The spectrum of end of life care: an argument for access to medical assistance in dying for vulnerable populations
- 15 Downloads
Medical assistance in dying (MAiD) was legalized by the Supreme Court of Canada in June 2016 and became a legal, viable end of life care (EOLC) option for Canadians with irremediable illness and suffering. Much attention has been paid to the balance between physicians’ willingness to provide MAiD and patients’ legal right to request medically assisted death in certain circumstances. In contrast, very little attention has been paid to the challenge of making MAiD accessible to vulnerable populations. The purpose of this paper was to examine the extant literature and resources that are available on the provision of MAiD in Canada. We found that the provision of EOLC in Canada offers insufficient access to palliative and EOLC options for Canadians and that vulnerable Canadians experience disproportional barriers to accessing these already limited resources. Consequently, we argue that palliative care, hospice care and MAiD must be considered a spectrum of EOLC that is inclusive and accessible to all Canadians. We conclude by imploring Canadian healthcare professionals, policy makers and legislators to consider MAiD as a viable EOLC option for all Canadians.
KeywordsAssisted death Medical assistance in dying Death with dignity Physician assisted suicide
- Alberta Government. 2016a. Alberta health medical assistance in dying - what we heard. Retrieved from http://www.health.alberta.ca/documents/MedicalAssistanceInDying-WhatWeHeard-2016.pdf.
- Alberta Government. 2016b. Medical assistance in dying framework assures access and safeguards for Albertans. Retrieved from https://www.alberta.ca/release.cfm?xID=419044FC0B679-9E67-3233-D04EEA31DB2B3867.
- American Medical Association (AMA). 2016. Opinions on caring for patients at the end of life. In The AMA code of medical ethics (chap. 5). Retrieved from https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-5.pdf.
- Arenas, A., and Hippocrates. 2010. Hippocrates’ oath. Arion 17 (3): 73–74.Google Scholar
- Bill C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying). 2016. Royal Assent June 17, 2016, Forty-second Parliament, 1st session. Retrieved from http://www.parl.ca/DocumentViewer/en/42-1/bill/C-14/royal-assent.
- Buckley, T. (2018). Physician assisted suicide: An end of life care option that should be available to all dying patients. Law School Student Scholarship. 943. https://scholarship.shu.edu/student_scholarship/943.
- Canadian Hospice Palliative Care Association (CHPCA). 2014. Fact sheet: Hospice palliative care in Canada. Retrieved from http://www.chpca.net/media/330558/Fact_Sheet_HPC_in_Canada%20Spring%202014%20Final.pdf.
- Chambers, S. (2017). It’s time to expand assisted-dying legislation to include advance directives for dementia. Huffington Post. Retrieved from https://www.huffingtonpost.ca/stuart-chambers/dementia-assisted-dying-legislation_b_17128476.html.
- Clarke, G., E. Fistein, A. Holland, M. Barclay, P. Theimann, and S. Barclay. 2017. Preferences for care towards the end of life when decision-making capacity may be impaired: A large-scale cross-sectional survey of public attitudes in Great Britain and the United States. PLoS ONE 12 (4): e0172104.CrossRefGoogle Scholar
- Collins, A., and B. Leier. 2017. Can medical assistance in dying harm rural and remote palliative care in Canada? Canadian Family Physician 63 (3): 186.Google Scholar
- Comfort Care Choices. 2009. What’s the difference between physician-assisted suicide and euthanasia? Retrieved from http://www.comfortcarechoices.com/index.php?option=com_content&view=article&id=89:whats-the-difference-between-physician-assisted-suicide-pas-and-euthanasia&catid=37&Itemid=72.
- de Lima, L., R. Woodruff, K. Pettus, J. Downing, R. Buitrago, E. Munyoro, C. Venkateswaran, S. Bhatnagar, and L. Radbruch. 2017. International association for hospice and palliative care position statement: Euthanasia and physician-assisted suicide. Journal of Palliative Medicine 20 (1): 8–14.CrossRefGoogle Scholar
- Institute of Medicine (IOM). 2014. Key findings and recommendations: Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.Google Scholar
- Kouwenhoven, P.S., N.J. Raijmakers, J.J. van Delden, J.A. Rietjens, M.H. Schermer, G.J. van Thiel, M.J. Trappenburg, S. van de Vathorst, B.J. van der Vegt, C. Vezzoni, H. Weyers, D.G. van Tol, and A. van der Heide. 2013. Opinions of health care professionals and the public after eight years of euthanasia legislation in the Netherlands: A mixed methods approach. Palliative Medicine 27 (3): 273–280.CrossRefGoogle Scholar
- Lewis, B. 2017. A deliberate departure: Making physician-assisted suicide comfortable for vulnerable patients. Arkansas Law Review 70 (1): 1.Google Scholar
- McNeil, R., T. Kerr, B. Pauly, E. Wood, and W. Small. 2016. Advancing patient-centered care for structurally vulnerable drug-using populations: A qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals. Addiction 111 (4): 685–694.CrossRefGoogle Scholar
- Rys, S., R. Deschepper, F. Mortier, L. Deliens, and J. Bilsen. 2015. Bridging the gap between continuous sedation until death and physician-assisted death: A focus group study in nursing homes in Flanders, Belgium. American Journal of Hospice and Palliative Medicine 32 (4): 407–416.CrossRefGoogle Scholar
- The College of Family Physicians of Canada (CFPC). 2012. Position statement: Issues related to end of life care. Retrieved from http://www.cfpc.ca/uploadedFiles/Resources/Resource_Items/Health_Professionals/CFPC%20Position%20Statement_Palliative%20Care_ENGLISH.pdf.
- Ubelacker, S. 2015. Assisted dying in Canada: On cusp of major medical shift, doctors contemplate the right they’ll have to help suffering patients end their lives. Halifax Chronicle-Herald. Retrieved from https://search-proquest-com.ezproxy.lib.ucalgary.ca/docview/1774239207?pq-origsite=summon&accountid=9838.
- World Medical Association (WMA). 2015. End-of-life-issues. In The World Medical Association’s medical ethics manual. 3rd ed., 59–60 Ferney-Voltaire: World Medical Association (WMA).Google Scholar