Experts warn lack of quality palliative care may be pushing patients towards MAiD

CALGARY — Many Canadians who need palliative care may not be receiving it prior to intense suffering — and this could influence their decision to receive euthanasia, also known as Canada's Medical Assistance in Dying (MAiD) program.Palliative care, reported by Policy Options, is meant to treat not only physical impairments and pain, but also the relational, emotional, psychological, and spiritual needs of people living with serious illness.However, according to statistics reported by the Canadian Institute for Health Information (CIHI), many Canadians in need of this care may not be receiving it until the last month of life.When palliative care is received earlier, people are less likely to experience extreme suffering later, an experience described under one MAiD requirement of having a "grievous and irremediable medical condition.".Patients were also less likely to visit emergency departments frequently, and less likely to receive aggressive forms of treatment that cause said distress — a finding measured by patient stays in intensive care units.This is something Health Canada acknowledges, stating in its 2024 MAiD report access to palliative care is important "to ensure that MAiD is not being sought because of a lack of options for end-of-life-care or support services."So, why aren't people receiving palliative care earlier to suffer less later?For one, few providers specialize in palliative care. According to CIHI, available (and limited) data show the number of healthcare providers in Canada specializing and practicing mainly in palliative care is limited..Palliative care focuses on improving the quality of life for patients suffering from serious illnesses — managing their symptoms and coordinating care, involving both doctors and other care providers.Only 1% of Alberta doctors practiced primarily in palliative care from 2012 to 2013, and only 2% of licensed practical nurses across the country in 2016 worked in palliative care.Furthermore, few Canadians receive formal palliative care outside of hospitals — in Ontario and Alberta, 1 in 6 people (15%) who died from 2016 to 2017 received publicly funded palliative home care.Another significant reason is the burden put on friends and family as caregivers to palliative care patients.Almost all (99%) of palliative home care patients had friends or family taking care of them — and about one in three of these caregivers reported feeling distress..This feeling of burden can even affect a palliative patient's decision to receive MAiD.CIHI recommends that in scenarios where caregivers feel overburdened, additional palliative care support is needed. In a case previously reported by the Western Standard, a woman in her 80s, reported by the Ontario MAiD Death Review Committee (OMDRC) as Mrs. B, opted for palliative care after a severe decline in her health following coronary artery bypass graft surgery — her husband being her palliative caregiver. Once Mrs. B was discharged and was receiving palliative care, she received a MAiD assessment but concluded palliative care was more aligned with her personal and religious beliefs. .Woman given MAiD 'against her will' because her husband had 'caregiver burnout'.However, her husband, as the caregiver, took Mrs. B the next day to the hospital because he was "suffering from caregiver burnout."She was discharged and sent home not long after, with her husband also attempting to get her into a hospice palliative care centre, but his request was denied.Her husband then requested a MAiD coordinator for an urgent assessment, and Mrs. B's euthanasia date was arranged — that evening.Some OMDRC members raised concerns about potential coercion of Mrs. B to receive MAiD because of her husband's "experience of burnout and lack of access to palliative care in an in-patient or hospice setting.".As experts from the Policy Options article state, "a significant proportion of MAiD recipients likely don’t receive quality palliative care."They go further to state a lack of palliative care and untreated suffering, which incentives patients to choose MAiD, should be considered "a medical error."Let's look at the most recent 2024 MAiD stats released by Health Canada — which show 74% of the over 16,000 MAiD patients in 2024 received palliative care, and only 2.5% of MAiD patients did not receive the palliative care they needed.Of those who did not receive palliative care, 91% confirmed the care was accessible to them. .The report then concludes, “consistent with previous years, most MAiD recipients who required either palliative care or disability support services received these services.”The Policy Options article states, "This conclusion simply cannot be made convincingly based on the data collected."The palliative care part of the MAiD report does not detail the timing, intensity, quality, or location of palliative care.It also reports it is unknown whether 2% or 327, MAiD patients needed palliative care..Another 0.6%, or 99, MAiD patients did need palliative care, but it is unknown if they received it.Not to mention although it is stated 74% of MAiD patients in 2024 received palliative care — this number declined from a year earlier — a trend seen for the past few years among MAiD patients.In both 2019 and 2020, 82% of MAiD patients received palliative care, in 2021, 81%, in 2022, 78%, and in 2023, 75%. Of the 21% of MAiD patients in 2024 who "did not require" palliative care, this may reflect issues in MAiD assessment, reports Policy Options..These may well have been MAiD patients not accurately identified as benefiting from palliative care or unaware of the full nature and benefits of palliative care."Given that palliative care should be provided at the point of diagnosis of a life-limiting or life-threatening condition, everyone who is assessed to be eligible for MAiD – at a minimum, everyone in Track 1 whose death is “reasonably foreseeable”– should receive palliative care," they stated.

Experts warn lack of quality palliative care may be pushing patients towards MAiD

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