Why is Medical Assistance in Dying (MAiD) considered a right but palliative care is not?

By Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition

Dr. Janis M. Miyasaki asks this question in her article published by The Conversation on June 14th: Why is access to medically assisted death a legislated right, but access to palliative care isn’t?

Dr. Miyasaki explains her concern based on personal experience. She writes:

John started his first appointment in the Neuropalliative Care Clinic with, “I want to talk about MAID.” In our clinic, his request for medical assistance in dying is common. As legislated by government, I referred him to the MAID navigator. I had one request: that John wait to make his MAID decision until after seeing a community palliative care physician.

At his next appointment, John informed us he had withdrawn his MAID request because his primary symptom —pain — was now well controlled after our suggestions and those of the community palliative care doctor. John lived for two more years, during which he became closer with his daughter and continued to enjoy the company of his siblings.

Dr. Miyasaki explains how MAiD is considered a priority:

In June 2016, the passed legislation gave all eligible Canadians the right to request MAID. Colleges of Physicians and Surgeons required physicians to refer people who request MAID to services or arrange for a physician who would make the referral.

Since then, every province and territory devoted resources to navigate requests and assessments for MAID. Typically, provinces have a website for self-referral, easily found by internet search and/or dedicated health-care staff to help navigate the MAID process or inform those who are MAID-curious.

Dr. Miyasaki then explains how palliative care is not prioritized:

By contrast, the referral process for palliative care is often convoluted. Many provincial web pages simply give a definition of palliative care (some confuse the issue by including the MAID navigation site) but do not provide a central access point for physicians or nurses. Referral forms (where available) are complex, which creates another barrier to access. Many palliative care programs have an unofficial prognosis of three to six months’ life expectancy for services, despite research demonstrating that early palliative care improves outcomes and in fact, can prolong life.

Dr. Miyasaki offers a solution:

The solution requires a multi-faceted approach. All health-care providers need to have general palliative care skills because, in the way we all learn to control blood pressure and read a basic electrocardiogram, palliative care is part of good medical care.

At a systems level, placing as much importance on palliative care as we do on MAID might make navigation to palliative care less difficult for patients and clinicians. Given the broader applicability of palliative care, it is time for palliative care to become an independent department. Up to 28 per cent of Canadians will be seniors, which means
more people with multiple, chronic conditions that could benefit from a palliative approach.

Building the palliative care workforce is essential. The palliative care workforce in Canada is estimated to be 773 doctors for a population of 39 million. Once the palliative care workforce is established, educating the public that palliative care includes a holistic approach to wellness and meaning in life can help re-frame and increase acceptance.

There are more people like John who should connect with a palliative care team before walking down the road to MAID. Let palliative care help you live well, now.

Sadly, MAiD (euthanasia) has changed palliative care. Palliative care centers are being forced to offer MAiD which confuses the purpose and nature of palliative care. Further to that, several palliative care professionals are advocating for MAiD, once again creating confusion about what palliative care is and what it can do.

Palliative care professionals must maintain a separation from MaiD if palliative care is to maintain its purpose.

Editor’s note. This appeared at Mr. Schadenberg’s blog and is reposted with permission.