This is a guest post by Tammy Pham, Advocacy Lead Chair for the Winnipeg chapter of Dying With Dignity Canada.

People who are opposed to Medical Assistance in Dying (MAiD) frequently pit palliative care against MAiD, claiming that the health care system should focus on palliative care rather than encouraging people to die; or that funding should go to palliative care rather than the provision of MAiD; or that if palliative care services were improved and more widely available, people would not need or request MAiD.

An op-ed in the National Post in November 2020 expressed these opinions. Read Tammy’s response below:

The op-ed from Father Raymond J. de Souza in the National Post, dated November 20, 2020, is full of misinformation. The conversation around the expansion of MAiD laws is complex, drawing advocates from diverse backgrounds for and against proposed changes to Bill C-7. It is crucial that these conversations are thoughtful, considerate, and well-informed to maintain the respect and dignity of those Canadians who are seriously and intolerably suffering, both physically and psychologically, from illnesses, diseases, or disabilities that have no cure. I will not tolerate arguments based on false information and, frankly, fear-mongering tactics.

“It will now be possible to get the lethal injection the same day it is requested”.

Logistically, this rarely happens but does happen under current MAiD laws. Currently, individuals requesting and approved for MAiD with high risk of imminently losing capacity or dying are eligible for waiver of the 10-day reflection period. In Manitoba, we have a provincial MAiD team under Shared Health Manitoba. It takes the team at least 3 days to work out logistics from request to assessments to provision of death, but there have been rare urgent cases where everything was arranged in one day. Individuals approved for MAiD will often express that they have been thinking about MAiD and their options much longer than 10 days before even meeting the team, and they often express that the 10-day period causes more harm than necessary.

Father de Souza compares the long wait time for diagnostic imaging to MAiD, but there is no explanation as to how this is relevant. Diagnostic tests are not needed to determine how much someone is suffering when they have already been diagnosed with a serious disease causing intolerable irreversible suffering.

“It’s more than strange during a global pandemic to expand the capacity of the health professions to administer death, but the federal government is hell bent on getting Bill C-7 on medically-administered death passed on an accelerated schedule.”

“Accelerated schedule” is inaccurate if you know the context. Bill C-7 came into action before the pandemic, due to the Quebec court decision (Sep 2019) that determined the criteria for “reasonably foreseeable death” was unconstitutional (it infringes on the right, liberty and security of the person). Bill C-7 was released in February 2020 and parliamentary processes have been delayed multiple times. Quebec would have started practicing their new MAiD laws over summer/fall 2020 but the federal government requested that Quebec delay that; otherwise, MAID would be practiced significantly different in Quebec versus the rest of Canada. Now this deadline is being delayed again.

Proponents against Bill C-7 have brought up the case of Taylor Hyatt. There is a difference between informing someone of ALL their options (including palliative care) and pressuring someone to pursue one option. In Manitoba, if an individual like Taylor Hyatt did indeed request MAID during her pneumonia bout, she would have met with the MAID team for TWO separate assessments. The teams include physicians, nurses, social workers, speech-language pathologists, pharmacists, and other healthcare providers. Each assessment involves a thorough, detailed discussion. Each assessment always includes private time with just the MAiD physician and the individual (no family, no friends, no other doctors/nurses). The individual is reminded frequently that they can change their mind at any time including at the moment right before the provision of death.

There are a couple of paragraphs by Father de Souza that insinuate a physician can kill a patient against their will and lie about it. Need I remind everyone that murder is still illegal. Physicians still have reporting and documentation standards. If the argument is that we can’t trust physicians to provide MAiD, then this would apply to all medical interventions. Should we trust physicians with administering chemotherapy? Can we trust palliative care physicians to prescribe pain medications? This is just inciting fear and ignores the issue at hand.

“Particularly perverse are those health care systems that count the costs of medically administered death as part of palliative care, diverting already too few resources”.

I am not sure what health care system Father de Souza is referring to, but MAiD is counted in end-of-life costs, NOT indiscriminately clumped with palliative care. This information is available in the report “Cost Estimate for Bill C-7 ‘Medical Assistance in Dying’” released Oct 2020 by the Office of the Parliamentary Budget Officer. MAiD does not take away resources from palliative care.

And finally, advocating for MAID does not negate advocating for palliative care.

Tammy Pham
Advocacy Lead Volunteer
Dying with Dignity Canada, Winnipeg Chapter