The legislation on medically assisted dying was passed in Canada over a year ago, in June 2016. We wrote this piece in an effort to clarify the difference and relationship between MAiD and palliative care, as well as highlight some of the important issues around the accessibility high quality palliative care to all Canadians.
As most Canadians now know, in June of 2016 Bill C-14 was passed by the Senate, making medical assistance in dying (MAiD) a legal option at end of life for those who meet the criteria.
This change has prompted conversations among individuals and their families, medical and support staff, and in care facilities across the country. As a society, we are grappling with fundamental questions regarding how and when we die, and how we support each other at the end of life.
The Hospice Yukon Society has been engaged with this discussion as well. We see it as a fitting time to reiterate our commitment to support all Yukoners in any choice they make at the end of their lives, and to examine and clarify the relationship between MAID and palliative care.
Discussions in health care facilities, prompted by the MAID legislation, now focus on how they will support eligible patients who choose medical assistance to end their life. Doctors and nurse practitioners have also had to determine their comfort level with it: some will provide MAID to eligible patients, while those who feel they cannot must help patients find someone who will.
At Hospice Yukon, one of the points of confusion we have seen surrounding MAID is whether or not it falls under the umbrella of palliative care. The question is a reasonable one. Palliative care is specialized health care for patients and families living with a life-limiting illness, and MAID is an option for eligible patients at end-of-life. Both relate to how we live out our last days, but we see an important difference in their underlying philosophies. Because of this difference most organizations involved in palliative care believe that assisted dying is a medical procedure that falls outside the scope of palliative care.
Part of the World Health Organization’s definition of palliative care states that it “neither hastens nor postpones death” and that the philosophy of care is one that “affirms life and regards dying as a normal process.” Palliative care is often used with standard medical care, and strives for pain and symptom management, as well as psychological, emotional and spiritual support for the patient and their family. Using a team approach, palliative care helps patients achieve the best possible quality of life and live as actively as possible until their natural time of death. It can take place in any care setting: hospital, hospice, long-term care facility, or the patient’s home.
One of the greatest misperceptions we see about palliative care is that it is only provided at the end of a life-limiting illness when the patient’s death is imminent. In fact, studies show that palliative care can be most effective when implemented early in the course of the illness and has many benefits when used this way. These include an improved quality of life for the patient and their family, less pain and depression, reduced strain on health care resources, and, commonly, an increase in longevity and survival rates.
Accessing palliative care generally takes place through referral from the patient’s doctor, or at the patient’s request. Here in the Yukon there is a palliative care resource team that consists of a palliative care doctor, registered nurse, social worker, and community liaison coordinator. Palliative care can be delivered to a patient in any care setting. There are currently no designated palliative care beds at any hospitals or long-term care facilities in Yukon, however, plans are in place for a full palliative care unit to be built as part of the new Whistle Bend continuing care facility in Whitehorse.
The availability of palliative care in Canada is highly variable, and not all of those who could benefit from it are receiving it. Federal Health Minister Jane Philpott acknowledges that there is evidence that only 15 to 30 per cent of Canadians have access to high quality palliative care when they need it, regardless of where they live in Canada. This means that there are people who may not be able to access palliative care, but now have the option of seeking a medically assisted death.
It is important to acknowledge that there is a small percentage of people will choose, despite excellent access to palliative care, to end their life through the MAID process. For these people it is important to have the freedom to be in control of the end of their life.
However, in the face of the new MAID legislation our challenge as a society will be to ensure that vulnerable people are not choosing a medically assisted death because of a sense of being a burden, loss of dignity, poor pain management, or because they can’t access the quality of care they need. We believe every Canadian should have access to palliative care when they need it and not feel compelled to choose MAID because of an absence of high-quality end-of-life care.
Also, while a heightened focus on MAID is justified in these early days, it is important to maintain a focus on the greater context of end-of-life care. Only a small fraction of people with life-limiting illnesses will be interested in MAiD; the vast majority of people facing end-of-life would benefit from palliative care that is accessible across all care settings.
Hospice Yukon Society will continue to engage with the many questions raised by the MAID legislation. We stand behind the philosophy of palliative care, and believe that people have the right to be informed about, and have access to all end-of-life care options. Yukoners can rest assured of Hospice Yukon’s continued support in any end-of-life choice they make.