Expanded Legislation, Insufficient Palliative Care Resources Are Causing Assisted Suicide Numbers to Rise in Canada, Say Physicians

A 60-year-old woman suffering from cancer rests in a hospital palliative care unit in an undated photo. (Alain Jocard/AFP/Getty Images)

Canada’s expanding assisted suicide legislation combined with countrywide insufficient palliative care resources are causing case numbers of medical assistance in dying (MAiD) to rise, say physicians and hospice workers.

Testifying before the parliamentary joint committee on MAiD on Oct. 18, Dipti Purbhoo, executive director of Dorothy Ley Hospice in Toronto, said the varied access to palliative care services in the country may be causing more patients to consider MAiD.

“Access to palliative care is dependent on where you live, if there are hospice palliative services available, how much information you have about palliative care, whether you speak the language, and whether your doctor or health-care provider thinks it will help you,” she said.

“As a result, many people do not get access to palliative care, which often results in death in hospital without support, and in some cases people choosing medical assistance in dying.”

Legal in Canada since 2016, MAiD can currently be accessed by patients who are physically and seriously ill—but not necessarily terminal—and are “in an advanced state of decline that cannot be reversed” paired with “unbearable physical or mental suffering.”

Starting in March 2023, MAiD will be expanded to patients whose only medical condition is a mental illness and who otherwise meet all eligibility criteria.

“The reasons we have heard why people choose MAiD is because they don’t want to be a burden to their family,” Purbhoo told the committee. “They don’t want to suffer and die alone. They don’t want to die in a hospital. They’re worried about getting care at home, or they want control over how they die.”

Romayne Gallagher, a doctor from the  Canadian Society of Palliative Care Physicians, also testified that the current state of palliative care in Canada is contributing to rising MAiD numbers.

“For about the past 40 years or so, palliative care has been striving to show people that we do not hasten death and we do not shorten their life,” she said.

“The problem with combining [palliative care] with MAiD is this confusion.”

Increasing Numbers

Between 2016 and 2021, nearly 32,000 Canadians received MAiD, according to Health Canada’s “Third Annual Report on Medical Assistance in Dying 2021.”

The report showed that assisted suicide accounted for over 3 percent of all deaths in Canada in 2021 and added that annual MAiD cases have been increasing steadily year-over-year.

In 2019, 5,661 people received assisted suicide in Canada. The following year, that number climbed to 7,603. In 2021, over 10,000 individuals received MAiD.

“The Government will continue to improve data collection and reporting to provide a comprehensive picture of who is accessing MAID, the circumstances and motivation for considering MAID, and how health care practitioners are implementing MAID across the country,” Health Minister Jean-Yves Duclos wrote in the report.

The report also says that over 88 percent of MAiD recipients in 2021 had received palliative care.

However, Gallagher told the committee these statistics don’t give the full picture.

“Health Canada reports on MAiD fail to indicate quality or quantity of palliative care received,” she said, adding that the statistics “show palliative care is often provided late in the illness, with 21 percent receiving it in the last two weeks, and 18 percent less than four weeks prior to MAiD.”

“We should provide palliative care in response to needs, not according to prognosis and not just in the last weeks of life,” she added.

However, accessing palliative care in Canada is just one of the problems, said Gallagher.

“There are no measures of the quality of palliative care. Really, this is extremely important because people have trouble defining it,” she said.

“When you think about it, this means that someone can be suffering pain, loss of independence, loss of community, and they finally request MAiD and they’re admitted to a palliative care unit, they will be listed as having received palliative care. It’s important to keep that in mind.”

‘Path of Least Resistance’

David Henderson, a doctor and former president of the Canadian Society of Palliative Care Physicians, said opposition to expanding MAiD legislation is often dismissed as being “overly religious.”

“I’m not a religious man,” Henderson told the committee on Oct. 18, but said that although he’s not completely opposed to assisted suicide laws, he does have reservations.

Canada’s struggling health-care system, characterized by a shortage of experienced doctors and nurses, is causing difficulties felt most by patients who are “dying” or in “vulnerable positions,” said Henderson.

“I’m very concerned that this has opened the door to medically assisted death as potentially a path of least resistance as we see people getting more and more overworked, tired, and exhausted,” he said.

Madeline Li, a psychiatrist at the Princess Margaret Cancer Centre in Toronto, told the committee during the same meeting that current assisted suicide legislation “leaves too much responsibility in the hands of clinicians” because the MAiD eligibility criteria allow for subjective interpretation.

“Incurability can include treatment refusal,” Li said. “An advanced state of decline may not need to be progressive. Suffering is determined only subjectively.”

Henderson added that MAiD is now “virtually ... available to any person for any reason.”

“I’m concerned that the government has given health-care professionals essentially a licence to kill without having significant checks in place to ensure people are assessed properly and thoroughly,” he said.

“I ask, is that what the Canadian public actually wants?”