Palliative care doctors draw the line

As Ottawa prepares to rewrite Canada’s euthanasia law, palliative care doctors and hospice operators are urging lawmakers to acknowledge that palliative care and medically induced death are separate and distinct things.

Ending a patient’s life is “not part of hospice palliative care, nor is it one of the tools ‘in the palliative care basket,’ ” said a joint statement from the Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians. 

“Health care articles and the general media continue to conflate and thus misrepresent these two fundamentally different practices,” said the statement.

Palliative care is different from assisted dying “in philosophy, intention and approach.”

“It has become more and more apparent that everybody has universal access to MAiD (medical assistance in dying) across Canada, but there is not universal funding for hospice and palliative care,” said Sharon Baxter, executive director of the Canadian Hospice Palliative Care Association.

Parliament is rewriting the law to broaden access to assisted suicide and euthanasia at a time when less than 30 per cent of Canadians have access to palliative and hospice care, said palliative care physician Dr. Denise Marshall.

“I cannot guarantee that the 99 per cent of Canadians who, when they get to a point when they have an illness that’s going to claim their life, will be able to get basic, equal access,” Marshall said. “We’ve never ensured it is equally available and accessible to all Canadians. We have failed to do that.”

Baxter said doctors and hospice operators aren’t necessarily opposed to expanded access to assisted dying. “The only linkage is that MAiD is 100-per-cent funded and palliative care isn’t. That’s our link,” she said.

Understanding the clear distinction between palliative care and deliberately ending a patient’s life is essential, said bioethicist Fr. Mark Miller.

“This is a very important statement by palliative hospice care providers, which means that their basic philosophy has not changed,” the Redemptorist priest said in an e-mail. “They take care of the dying and their families, remembering that the dying are living and they neither hasten death nor prolong the dying.”

Dying With Dignity Canada, the largest euthanasia lobbyist, insists medically-induced death and palliative care are integrated components of end-of-life care.

The organization opposes any right of hospices, hospitals, nursing homes or palliative care providers to deny euthanasia or assisted suicide on their premises or reject it in the context of continuing care.

“Requiring a patient to leave palliative care to access MAiD causes them unnecessary pain and distress and separates them from their care team at a very difficult moment in their life,” said Dying With Dignity spokesperson Cory Ruf. “People should not be deprived of the best palliative care available simply because they have decided to access MAiD.” 

The rewrite of Canada’s three-year-old law follows a Quebec court ruling that struck down a provision of the law that restricted assisted suicide to those whose death is “reasonably foreseeable.” The decision in the Truchon-Gladu case was handed down Sept. 11, just as federal politicians hit the campaign trail, impeding the federal government from launching an appeal within the usual time limit.

“The disability community is very concerned about the decision by government not to appeal the Truchon-Gladu case,” said the chair of the Council of Canadians With Disabilities’ end-of-life committee Dr. Heidi Janz. “We have been working with government and will continue to do so in the coming months to ensure the revised legislation protects Canadians with disabilities.”

The idea that euthanasia is a simple matter of free choice is laughable, said Jonathan Marchand, who has muscular dystrophy and lives in a long-term care facility in Montreal.

“Often you are choosing between living as a burden or euthanasia, or living in a medical prison,” he said. “I never thought the doctors, the nurses, the professionals were there to help me die. I thought they were there to help me to live.”