How has medical assistance in dying changed palliative care?

I’ve been consulting in palliative medicine for 17 years. I’ve seen patients facing frightening diagnoses and hospital admission experience a loss of dignity and worry about burdening loved ones. The cornerstone of palliative care is to reaffirm patients’ inherent dignity, helping them live well as they navigate the challenges of serious illness, as rooted in the work of Cicely Saunders, UK physician and founder of the modern hospice. In the words of Dame Cicely, reminding patients that “they matter.

Canada’s medical assistance in dying (MAID) laws have affected my field more quickly than I’d expected. There’s now this sense that by wanting to address the patient’s suffering palliative care doctors are trying to convince someone out of getting an assisted death.

I’ve seen patients receiving MAID [which encompasses both euthanasia—where the doctor administers the drug—and assisted suicide—where the patient takes the drug themselves] within 24 hours of approval. It can happen without first accessing other care options or before a palliative care specialist, like me, can meet with them—which I have experienced.

MAID being labelled as “end-of-life care” and being placed operationally and administratively under the same umbrella as palliative care has intensified confusion. I think there’s been a strange shift in the culture. Addressing suffering was considered such a profound art that takes time and was valued. Now it feels like we’re saying that the best way to address suffering is to end someone’s life.

Canada’s initial MAID legislation was portrayed as an option in exceptional situations where suffering could not be tackled in other ways. It is now routinely offered to those who might meet the eligibility criteria. I’ve had patients tell me that when a trusted physician has suggested assisted dying to them, it must be a good idea because they cannot see why they would be offered it otherwise.

We are spending increasing amounts of time dealing with the procedural matters related to MAID, for fear of being met with complaints, which is taking us away from our work in palliative care. Healthcare providers are getting traumatised by seeing more and more people getting euthanasia as a stopgap for other lack of resources and access to care.

This opinion piece is part of an interview given to Sammy Chown, freelance journalist, Montreal. It was originally published as part of this feature article but removed on Leonie Herx’s request. Editor’s note: This piece was updated on 5 November to correct Sammy Chown’s address to Montreal.