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.