The financial case for palliative care

I wonder if B.C. Health Minister Adrian Dix is drawing any conclusions from a recent Parliamentary Budget Office report on the cost of expanding assisted suicide in Canada. As someone who seems to want euthanasia available every place the government spends money, Dix surely must have gained some insights from the report.

The federal budget office examined Bill C-7, which would amend the Criminal Code of Canada by further expanding euthanasia access to pretty much anyone who wants it – proximity to death no longer being a prerequisite.

The PBO report notes that while the Criminal Code is federal jurisdiction, the costs of health-care delivery are provincial and there is money to be saved by expanding access to euthanasia by cutting health-care costs for the provincial governments.

The report is quick to point out it’s not making the case for cost-cutting through death, since the savings would be negligible considering the staggering size of provincial health-care budgets.

To its credit, the report also has quite a bit to say about palliative care and how much money could be saved if it were more widely available. It cites medical literature that says palliative care could reduce end-of-life health care costs by 40 to 70 per cent. It quotes an Ontario study that said, “We should strive to save on suffering and to invest more in its reduction, which may in turn reduce requests for medical aid in dying.”

The report also notes the difficulty of getting information on how many patients are receiving palliative care when they request euthanasia.

Sadly, despite the report’s numerous references to palliative care, mainstream news coverage contained not a word about end-of-life care. Instead, the typical news story resembled a cost-benefit analysis, focusing on the number of increased deaths versus the savings. (Not that this should come as any surprise. Not a single media outlet outside of Canada’s Catholic press has yet reported on Canada’s First Annual Report on Medical Assistance in Dying in Canada 2019, released in June.)

It’s hard to see how the Parliamentary Budget Office report won’t simply become more ammunition for euthanasia advocates. Even if the budget office didn’t produce it to demonstrate cost-saving measures, some people are certainly going to use it for that purpose, especially those trying to expand access to euthanasia.

Which brings us to Adrian Dix.

Dix has been B.C.’s health minister for about three years, and he presumably has at least a few more years in the role. Unfortunately, his government has had next to nothing to say about end-of-life care. B.C.’s End of Life Care Action Plan hasn’t been updated since the B.C. Liberals were in power, long before assisted suicide was legalized in Canada.

A 2018 report from the Canadian Institute for Health Information said only six per cent of Canadians residents in long-term care and 15 per cent of those living at home received palliative care in their last year of life. 

Meanwhile, COVID 19 has taken its toll on seniors in long-term care. The province’s seniors advocate this week said visiting restrictions need to be eased for those in care facilities. Isobel MacKenzie noted that while there have been 151 COVID-19 deaths in care facilities during the pandemic, 4,500 residents have died of non-related causes. Many of them never had a chance to see their loved ones due to visiting restrictions.

Dix says his government is “committed to making every effort to increase the amount of visitation that takes place, understanding that the risk in long-term care continues to exist.”

Yet at the same time, he is getting set to strip the Irene Thomas Hospice in Delta of its $1.5 million in annual funding in February, their punishment for not complying with the government’s demand that residents be allowed to receive lethal injections onsite.

If Dix won’t listen to private hospice that wants to put its principles of palliative care first, maybe he’ll listen to them make the case that they’re saving the government money.

The costs associated with living and dying seem to be the only factors that matter these days.