Before a joint House of Commons-Senate committee examining a possible expansion of MAID on April 28, experts argued over whether or not palliative care includes MAID, whether funding for MAID takes away money to palliative care and whether patients really earn free, rational and autonomous choices when opting for early discharge at the hands of their doctor.
“If someone is standing on an open balcony in a high-rise building, quickly engulfed in hot flames, is it reasonable to say they have a choice whether to jump or not?” Dr. Harvey Chochinov, professor of palliative psychiatry at the University of Manitoba and senior scientist at the CancerCare Manitoba Research Institute, asked senators and MPs during committee hearings on April 28: “Exercising autonomy means having real options and viable. If you are dying without quality and available palliative care, if you are disabled but do not have access to supports and services, or social housing and employment opportunities; if you suffer from chronic pain or uncontrolled symptoms and you do not have timely access to a specialist; If you’re struggling with a mental illness and can’t find a therapist willing to help you navigate your way to recovery, can we really say you’re making an independent choice? »
On the other side of the expert spectrum, Dr. James Downar, a specialist in critical care, palliative care and medical ethics at the University of Ottawa, ruled out the possibility that MAID would coerce or tempt people to jump.
“There is absolutely no data to suggest that the practice of MAID at this stage is motivated in any degree by poor access to palliative care, socioeconomic deprivation, or any isolation,” Downar said.
Not so fast, said Dr. Ebru Kaya, consultant in palliative medicine at Toronto General Hospital and professor in the University of Toronto’s Faculty of Medicine.
“The data that Dr. Downar is referring to and the data that Health Canada reports are referring to are the wrong kind of data,” she said.
Kaya held up a single-sheet form with ‘yes’ and ‘no’ boxes under questions to find out if the patient seeking MAID was informed of the palliative care option and if the patient could access palliative care .
“This kind of health administration data doesn’t do that,” she said.
A retired professor from Laval University and veteran of palliative care, Dr. Pierre Viens insisted that MAID was only one possibility in the continuum of palliative care.
“It’s a volley, an aspect of palliative care, which is intended to meet patient demand — situations where standard, conventional palliative care provides no relief, no comfort,” he said.
Kaya suggested that Canada develop an end-of-life policy with insufficient information.
“When it comes to knowing what we have, who is doing what in terms of palliative care, we don’t have that information,” she said. “We don’t have national standards for evaluating palliative care. These do not exist and we must create them.
“I’ve never seen so much confusion,” said Dr. Marjorie Tremblay, an expert in palliative care and family medicine in Montreal.
Tremblay, who is not opposed to legal access to MAID but does not include it in his scope of practice, insisted that MAID should not be confused with palliative care.
“The thing I hear most often in my practice is, ‘If only I had known what palliative care really is,'” Tremblay said.
Confusing MAID with palliative care, or only offering the palliative option to patients in the most advanced stages of a terminal illness, has led patients to believe that palliative care physicians will hasten their death – leaving Tremblay trying to convince them that good palliative care, delivered sooner rather than later, will improve their overall health.
Dr. Sandy Buchman, MAID evaluator and provider and Freeman Family Chair in Palliative Care at North York General Hospital, argued for MAID as an expression of compassion.
“I entered this profession to relieve suffering and finally, after years of reflection, I felt that I could do my best to treat suffering – when I encountered the limits of modern medicine, including the limitation of palliative care, and that I have not been able to address the suffering of my patients – through the provision of MAID,” he said.
At the same time, Buchman cautioned against the formulaic and procedural application of end-of-life decision-making.
“I believe too many clinicians in this world of MAID will just refer when a patient asks for hastened death, instead of exploring their suffering,” he said.
Despite Downar’s strong objections, Kaya argued that the expansion of MAID was taking money and resources away from palliative care.
“We definitely need more funding and resources for palliative care, which needs to be separate from MAID. Right now, we are pretty much all competing for the same resources,” she said. “My community (palliative care physicians and nurse practitioners) is shaken. We are exhausted. We are being asked to do more with less. Some members of our community have taken early retirement. Others left the field. Really, we need to be able to provide investment, sustained investment, in palliative care. »
Chochinov echoed Kaya’s call.
“Winnipeg, a city of about one million people, has not seen an increase in funding for palliative care in the last 20 years,” he said. “We have 16 palliative care beds, all inside the Perimeter Highway – none outside, beyond the one in Manitoba. We are sorely missed. »
The Catholic Health Alliance of Canada is not presenting to the Special Joint Committee of the Senate and House of Commons on MAID, but its opposition to MAID is well known, CASC President and CEO says , John Ruetz.
“We are strong advocates for the provision of high quality health care, especially access to palliative care,” Ruetz said in an email to The Catholic Register. “We continue to champion issues of social justice and equitable access to health care, especially for vulnerable patient populations.”
The Canadian Conference of Catholic Bishops does not participate in the committee’s hearings, but maintains its opposition to the legalization of euthanasia.
“We continue to consult with like-minded organizations to determine how best to respond to the current legislative process and anticipated changes,” said CCCB spokesperson Jonathan Lesarge.
While Viens insisted that before MAID was legalized, physicians “couldn’t handle existential suffering, psychic suffering,” Chochinov pointed to medical textbooks, scientific journals, and emerging therapies specifically dedicated to to alleviate the suffering of people who feel that their life has no meaning.
“This idea that MAiD is the only card in our deck, I think, is really terribly unwarranted,” he said.
In defense of MAID, Downer opposed any implication that paying doctors for MAID assessments and procedures would take money from palliative care.
“MAID is not the reason palliative care is under-resourced in Canada,” he said. “The reason palliative care is under-resourced in Canada is that palliative care is under-resourced in Canada. »
As politicians consider advance directives for people who fear living with dementia and issue MAID to people who would choose death to relieve mental illness, Chochinov warned them against expanding euthanasia in Belgium and Switzerland.
“If individual autonomy is the driving force and we watch what is happening with our European brethren, we will see AMM expand to include life completion and life fatigue,” he said. he declares.
Committee hearings are continuing.