IN DEPTH: Is MAiD replacing palliative care in Canada?

Called a "medical error" by physician Romayne Gallagher, palliative care options for Canadians seem to be few and far between.This is a problem Canada has faced for years — and instead of solving it, many are resorting to euthanasia.Those who opt for Canada's Medical Assistance in Dying program, or MAiD, under Track 1, which includes patients whose deaths are “reasonably foreseeable,” must experience unbearable suffering from a grievous or irremediable illness. However, herein lies the error: how did the people applying for MAiD get to the point where their suffering was so bad it was better to die?It could be the Canadian healthcare system is not providing the quality palliative care it needs to prevent people from opting for MAiD..Palliative care focuses on improving the quality of life for patients suffering from serious illnesses — managing their symptoms and coordinating care, involving doctors and other care providers.Gallagher, a retired palliative care physician, wrote a research paper on the subject of hastened death and the lack of quality palliative care.In the paper, Gallagher says evidence supports palliative therapies having a positive outcome when applied early on in a patient's illness.This is echoed in a review done by the Canadian Institute for Health Information (CIHI), which found in Alberta and Ontario, patients who had access to palliative care earlier than the last 30 days of life had better outcomes — spending less time in the ICU and having fewer emergency room visits. .Another shocking statistic in the same report states over 80% of those receiving palliative care in hospital were admitted through emergency — showing palliative care is not being accessed early enough.As Gallagher describes it, palliative care should be used as chronic disease therapy, working by treating and even preventing emergency measures, according to what she wrote in Policy Options.This therapy for symptoms cannot be solved through basic treatments — and works best when needs are complex.For reference, Gallagher provides an example of people with advanced heart and lung disease receiving multiple medications to manage their heart function..However, the medication does not provide them with relief from shortness of breath, a symptom that arises from minimal physical effort.To cope with this breathlessness, most patients tend to reduce their physical movement to prevent this experience.They begin doing less and less until they become homebound and isolated, which can lead to feelings of hopelessness.In this state — wouldn't MAiD begin to sound more appealing?To prevent this experience, opioid medication must be prescribed, since it relieves shortness of breath.But Gallagher says physicians are often reluctant to give patients the medication because of the opioid crisis and the fear of causing harm..Chronic illnesses like these require physicians and nurses to be highly knowledgeable about palliative care treatment, including dedicating more time to observing, identifying, and treating symptoms.Not just that, but this type of care has been shown to reduce symptoms of depression, improve quality of life, and sometimes lengthen life — making someone far less likely to choose MAiD. The problem is, Canada's healthcare system views this care as an extra therapy, not a basic required one. That's why Gallagher considers it a medical error.."Implanting a defective device or prescribing the wrong medication are two examples of medical errors causing death and ravaging lives," stated Gallagher. "Doing the wrong thing to someone is vastly more noticeable than failing to provide an available therapy, but omission error causes significant harm to the individual and to those who witness their suffering."Back in 2009, Gabrielle Peters, who wrote about her personal experience with a rare neuromuscular disease in Policy Options, was seeing a number of specialists at three different hospitals in Vancouver..She had already had the disease for a number of years, with her symptoms worsening to the point where she was wheelchair-bound, disabled, and "unfixable."She then found herself unable to access the eligibility criteria for medical benefits due to living with her boyfriend and being classified as a dependent. Peters testified she took three trips to two different hospitals before being diagnosed and treated for two different blood clots. Peters says her condition created multiple symptoms.."With each hospitalization, staff would do just enough to be able to send me home to die," remembers Peters.She adds between these hospital visits, nurses and home care aides would provide her care. One day, she asked a nurse if there was anywhere she could go to prolong her life.The nurse told her St. Paul's, a Catholic hospital in Vancouver, took on patients like Peters — swearing the care most of the other hospitals were unwilling to provide, they were willing to offer. Even though Peters eventually found the care she needed there — the first thing she encountered at St. Paul's was similar to many of her other encounters at hospitals..Carrying a box of tissues and a clipboard, a St. Paul's employee came into a room where Peters was already waiting.They discussed Peters' living conditions, including her boyfriend had left her, which would leave her without housing or money.Knowing this, the hospital employee told Peters she had gone through so much and deserved to rest."The rest she was offering me was permanent. She urged me to sign a do-not-resuscitate order," says Peters..Peters declined to sign.Though not MAiD, since at the time it was illegal, the religious hospital offered the next best thing — if the opportunity arose to die, the ability not to fight it. Peters says the hospital employee was reluctant to accept her decision to decline signing and couldn't understand how Peters could go on living. However, once a specialist entered the room, Peters begged them to help her — and as Peters attests, 15 years later, she's still alive..While Peters was at the hospital, she encountered people she had never seen at other facilities, people who needed more time to be cared for."There was a man who was a patient for many months. He had been living outside and had developed a skin infection," Peters recalled."His whole body was bandaged."Back in 2009, MAiD was not an option.But Peters' story highlights the lack of options for patients with chronic symptoms, who tend to fall on deaf ears within the healthcare system..MAiD has given the healthcare system another option, instead of treating these patients. Dr. Peter Tanuseputro, a family physician, who previously did palliative care home visits, tells the Western Standard why more patients are not receiving quality palliative care."There are not enough palliative care specialists (i.e., doctors that mainly practice in palliative care) to reach everyone (they only reach about 20% of the dying population)," Tanuseputro stated.This is echoed in a CIHI report, which shows from available (and limited) data, the number of healthcare providers in Canada specializing and practicing mainly in palliative care is limited..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.So — why are these specialists so limited in Canada?Palliative care "generalists," those who do palliative care home visits on top of their specialization, are very few."In my previous family [physicians] health team of about 12 family doctors, for example, only 3 of us did home palliative care," stated Tanuseputro.."Doctors are not emphasizing this portion of their care for several reasons, including: inadequacy of training (e.g., during medical school and residency — it's often not part of the core curriculum); perceived lack of incentives; and family doctors are already in shortage," stated Tanuseputro."And [they are] quite busy tending to their patients during office hours; it's just not part of our medical culture to expect family physicians to care for dying patients; and overreliance on hospital-based care (including funding)."It's not only the lack of specialized doctors, Tanuseputro points out, it's also the shortage of nurses that specialize. What can be done to improve the quality of care?."'Fixing' this would require a shift in resources (money, people, etc.) from hospital-based end-of-life care (where it is very expensive and where patients do NOT want to be at when they're dying) to community-based care," stated Tanuseputro. Tansueputro says he believes if patients' access to quality palliative care were to increase — MAiD deaths would go down in Canada."From personal experience, some of my palliative care patients have requested information about MAID but none of them have gone through with MAID once our team starts delivering our palliative care services," Tansueputro testified.

IN DEPTH: Is MAiD replacing palliative care in Canada?

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