Euthanasia has had negative effect on palliative care in Canada: report
Canada’s Medical Assistance in Dying (MAiD) act began to operate in 2016. It is a laboratory for how legalised euthanasia will operate in a largely English-speaking country. And, according to an article in the journal Palliative Care written by five Canadian specialists, it has had a very negative effect upon palliative care.
The authors interviewed 13 doctors and 10 nurses about their impressions. Some of the feedback is unexpected.
First, all of them spoke about an inherent conflict between the provision of palliative care (PC) and eligibility for MAiD. To ensure that their patients remained eligible, they had to withhold medications which would have otherwise removed or alleviated their pain. “Maintaining lucidity and eligibility for assisted death, by avoiding sedative medications, took priority over achieving good symptom control for some patients,” they write. Both the patients and the PC providers found this distressing.
Second, simply mentioning the existence of MAiD can be interpreted as an invitation to the patient to request it. This adds to the emotional and existential burden upon the patients and their families. Conversations have become very difficult.
Third, MAiD has a significant emotional and personal impact on PC providers. Many of the clinicians described a large emotional toll created by exposure to Medical Assistance in Dying.
Fourth, the existence of MAiD has complicated the relationship of PC providers with their patients. Some believe that PC means assisted dying. Doctors or nurses with moral or religious objections to MAiD find that it is difficult to build a relationship with patients who want assisted dying.
Finally, PC providers believed that PC and MAiD were competing for funding, especially rural and underserviced areas. It was a zero-sum game.
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Thank you for allowing alternative opinions about Aid in Dying and Euthanasia. People will continue to plead for an end to their suffering. Inaccurate depictions of such practices in the world will mislead and confuse your readers — and lower the status of this column as a reliable source information. Every year more states and more countries are adopting protocols to provide their citizens with a choice. Well-informed voices from people like Dr. Shavelson and Dr. Jonquiére are essential to setting the record straight.
In 2017 the Liberal government of Justine Trudeau, the very government who legalized euthanasia the year before, said it would spend C$6-billion on upgrading palliative and hospice care. As of today, they’ve spent only a tiny fraction on studies. At the moment only 30% of Canadians who want palliative care can get it. Even Trudeaus said (lied?) that Canadians should have a real choice. Nothing will ever be spent. Too many people now support MAID so there’s no poltical capital in helping those who want to die a good naturay death.
I’m assuming that the 13 MD’s and 10 Nurses (a very small sample indeed) worked on an academic PC unit where MAiD, if not denied altogether, was discouraged. I work on a PC unit where this is not the case and am constantly amazed ay how PC and MAiD compliment each other. There is no need to withhold sedative medications as mentioned (especially with the ability for the patient to sign a waiver). Patients and families are happy to discuss MAiD and in fact this leads to very frank conversations with patient and family around their deaths and what it will look like.If there is reticence on the part of the patient the subject of MAiD is dropped. I have see no evidence of the “emotional toll” on PC providers, in fact the reverse is true as these deaths represent merely another way for us to fulfill our duty to our patients… to provide a peaceful and meaningful death, be that naturally, with sedation or with MAiD. As to the fourth point I would ask those PC providers who feel that their relationship to PC patients is “complicated” by their opposition to MAiD to consider putting the patient’s needs first and if not possible to transfer the patient to an open minded colleague.
Dear Gerald Ashe. Your comments are such breaths of fresh, compassionate, professional air. I believe fervently that patients’ CHOICE is the operative word at the end of one’s life – whether it be by PC or MAiD. I have 76yrs, have COPD, am double vaccinated against Covid 19, & feel SO empowered because I now have a CHOICE in New Zealand in the way of my dying should I have a nasty situation arising. THANKYOU SO MUCH. Yours sincerely, Jan Randle.