The spectrum of end of life care: an argument for access to medical assistance in dying for vulnerable populations

Abstract

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.

Early experience with medical assistance in dying in Ontario, Canada: a cohort study

“…Many providers in these fields have completed nonaccredited training, or have developed a focused practice based on many years of clinical experience. Canadians in general, 6 is not clear. We did not have data about physical or other disabilities, although only 6.3% of the MAiD cohort resided in an institution compared with 28.0% of Ontario decedents overall.…”

“…expressed about potential barriers to accessing MAiD 5 due to geographic location, provider or institutional conscientious objection, or administrative delay. 6 Using data collected by the Office of the Chief Coroner for Ontario (hereafter, the "Coroner's Office") and population-based health administrative data, we sought to describe Ontario's early experience with MAiD, including the demographic and clinical characteristics of MAiD decedents in comparison with those of the general population of decedents in Ontario, to address the expressed concerns about MAiD.…”

Too much safety? Safeguards and equal access in the context of voluntary assisted dying legislation

“…The limited existing ethics literature on access to VAD is concerned with access for marginalized populations (e.g. [33,34]) or focused on the concept of conscientious objection (e.g. [35,36]).…”

Framework for Patient and Informal Caregiver Participation in Research (PAICPAIR)

“…But first, and importantly, in some countries and cultures dying with dignity has been discussed in relation to assisted suicide of seriously ill patients suffering from incurable diseases. 2 This present study is not based on this perspective, but on the ontology, caring science, and caritative caring theory developed by Katie Eriksson 3-5 -emphasizing preservation of the absolute dignity of all humans, the respect for human wholeness consisting of body, soul, and spirit, and the creation of room for life and living.…”

“…During this initial phase of research collaboration, also called a codesign process 6 ADVANCES IN NURSING SCIENCE/00 2019 and the first step in a broader coresearch process, 2 main questions have been addressed: (1) How can we organize, in both a practical and an ethical manner, patient and informal caregiver participation in this study? (2) How can patient and informal caregiver participation improve research tools and research outcomes?…”