08 Mar Assisted Death Study Suggests Focus on Palliative Care
Is assisted death becoming a treatment for depression and the loss of hope rather than a tragic consequence of the two?
Shouldn’t we focus on better palliative care, rather than medically assisted death? According to a new study in the Canadian Medical Association Journal (CMAJ), 96 per cent of Ontarians who received Medical Assistance in Dying (or MAiD), a procedure legalized across Canada in 2016, reported psychological suffering. According to the study’s lead author, Dr. James Downar of the University of Ottawa and The Ottawa Hospital, it is important to tackle the psychological cause at the root of MAiD, namely existential distress.
Downar is to be commended for this attitude towards his research.
He describes existential distress as the patient’s feeling of distress that their role in the world has changed and their identity has been undermined by their illness. If 96 per cent of those who opt for assisted death are having their lives ended prematurely due in full or in part to psychological suffering, such as existential distress, then what kind of society are we that we would encourage their death? Why provide such people with life-ending care, rather than end-of-life care?
Instead of helping people die, is the answer not rather to accompany the dying compassionately on the journey towards death – with an early intervention of the full complement of palliative care services, including emotional, spiritual, psychological and physical treatments? Yet, according to the Canadian Institute for Health Information (CIHI), less than 15 per cent of Ontarian adults who died in 2016-2017 received palliative home care services. Most alarming is that the recent CMAJ study shows that psychiatric consultations were performed in merely 6.2 per cent of medically assisted death cases.
Instead of helping people die, is the answer not rather to accompany the dying compassionately on the journey towards death – with an early intervention of the full complement of palliative care services, including emotional, spiritual, psychological and physical treatments?
Let’s be clear, as the Bell Let’s Talk mental health campaign encourages us to be: Helping end the lives of people who suffer from existential distress is a mental health crisis. And if those who suffer existential distress include clinically depressed people, is suicide becoming a treatment for depression and the loss of hope rather than a tragic consequence of the two?
The CMAJ study claims that palliative care providers were “involved” at the time of the request for death in 74.4 per cent of cases. The study suggests, therefore, that we can rest assured that a lack of access to palliative care is not the reason people seek MAiD. But, with respect, there are two problems with this conclusion.
Focus on early access to palliative care
First, what does it mean that a palliative care provider was “involved,” given that less than 15 per cent of Ontarians receive palliative home care services, and given that 85 per cent of those who were given a medically assisted death in Ontario lived in private homes before they died? Unfortunately, the CMAJ article does not spell out the level of palliative care “involvement” such as quality, timing and tools used in the assessments. In other words, the study does nothing to disprove the point that a lack of palliative care is at the root of requests for MAiD.
Second, a 2018 Quebec study by Seller, Bouthillier and Fraser found that in the majority of cases, palliative care was offered woefully late in the process of patients’ journeys towards death; in 32 per cent of cases, palliative care consults came less than seven days prior to the request for MAiD, and in another 25 per cent of cases palliative care consults occurred the day of or after assisted death was requested. If we believe in choice, then we are not offering true choice when palliative care consults are offered so late in the journey towards death.
According to the same Quebec report, “studies show that early palliative care consultation results in improved quality of life and fewer depressive symptoms.” Given this, it is not unreasonable to assume that early palliative care interventions would equip more patients to choose to live until their natural, dignified death. Indeed, the World Health Organization cancer care guidelines recommend that palliative care be involved as early as possible, specifically from the time of diagnosis.
Therefore, we invite Canadians to join us in demanding timely, complete and universal palliative care and mental health services, especially for those crying for help through requests for MAiD.
This article was originally published in the Ottawa Citizen. Click here for the original.
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