Ensuring access to euthanasia by encouraging physician participation: it’s complicated

Sean Murphy*

In July, 2017, Canadian euthanasia/assisted suicide (EAS) practitioners and advocates alleged that patient access to euthanasia and assisted suicide was in danger because of “barriers” and “disincentives” to physician participation. Dr. Stefanie Green, president of their professional association, described the situation as “a crisis.”1 There was, in fact, no crisis — only a false perception of crisis fuelled by unrealistic expectations about levels of physician participation in euthanasia and assisted suicide.2

Nonetheless, it is reasonable for policy makers to respond to their concerns that physicians are discouraged from participating in euthanasia and assisted suicide. Indeed, objecting physicians are less likely to experience disadvantage and coercion if policy-makers seriously consider suggestions by EAS practitioners and advocates about how to encourage physician participation in euthanasia.

Removing barriers and disincentives to physician participation

Minimizing procedural and administrative requirements
Returning to the complaints and concerns of Canadian euthanasia practitioners (see Canada’s Summer of Discontent2), reducing or streamlining procedural requirements and minimizing burdensome paperwork might encourage more physicians to participate. However, this raises a question that may prove difficult to answer. Is a procedural requirement a “barrier” — or a necessary safeguard? A “disincentive” — or an essential ethical prerequisite? The difficulty is illustrated by developments in Belgium. . . .[Full text]

Canada’s summer of discontent: euthanasia practitioners warn of nationwide “crisis”

Shortage of euthanasia practitioners “a real problem”

Sean Murphy*

There were 803 euthanasia/assisted suicide (EAS) deaths in Canada during the first six months after the procedures were legalized. In the second half of the first year (ending in June, 2017) there were 1,179 — a 46.8% increase, and about 0.9% of all deaths. Health Canada correctly states that the latter figure falls within the range found in other jurisdictions where euthanasia/assisted suicide are legal, but the Canadian EAS death rate in the first year was not reached by Belgium for seven to eight years. The dramatic increase of EAS deaths in the last half of the first year would have had a direct impact on EAS practitioners, and this may be why they ended the first year by sounding the alarm about access to the service. . . .[Full text]

Should doctors be paid a premium for assisting deaths?

Physicians can make more doing paperwork than performing this legal, but emotionally demanding, service. For many, it’s just not worth it.

MacLeans

Catherine McIntyre

Back in March, Dr. Tanja Daws took time off from her family practice to travel from B.C.’s Comox Valley to a remote community on Vancouver Island and provide an elderly patient who was dying and suffering with medical assistance in dying (MAID). After the five-and-a-half hour endeavour, which involved some of the most emotionally and technically difficult work Daws has ever done, the physician calculated that, after factoring in her staffing costs and other office expenses, she had lost about $28 for every hour she worked.

“It struck me that I can’t keep doing this,” says Daws. “I can work for nothing, but I can’t work for a loss.” . . . [Full text]

Low fees have B.C. doctors thinking twice about providing assisted dying

‘We’re being paid 50% of what we would doing routine office work. So it’s difficult to justify continuing’

CBC News

Karin Larsen

Medically assisted dying has been legal in Canada for over a year, but one B.C. doctor says he can no longer afford to offer the service, because the costs involved are much greater than the $200 payout from the provincial medical services plan.

In a letter, Dr. Jesse Pewarchuk calls the situation “economically untenable” while outlining a number of steps a physician must follow in the medical assistance in dying (MAID) procedure. . . [Full text]

 

Canadian doctors turn away from assisted dying over fees

Globe and Mail

In a recent letter to some of his colleagues, Vancouver Island doctor Jesse Pewarchuk explained why he won’t be helping any more gravely ill patients to end their lives, despite his fervent support for assisted death.

“It is my deep regret to inform you that I am no longer accepting referrals for Medical Assistance in Dying,” the letter began. “Recent changes to the [Medical Services Plan] physician fee schedule have made MAID economically untenable and I unfortunately can no longer justify including it in my practice.” . . . [Full text]

 

One year after Canada’s medically assisted dying law, patients face uneven access

‘This dying, elderly man was stuck in the back of an ambulance so he could access his dying wishes’

CBC News

Nicole Ireland

“Martha” was stunned when her 78-year-old father told her he wanted a medically assisted death, after battling lung cancer for almost two years.

“It’s something you’ve never contemplated before in your family,” she said. “How do you prepare for this? This date that somebody’s going to pass away. It’s really hard.”

Martha has asked CBC News to use only her middle name, because children in her family don’t know that their grandfather’s death was medically assisted.  A year after Canada’s Medical Assistance in Dying law passed on June 17, 2016, the issue remains highly controversial. . .  [Full text]