This article was published by Dying Well on November 3, 2021.
A study conducted by a group of physicians in Canada reveals the detrimental impact that the legalization of assisted dying has on palliative care.
In their 2020 qualitative study, Matthews and Colleagues interviewed palliative care physicians and nurses who practiced in healthcare settings where patients could access Medical Assistance in Dying (MAiD) in Southern Ontario. Their findings conclude the negative impact that MAID has on palliative care in Canada:
- All clinicians spoke about a conflict between maintaining Medical Assistance in Dying eligibility and effective symptom control. Clinicians felt they must withhold symptom control medications that could cause sedation or confusion and therefor jeopardise MAID eligibility, even if the medication could significantly alleviate their patient’s pain. This difficulty in providing optimal symptoms management created by the Medical Assistance in Dying legislation resulted in increased providers and patients’ distress.
- Many clinicians described the prevalence of ethical and moral dilemmas regarding the appropriateness of certain discussions regarding MAID with their patients, such as introducing MAID to patients who did not initiate these requests. Clinicians were concerned that introducing the topic of Medical Assistance in Dying might be misinterpreted as an invitation to request for it, and may add to the burden of vulnerable patients and erode families’ trust. Participants also described challenging conversations around supporting patients and resolving tension with families around Medical Assistance in Dying.
- Medical Assistance in Dying has a significant emotional and personal impact on palliative care providers. Many of the clinicians described a large emotional toll created by exposure to Medical Assistance in Dying.
- Medical Assistance in Dying changes the patient palliative care provider relationship. The clinicians described how patients thought that palliative care included assisted death, which complicated their relationships with these patients. Further, clinicians with moral or religious objections to Medical Assistance in Dying described substantial challenges with building trust with patients pursuing assisted death.
- The clinicians felt that the providing of assisted suicide led to more palliative care resources being dedicated to assisted deaths that would have otherwise been allocated to palliative care.
This study should serve as a warning to the UK as Parliament debates the legalization of assisted suicide. If Canada serves as any example, the implementation of assisted suicide will have a profound negative impact on palliative care.