Assisted suicide is a cancer that is destroying authentic palliative care.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Terry O'Neill wrote an excellent article that was published by the BC Catholic on May 12 titled: Assisted suicide is a cancer that is destroying authentic palliative care.

Authentic palliative and hospice care does not hasten death.

O'Neill quotes key people including: Palliative-care expert Dr. Neil Hilliard from Abbotsford BC, Dr. Ebru Kaya, president of the Canadian Society of Palliative Care Physicians, Dr. Leonie Herx, the immediate past president of the Canadian Society of Palliative Care Physicians and myself.

Hilliard, who is a past medical director of palliative care in the Fraser Health BC region stepped back from his role after the BC government demanded that all palliative care facilities (non religiously affiliated) must provide euthanasia. O'Neill quotes Hilliard:

health facilities’ introduction of assisted suicide into palliative-care wards and hospices, following legalization of Medical Assistance in Dying (MAiD) in June 2016, has led to a reduction in true palliative-care services.

“It’s like a cancer growing within the palliative care programs,” said Dr. Hilliard who, in 2017, resigned as medical director of the Fraser Health Authority’s palliative-care program because of his opposition to the authority’s insistence that he support the performing of assisted suicide in hospices.

Dr Leonie Herx

O'Neill quotes Dr Herx from her testimony to the Special Joint Committee on Medical Assistance in Dying who stated:

“When patients’ palliative care needs are not met, the ensuing physical, emotional and spiritual suffering can lead to them feeling depressed, hopeless, and a burden to others— many of the factors driving requests for MAiD,” Herx said. “Earlier palliative care can alleviate suffering before it becomes irremediable.”

“With almost six years of lived experience now, we have seen significant deleterious effects of the impact of MAiD implementation on palliative care, including diminished resources and increasing distress experienced by palliative care clinicians,” Herx said.

She said some health authorities’ incorporation of euthanasia into palliative care has led to palliative nurses leaving their jobs because they felt unable to provide palliative care. And in Ontario, for example, some hospice palliative care nurse practitioners are using their full-time paid palliative care roles to provide assisted suicide.

Moreover, there is “increasing moral distress in palliative care clinicians from forced participation in MAiD due to some health authorities mandating that MAiD be provided in hospices and palliative care units or lose funding,” she said. “This is resulting in retention difficulties and early retirements from palliative care which is accentuating and accelerating the already critical shortage of specialist and generalist palliative care physicians.”

O'Neill also quotes Dr Kaya from her testimony to the Special Joint Committee on Medical Assistance in Dying who stated:

assisted suicide needs to be “distinct and separate” from palliative care to ensure that the latter does not suffer.

“By separating them, palliative care can continue to be the safeguard, as intended,” Kaya said. “MAiD assessors and providers are in a conflict of interest if providing palliative care at the same time. This does not prevent palliative care physicians from practicing MAiD – however they should not be providing palliative alongside MAiD for the same patient.”

Alex Schadenberg

O'Neill also interviewed me on the topic. Among other comments, I told O'Neill:

governments should stop giving lip service to improving palliative care and should devote more resources to improving it, especially now that MAiD is available.

“In my opinion, palliative care has been completely undermined” by MAiD, he said. “I haven’t seen anything to improve palliative care. Even if we had just left palliative care alone, where it could be a safe space, that would have made a big difference.”

Forcing palliative care facilities to provide euthanasia and assisted suicide (MAiD) has resulted in palliative care medical experts leaving the field, at a time when more end-of-life care is necessary. At the same time it has changed palliative care.

People need safe places to die. When BC Ministry of Health defunded the Delta Hospice Society (DHS) for refusing to kill their patients by euthanasia (MAiD) the DHS response was to commit to establish safe places to die in Canada. Groups and individuals who are committed to creating safe places to die need to join with the DHS and work towards this common goal.

Assisted suicide must not be confused with palliative care.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr. Ebru Kaya is an associate professor of medicine and the president of the Canadian Society of Palliative Care Physicians (CSPCP) and Dr. Leonie Herx is division chair and associate professor of palliative medicine at Queen’s University and a past president of the CSPCP wrote an opinion article that was published by the Globe and Mail on May 9, titled: Assisted dying must not be confused with palliative care.

The context for the article is the government committee that is examining the expansion of MAID to children (mature minors) and incompetent people who requested death in their advanced directive. Kaya and Herx continue:

While access to MAID is guaranteed in Canada, access to palliative care and other supports, including home and disability services, are not – and worse, MAID is being provided at the expense of already limited palliative care resources. No one should feel compelled to choose an early death because of inadequate care. Tragically, too many physicians know of patients who opted for MAID due to lack of adequate palliative home-care resources to remain in their homes or communities.

Palliative care is a vital service, with clear economic, health and social benefits. It provides medical assistance in living (MAIL) through early identification and impeccable assessment and management of pain and other symptoms – physical, emotional, social and spiritual – that enhance quality of life, reduce depression and anxiety, reduce caregiver distress and may even help people live longer; it does not hasten death, nor does it end life. The National Framework on Palliative Care received unanimous support by parliamentarians in 2018. Yet palliative care has not received the necessary investments and attention to make it a reality for Canadians.

They explain that Canadians lack the necessary information to seek palliative care, rather than MAID but then MAID is now being integrated with palliative care. They write:

Moreover, many palliative care services have had to integrate MAID into their programs in order to continue to receive provincial or federal funding, even though they are fundamentally different. As a result, already scarce resources – including hospice and palliative care unit beds, as well as skilled nurses and doctors – have been diverted to support MAID services.

Palliative care must remain separate from MAID to avoid the risk of confusion between the two. This is especially important for communities that have an underlying distrust of the health care system who decline palliative care because they confuse it with MAID. This does not preclude people who contemplate, request or opt for MAID from receiving palliative care – but in order to make informed choices, patients and family caregivers need to know what palliative care actually has to offer.

They then point out how MAID is an act that is used by the privileged:

As a person approaches the end of his or her life, the inevitable physical decline is viewed in Western European culture as undignified, full of suffering, and a burden on caregivers. However, this belief is not shared by all cultures. Indeed, it should be noted that white, well-educated and wealthy Canadians have led the advocacy for legalization and expansion of MAID; it is not, however, this demographic that bears the pressures to choose MAID due to lack of access to palliative care and other supports needed to live. The government focus on MAID thus disproportionately benefits the already privileged, while continuing to underserve the rest of our society who might not have the same values or advantages.

They conclude that MAID should not be associated or confused with palliative care.

Canadian legislation positioned palliative care as a safeguard to address suffering that might otherwise lead to MAID, and it has led to a tension between MAID and palliative care. As a result, physicians and organizations such as the Canadian Society of Palliative Care Physicians are seen as opposing MAID or obstructing access to MAID when they advocate for palliative care to address suffering.

The expansion of MAID should not be considered without first addressing fundamental problems of inadequate access to care and resources. The expectation that MAID and MAIL can develop in parallel is a fantasy – and the most vulnerable among us risk paying the price.

Thank you Dr's Kaya and Herx for once again defending the proper use of palliative care.

More articles on this topic:

• The Delta Hospice Society continues to fight for safe places to die (Link).
•  Study shows negative impact of MAiD on palliative care in Canada (Link).