The push to merge palliative care with MAiD 

Two hours after I left the hospice, my friend was dead. We had talked about fears, read Psalm 23, and sang 10,000 Reasons. The hovering nurses smiled as I left. It seemed so peaceful. And sudden. At times I wondered if this hospice had fallen prey to the push to merge palliative care with MAiD (Medical Assistance in Dying).

A July 2019 article from the Association for Reformed Political Action Canada (ARPA) focused on a conference hosted by the Canadian Association of MAiD Assessors and Providers (CAMAP). Three doctors there “presented on how euthanasia could be pushed into palliative care spaces” as if MAiD was a natural part of palliative care. 

The skirmish between Fraser Health and the Irene Thomas Hospice in Delta, BC is one example of the pressure government can bring. Back in 2016, the health authority dictated that euthanasia be provided but public outcry slowed the mandate’s enforcement. Despite pressure from Health Minister Adrian Dix, current board president, Angelina Ireland said the motion was based on “two independent legal opinions that MAiD is not compatible with the purposes of Delta Hospice Society as stated in its constitution.” 

The resistance from the new board not meeting the February 3 deadline to implement MAiD has likely resulted in the government withholding $750,000 despite the current law permitting, not mandating, medically-assisted death in some circumstances. The region has provided approximately $1.4 million in annual funding to the hospice society (half of its operating budget).

A brochure available from Fraser Health on MAiD states “this brochure gives you basic information about MAiD. We encourage you to talk with your loved ones about your wishes. Whatever you decide, we are here to give you the care you need and honour your wishes.” With those words, the Health Authority backs all those under its umbrella into a corner. 

A few months before the aforementioned CAMAP conference, “the Canadian Society of Palliative Care Physicians clarified in a statement that MAiD is a practice distinct from palliative care.” Palliative care physicians “intend neither to hasten nor to postpone death…. It is fundamental to palliative care providers… that they maintain their integrity and freedom of conscience, and that the Canadian public continue to trust them to help them live as best they can until their natural death.”

The pressure is on however. At the conference, Dr. Jyothi Jayaraman (a palliative care physician and MAiD provider in Vancouver) argued that palliative care and MAiD “are designed to relieve suffering.” Dr. Paula Chidwick (Director of Research and Corporate Ethics at William Osler Health System in Ontario), sees that “loyalty to the patient and their wishes should trump a physician’s personal position.” The personal integrity and conscience of the doctor is considered irrelevant. She advocates that with time and strategy, strong leaders can overcome the resistance in many of the places which tend to be religious. The removal of government funding is only one such strategy.

Dr. Kate Lally from the Institute for Healthcare Improvement states that “palliative care is symptom-focused care regardless of diagnosis and prognosis; hospice is a subset of palliative care offered to patients at the end of life with a prognosis of six months or less. It requires multi-disciplinary care of physicians and nurses for pain management, social workers and spiritual care from a chaplain.”

Dr. Sarah Harrington says that palliative care is a relatively new subspecialty with a primary focus on cancer but starting to invite patients with any serious diagnosis. Individuals facing death are given an individual plan of care to deal with adversity. 

Alberta Health has developed a framework based on seven core values and the ‘mission of providing a patient-focused, quality health system that is accessible and sustainable for all Albertans’ – ‘regardless of the type of life-limiting illness or geographic location in which one resides.’ Palliative care begins “at the time you’re diagnosed with a serious illness, all the way through to the time after death, including bereavement support for your family.”

The MAiD option is clearly embedded in the information given to patients considering palliative care. Right after a paragraph explaining palliative care, the website boldly highlights the question “What is medical assistance in dying?” It states “Medical assistance in dying is a relatively new healthcare option available to Albertans at the end of life. It allows a capable adult suffering from a grievous and irremediable medical condition to voluntarily request medicine that will bring about their death.”

Five steps: Pre-contemplation, Contemplation, Determination, Action and Care after Death are listed.

It is too late for the government to appeal the pressure from the courts but a public survey is now informing their next steps. Quebec Justice Baudouin disregarded the goals of the original legislation to confirm the “inherent and equal value of every person’s life,” while preventing negative perceptions “of the quality of life of persons who are elderly, ill or disabled.” 

It is crucial that the church reclaim the care and dignity of those created in the image of their Creator. They must advocate with those who trumpet that disabled lives are worth living. Before those who are dying have to face questions of their sense of isolation, health-care complications and social stigma, perhaps it is time for Christians to invest in changing the culture and environment around palliative care.