Assisted suicide a ‘cancer’ that’s destroying authentic palliative care: expert

A woman holds the hand of her mother who is dying from cancer during her final hours at a palliative care hospital in Winnipeg, Manitoba, July 24, 2010. (CNS photo by Shaun Best, Reuters)

By Terry O’Neill, The B.C. Catholic

Evidence is mounting that assisted suicide’s introduction into the Canadian medical system is not only undermining governments’ oft-stated plans to improve palliative care but is actively damaging the country’s already inadequate palliative-care system. Worse yet, patients are choosing to die rather than to continue to live without adequate palliative care.

Palliative-care expert Dr. Neil Hilliard of Abbotsford said in an interview that health facilities’ introduction of euthanasia / assisted suicide into palliative-care wards and hospices, following legalization of so-called “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.

Medically-provided euthanasia “is starting to take over to a certain degree. But still only five per cent of people are choosing MAiD. Ninety-five percent would prefer to live well until they die naturally.”

“Currently Canadians have a right to medical assistance in dying but not to medical assistance in living.” Dr. Leonie Herx

The Catholic Church has long supported palliative care for patients living with a life-threatening illness and has branded euthanasia or medically assisted suicide as an “intrinsically evil” act.

Dr. Hilliard’s comments support recent testimony, from two of Canada’s leading palliative-care physicians, to a Special Joint Committee of Parliament that is reviewing the country’s assisted suicide legislation.

Dr. Leonie Herx, head of Palliative Medicine at Queen’s University and immediate past president of the Canadian Society of Palliative Care Physicians, testified April 25 that only 30-50 percent of Canadian who need palliative care have access to it, and only a “very few,” or about 15 per cent, have access to specialist palliative care.

“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.”

She pointed out that in its landmark 2015 Carter v. Canada decision, which legalized assisted suicide, the Supreme Court of Canada discussed what possible impacts implementing a law for assisted death prior to securing universal access to palliative care might have on the development of a strong palliative care system.

“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.”

As well, “palliative care clinicians are having to spend a significant amount of time on administrative issues related to MAiD which takes away from being able to provide palliative care,” Herx said, adding that there is “decreased access to specialized palliative care beds when health authorities require hospices and palliative care units to admit patients for the sole purposes of administering MAiD.”

Another consequence of adding assisted suicide to palliative care is that some patients are unwilling to access palliative care services because they associate it with assisted suicide and are afraid palliative care will hasten their death or euthanasia will be provided without their consent.

“Currently Canadians have a right to medical assistance in dying but not to medical assistance in living,” Herx said. “Having accessible, high quality palliative care needs to be a universal health care right in Canada.”

Dr. Ebru Kaya, president of the Canadian Society of Palliative Care Physicians, told the Parliamentary committee on April 28 that 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.”

She continued: “We urgently need investment in palliative care programs that are administered and funded separately from MAiD, so that we are not competing for the same resources. Many programs have had to divert their already scarce resources to support MAiD services. This has made it even more challenging to provide palliative care when there are dire shortages in palliative care experts from coast to coast and as a result, patients are even less likely to access palliative care.”

The House of Commons recently extended the mandate of the MAiD committee until Oct. 17. Persons wishing to make a presentation can contact the committee clerk by emailing AMAD@parl.gc.ca.

Recent news reports (including coverage in The B.C. Catholic) about inadequate social and health-care support leading patients to choose assisted suicide has led some individuals and groups, that are neutral or even in favour of euthanasia/ medically assisted suicide to call for greater focus on palliative care.

The Hills Times reported May 5 that Senator Chantal Petitclerc of Quebec, who sponsored the 2021 bill that expanded access to medically-provided euthanasia/assisted suicide, said she was “very troubled” by news that patients were resorting to medically assisted suicide as an alternative to poor support.

“Medical assistance in dying is not and should never be something that an individual will have access to because we don’t do enough as a country, as a province, to provide the care, the services, the tools that a person needs,” Petitclerc said.

Former Ontario Lt-Gov. David Onley was quoted as saying he supports euthanasia administered for medical reasons, but opposes “political assistance in dying, where the various politicians and various other people in the structure of government simply fail to do their jobs.”

The B.C. Catholic reached out to several palliative-care groups for their views on the crisis, and all said that governments were failing to support palliative care.

“The unfortunate truth is that equitable, accessible, quality hospice palliative care is not yet a reality for all in Canada,” said Katrielle Ethier, spokesperson for the Canadian Hospice Palliative Care Association. “The reasons for that fact are varied from province to province and pre-date the introduction of Medical Assistance in Dying in Canada.”

Ethier noted Health Canada published plans in 2018 and 2019 to improve palliative care but their goals remain unfulfilled. “We continue to advocate for all the recommendations and goals in these documents to be fully implemented to help address the issues surrounding access to quality hospice palliative care.”

In B.C., Pablita Thomas, executive director of the B.C. Hospice Palliative Care Association, said some progress has been made in enacting improvements suggested in a provincial palliative-care action plan adopted in 2013. Nevertheless, access to palliative care remains limited, “which may influence those that have not accessed it to choose MAiD prematurely.”

Thomas said she is also greatly troubled by “the lack of validation and support” that the association receives from Victoria. Without extra funding, the association may be forced to cease operations.

“As the only collective voice of hospice palliative care in the province, if the BCHPCA closes its doors due to lack of funding, how will the government continue to move forward with the Action Plan, support and serve the community, further strengthen hospice society providers and those that need end of life support navigation with an already overburdened and exhausted health care system?” she said.

“The association has been playing a lead role in supporting the community for over 36 years with the priorities and activities mentioned above at the fraction of the cost that any fully funded ministry program could ever do. So why not fund us, at even 30% of our operational budget?”

Officials at the Ministry of Health have repeatedly failed to respond to questions, from the B.C. Catholic, about the government’s commitment to palliative care.

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, said governments should stop giving lip service to improving palliative care and should devote more resources to improving it, especially now that medically-provided death is available.

“In my opinion, palliative care has been completely undermined” by euthanasia/assisted suicide in Canada, 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.”

-30-