10 Jul 2019 Merging palliative care and MAiD
Increasing pressure on palliative care providers to offer assisted suicide and euthanasia
At a recent conference hosted by the Canadian Association of MAiD Assessors and Providers (CAMAP), three doctors presented on how euthanasia could be pushed into palliative care spaces. Evidently, some palliative care physicians and nurses believe that “Medical Assistance in Dying” or “MAiD”* is a natural part of palliative care. But many are strongly opposed to the encroachment of MAiD into palliative care wards and facilities.
In May 2019, the Canadian Society of Palliative Care Physicians clarified in a statement that MAiD is a practice distinct from palliative care. The Society says its focus is on providing high-quality care and relief of suffering as life and death take their natural course. Palliative care physicians intend neither to hasten nor to postpone death. It is fundamental to palliative care providers, the Society states, 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.
However, MAiD assessors and providers are not willing to take “no” for an answer. At the CAMAP conference, Dr. Jyothi Jayaraman, a palliative care physician and MAiD provider in Vancouver, argued that both palliative care and MAiD are designed to relieve suffering, a common goal that should bring the two together. Of course, most medical interventions share the goal of relieving human suffering, but no one would suggest that MAiD should be offered alongside the casting of a broken leg.
Dr. Paula Chidwick, Director of Research and Corporate Ethics at William Osler Health System in Ontario, spoke about the confusion and stress around end-of-life care due to the tension between palliative care and MAiD providers. She spoke about solutions being implemented in some places to try to bring the two fields together, which invariably means bringing euthanasia into palliative care institutions.
“[Dr. Chidwick] believes that loyalty to the patient and their wishes should trump a physician’s personal position. In other words, despite her credentials as an ethicist, she advocates for a position where conscience rights and personal integrity don’t matter: a doctor is a vending machine meant only to give patients what they want.”
The solution, according to Chidwick, is to highlight patient stories, and continually put patient care at the forefront of the discussion. She believes that loyalty to the patient and their wishes should trump a physician’s personal position. In other words, despite her credentials as an ethicist, she advocates for a position where conscience rights and personal integrity don’t matter: a doctor is a vending machine meant only to give patients what they want.
Dr. Chidwick also focused on the psychology of introducing changes into palliative care. People in any organization who are forced to accept a new direction will feel a “sense of loss” as an old way is left behind, so they need to have their expectations “disappointed at a rate they can tolerate.” They need to not only learn the new information and capabilities, but “internalize them.” She cited the need for strong leaders to drive this change among their staff.
Many of the resistant palliative care institutions are faith-based, and oppose euthanasia for moral and religious reasons. Dr. Chidwick seems to think that overcoming their resistance is merely a matter of time and strategy, including possibly the removal of government funding. Indeed, Dr. Jayaraman was also pleased to share progress made with both individuals and institutions.
There is an increasing number of palliative care physicians participating in assessments of patients’ eligibility for MAiD. Some faith-based institutions now allow assessments to be done on site. Some then require the patient to be moved off site if they choose to go ahead with ending their life. (Promoters of full-service MAiD in palliative care institutions claim that patients in palliative care are often too fragile to move, and transferring them to a different place to receive MAiD could kill them. Though death is exactly what the patient is asking for, they want to maintain control over that death experience.)
“MAiD providers and supporters want assisted death to be a standard palliative care option, while most palliative care providers want MAiD to remain separate from the care they offer. But we already see evidence of this resistance being worn down. . . . This is a matter for continued prayer . . . .”
MAiD providers and supporters want assisted death to be a standard palliative care option, while most palliative care providers want MAiD to remain separate from the care they offer. But we already see evidence of this resistance being worn down. MAiD teams are, in some cases, being integrated into palliative care units. Several speakers at the CAMAP conference favoured defunding institutions opposed to MAiD, apparently ignoring the broader impact that could have on access to healthcare for Canadians, given that many hospitals and care homes continue to be run by faith-based organizations.
This is a matter for continued prayer: that faith-based institutions and faithful individuals in the medical field would be able to stand their ground, and would be allowed to honor God and their conscience by refusing to take the lives of their patients. We can pray that Christian doctors, nurses, and other health care professionals who face this challenge in their daily work will find support from colleagues. We need to consider the readiness of our own institutions that care for elderly or disabled Christians to carry on without government funding.
Through it all, we need to bring a message of inherent dignity and value, of meaning in suffering, and of the omniscient, omnipresent God who makes all our human attempts at control of our lives (and deaths) ultimately meaningless.
*The term “MAiD” is used throughout this article to reflect the presentations and discussion at the conference. MAiD, or Medical Assistance in Dying, is the legally accepted way of referring to euthanasia, though the keynote speaker did specifically mention that the wording had been deliberately chosen to move away from the impact of terms like “euthanasia” and “assisted suicide,” which more accurately describe what is taking place.
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