A little-known fact, in a country that kills 13,000 of its citizens every year by euthanasia, is that it’s still a crime in Canada to counsel a person to commit suicide.
On the other hand, “there is no provision in the law that prohibits healthcare professionals from initiating a discussion about MAiD,” the Canadian Association of MAiD Assessors and Providers points out.
As a result, the euthanasia advocacy group stresses that bringing up euthanasia “should always be done with sensitivity.”
In its 2022 document “Bringing up Medical Assistance in Dying (MAiD) as a Clinical Care Option,” the euthanasia organization offers script scenarios to “guide your conversation” with patients who aren’t ready for a conversation about euthanasia.
One of the scripts says, “There are different kinds of services available,” before pointing out, “Palliative care can be provided through a natural death or a medically assisted death.”
As euthanasia grows like a weed across the country, it’s obscuring the definition of palliative care, say experts watching the line between palliative care and euthanasia get increasingly blurred. It’s also aggravating already existing problems related to caring for the dying.
“There are a lot of misunderstandings about what palliative care actually entails,” said Rebecca Vachon, health program director at the think tank Cardus, which has been spending a lot of its time lately on the impact of expanding euthanasia expansion on palliative care’s existing weaknesses.
In an October 2023 article, Palliative Care Has Become a Casualty of Euthanasia, Vachon and co-authors Dr. Leonie Herx and Dr. Eric Wasylenko wrote that palliative care “provides a holistic approach to supporting the lives of patients with life-limiting or life-threatening illnesses or conditions as well as their families, providing for physical symptoms and needs as well as broader psychosocial needs.” Euthanasia, on the other hand, “intentionally ends life through the administration of lethal drugs.”
When euthanasia and palliative care are conflated, as in the CAMAP script, suffering individuals can be left unable to distinguish euthanasia from actual palliative care.
“People don’t want [palliative care] because they think that means [doctors are] giving up, which is not the case,” Vachon said in an interview. Palliative care “can be used in parallel with curative treatments and help mitigate side effects.”
So-called “medical assistance in dying (MAiD)” was introduced in Canada in June 2016 when Parliament passed legislation allowing it to be requested by adults who have had a "grievous and irremediable medical condition" and whose natural death was "reasonably foreseeable." From there, the slope has only gotten more slippery.
The delivery of health care in Canada is the responsibility of the provinces, but federal law in Canada says MAiD must be available in every jurisdiction in the country. The term “available” is left to the hands of provincial regulators, making it increasingly unpredictable and difficult to pin down with an exact definition.
“It depends on what province you are in,” Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, said. “From the very beginning, British Columbia decided that … unless you’re religiously affiliated, you must provide MAiD. Not that employees must do it, but that they must have the provision offered.”
One of the chief problems, said Vachon, is that universal palliative care should have been available before euthanasia was brought in. The Canadian Medical Association said the availability of palliative care for all who needed it had to be “a mandatory precondition to the contemplation of permissive legislative change.”
Instead, the Trudeau government introduced euthanasia without establishing any right to palliative care, something even euthanasia pioneers like Belgium hadn’t done. So five years after Parliament passed the Framework for Palliative Care in Canada to improve access, significant problems with access and quality of care remain, notes Cardus, particularly within some marginalized communities. Cardus wrote, “The Quality End-of-Life Care Coalition noted the embarrassing reality of how ‘Canada lags behind in international counterparts in terms of access to quality end-of-life care.’”
Experts are now watching as warnings come to fruition, with euthanasia becoming mingled with genuine palliative care and its pre-existing inadequacies.
In their 2003 article Palliative Care Has Become a Casualty of Euthanasia, the Cardus writers said palliative care should have been a safeguard that prevented MAiD. Instead, it’s becoming a casualty of universal euthanasia.
“Part of the process of informed consent to receive MAiD was predicated on being offered palliative care,” the authors wrote, quoting legal scholar Dr. Mary Shariff. Palliative care was supposed to be a guardrail. But without meaningful access to palliative care “at the time of the diagnosis of a life-limiting or life-threatening illness or condition, this safeguard is largely meaningless,” they said.
“It is far too little and too late to mention palliative care only after a patient has already asked to be killed due to feeling that their suffering—whether physical or existential or their fear of future suffering—is too great to bear.”
Some palliative care doctors say palliative resources and personnel are now being reallocated to provide MAiD – further reducing the availability and quality of what palliative care might be available. The result, says Cardus, is moral distress for clinicians, some of whom are leaving their professions.
Schadenberg said palliative care is being redefined as euthanasia is thrown in with it. “The whole orientation of palliative care is to care for the person, the symptoms, and care for them with dignity. When you add in euthanasia, which is actually killing, it changes the whole orientation of what palliative care is about, and that is becoming a serious problem.”
Confusing euthanasia with palliative care is also reorienting how people think about the end of life, says Romayne Gallagher, a Vancouver palliative care specialist. That’s an added reason why euthanasia should not be accepted as part of palliative care: “Because we see this time in life as being extremely important and meaningful for people,” said Gallagher.
“We feel that when people say ‘well, you’re dying anyways ...’ it devalues this time and devalues these people’s lives. [We want to] make the best of this time rather than throw it away.”
Gallagher, who last worked as a physician with Providence Health Care in Vancouver, said most of the problems developing from the current MAiD model are coming from the increasingly blurred lines between palliative care and euthanasia.
“Patients have told palliative care providers that they were more fearful when the doctor suggested MAiD, as the doctor made that suggestion because they knew they would have a hard time with the illness, Gallagher said. “People who are fearful and have little experience with illness may take this as a suggestion rather than an option.”
Through Cardus, Vachon has also voiced concerns over the state of pediatric palliative care. The lack of accessible care for children combined with the growing culture of MAiD was highlighted in a report in February. In The State of Pediatric Palliative Care in Canada, she shows that too many Canadian children who need palliative care are not receiving it.
In November 2023, the Canadian Network of Palliative Care for Children said there were children’s pediatric programs in only 13 urban hospitals and eight urban pediatric hospices. That leaves Canada without a single palliative care program for children in any of the country’s territories, and only one in all of Atlantic Canada.
The rapid adoption of euthanasia in Canada makes the issue of accessible and quality pediatric palliative care more critical, said Vachon, “as the public conversation has begun to consider expansion of MAiD for ‘mature minors,’ that is, children deemed capable of consent.”
Given the existing problems providing children with palliative care, “Canadians must ensure that children with serious illnesses or conditions do not feel that MAiD is their only option,” Vachon wrote.
“I believe there is a huge push to convince people that MAiD is no different from palliative care and that it is a ‘tool in the toolbox of palliative care,’” Gallagher said. “Most palliative care providers are against this, as the principle of palliative care since its inception 60-plus years ago was that it neither hastens nor prolongs death.”
Children aren’t the only particularly vulnerable group when it comes to euthanasia. Gallagher was one of over 170 palliative care professionals who signed a report in December 2023 that highlights serious concerns the threat MAiD poses for structurally vulnerable populations, such as those with mental illness.
Gallagher was one of the key authors and said individuals with mental health issues or social suffering are increasingly likely to opt for MAiD during moments of vulnerability, something policy discussions often fail to consider.
The report, which was a response to an earlier report minimizing the significance of structural vulnerability in MAiD, pointed out that British Columbia has a MAiD Oversight Unit within the Ministry of Health, but it “lacks a robust framework for reviewing cases.” Notably, the report says, “BC has not published comprehensive data on MAiD since 2016, leaving a gap in transparency and oversight.”
Canadian Catholic News
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