiD provincial policy was developed, approved, and implemented before a provincial MAiD Policy. One impact of this decision by the NDP government is the controversial issue between Fraser Health and Delta Hospice Society. Fraser health ended the 35-year finance-build-operate agreement by defunding the Hospice Society and took over the hospice and supportive care that was built under the finance-build-operate project. In the exclusive possession of the two facilities and Fraser Health taking over the hospice operation, MAiD is now offered in the hospice and the supportive care centre was left vacant since the exclusive possession of the health authority.
In the Accreditation Canada report for Fraser health, it claimed that the palliative care network of the Fraser health authority is being led by a medical lead AND operational lead to standardizing the delivery of care but this is not the case in Fraser Health Authority, it is only the operational lead that decides, the former medical lead objected with the mandate of the Fraser Health Authority to provide Medical Assistance in Dying or euthanasia in hospices in palliative care units. How can a health authority depend on an operational lead alone and exclude a MEDICAL LEAD (PALLIATIVE CARE MEDICAL EXPERT) in establishing standardization of the delivery of palliative care services in the Fraser Health Region?
There is a negative impact of the Fraser Health mandate to provide MAiD in hospices. The hospice bed occupancy rate in Fraser Health is below the KPI set by the health authority. The hospice bed that should be used for palliative care services for those who have less than 6 months to live, is not being utilized by Fraser Health as a bed to provide MAiD. Do Fraser Health really care for those who needs the hospice palliative care beds? They have MAiD Coordination Centre but no Palliative Care Coordination Centre. The health authority should think about coordinating the care for the patient and the family who may need mental health support, community support as part of the palliative care. The MAiD legislation includes referral to mental health and community support but this are overlooked by Fraser Health Authority policy makers of their corporate MAiD policy.
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